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Eliminating Barriers to Virtual Care: Implementing Portable Medical Licensure
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Eliminating Barriers to Virtual Care: Implementing Portable Medical Licensure

Pooja Chandrashekar, AB; and Sachin H. Jain, MD, MBA
In this commentary, the authors argue for moving away from state-based medical licensure and describe policy, technological, and administrative changes necessary for implementing portable medical licensure.
Standards for Using and Regulating Telemedicine Services

Each state currently defines the “practice of medicine” differently, making it difficult to discern what constitutes an acceptable telemedicine consultation in any given state. Standards of practice, conduct, and behavior during telemedicine consultations—including requirements related to physician credentialing, patient education, and physician supervision of other healthcare professionals—vary widely among states.3 Thus, the shift to mutual recognition must be accompanied by efforts to establish consistent standards for using and regulating telemedicine services. These standards should be defined at the federal level.

Interstate Data Sharing

State medical boards are tasked with the responsibility of monitoring and disciplining physicians licensed in their state. However, due to gaps in information sharing among states, nearly one-third of physicians disciplined in one state are able to practice elsewhere without limitations, repercussions, or public disclosure. This is especially dangerous in a mutual recognition scheme in which out-of-state physicians routinely see and treat patients with little oversight.

For mutual recognition to promote patient safety, information on malpractice, medical errors, and license cancellation or suspension must be shared among states, made publicly available to patients, and used to enforce disciplinary actions across state borders. States should use resources like the National Practitioner Data Bank, established in 1986 as a central data repository for malpractice payments and state disciplinary actions, to conduct rigorous background checks before physicians participate in telemedicine consultations and deliver care across state borders.

Financial Support for States

Given the administrative and technological costs of implementing mutual recognition and dismantling the existing state-based medical licensure system, HHS could provide states with incentive payments for adopting mutual recognition agreements and eliminating state-specific licensing and renewal fees. Additionally, HHS could offer grant funding to enhance interstate data sharing systems and other functions that promote mutual recognition. While financial support for states is an important first step, mutual recognition can reduce healthcare costs in the long run as telemedicine services increase access to care for rural and underserved populations.

SPL

One challenge of mutual recognition is attributing physicians to any given state. This can complicate physician reimbursement for telemedicine services and reduce the effectiveness of state healthcare programs dependent on physician participation. A possible solution is requiring physicians to select a single SPL for questions regarding reimbursement and attribution. This requirement already exists for physicians participating in the Interstate Medical Licensure Compact. Because physicians would fall under the jurisdiction of their SPL’s medical board, the SPL could hold primary responsibility for collating information from interstate data-sharing systems and enforcing disciplinary action against errant physicians.

Conclusions

The environment of medicine is changing. More than three-fourths of patients want access to virtual care services, and patients across all age groups express a desire to use telemedicine to gain easier, more immediate access to physicians.7 To meet growing patient demand and solve our country’s critical physician shortage, we can and must reform our outdated state-based licensing system.

Author Affiliations: Harvard Medical School (PC), Boston, MA; CareMore Health System (SHJ), Cerritos, CA; Stanford University School of Medicine (SHJ), Stanford, CA.

Source of Funding: None.

Author Disclosures: Dr Jain is an employee of CareMore and Aspire Health, which are both multistate provider entities. Ms Chandrashekar reports no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (PC, SHJ); drafting of the manuscript (PC); critical revision of the manuscript for important intellectual content (PC, SHJ); administrative, technical, or logistic support (SHJ); and supervision (SHJ).

Address Correspondence to: Sachin H. Jain, MD, MBA, CareMore Health System, 12900 Park Plaza Dr, Cerritos, CA 90703. Email: Sachin.Jain@caremore.com.
REFERENCES

1. Dall T, West T, Chakrabarti R, Reynolds R, Iacobucci W. 2018 update: the complexities of physician supply and demand: projections from 2016 to 2030. The Heartland Institute website. heartland.org/_template-assets/documents/publications/aamc_2018_workforce_projections_update_april_11_2018.pdf. Published March 2018. Accessed November 18, 2018.

2. Bodenheimer TS, Smith MD. Primary care: proposed solutions to the physician shortage without training more physicians. Health Aff (Millwood). 2013;32(11):1881-1886. doi: 10.1377/hlthaff.2013.0234.

3. Kocher R. Doctors without state borders: practicing across state lines. Health Affairs Blog website. healthaffairs.org/do/10.1377/hblog20140218.036973/full. Published February 18, 2014. Accessed November 18, 2018.

4. Svorny S. Liberating telemedicine: options to eliminate the state-licensing roadblock. Cato Institute website. cato.org/publications/policy-analysis/liberating-telemedicine-options-eliminate-state-licensing-roadblock. Published November 15, 2017. Accessed December 9, 2018.

5. Schwamm LH. Telehealth: seven strategies to successfully implement disruptive technology and transform health care. Health Aff (Millwood). 2014;33(2):200-206. doi: 10.1377/hlthaff.2013.1021.

6. Vestal C. Why physician licensing is a problem for telemedicine. Governing website. governing.com/news/headlines/why-telemedicine-is-a-problem-for--.html. Published March 7, 2014. Accessed December 9, 2018.

7. Heuser EZ. What do consumers want from virtual visits? Advisory Board website. advisory.com/research/market-innovation-center/research-briefs/2017/virtual-visits-briefing. Published April 27, 2017. Accessed December 9, 2018. 
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