1. Physician Licensing
In theory, telemedicine would allow cross-state consultations that would allow specialists to help more patients. However, physicians face several telemedicine and telehealth challenges if they wish to practice in another state, including regulations that vary state-by-state. In some cases, practitioners may need a full medical license in both the state they live in and the state where the patient resides. In other situations, physicians may have to pay an exorbitant fee to practice across state lines. Additionally, even after obtaining the necessary clearances to practice medicine across state lines, physicians may be asked to adhere to state medical practice rules that are diverse and even sometimes conflicting. The arduous nature of these laws defeats the quick convenience of telemedicine.
One reasonable move that could help solve the problem would be to create a national telemedicine license. However, with differing opinions between states’ lawmakers, universal medical licensure is still a distant fantasy. Currently, there are telemedicine-specific licenses available in Tennessee, Texas, Oregon, Oklahoma, Ohio, New Mexico, Minnesota, Montana and Alabama, and Nevada offers a special purpose telemedicine license. The American Telemedicine Association has a petition out for removing barriers to medical licensure. And in good news, many states have adopted language consistent with the Interstate Medical Licensure Compact, which seeks to reduce the obstacles of cross-state telemedicine adoption.
The telemedicine credentialing process can get very complicated. For example, in hospitals that work from a hub and spoke model, physician specialists at every hospital in the system must have telemedicine credentials at all the other hospitals. Not only is the volume of paperwork needed for credentialing time-consuming, but the administrative processing costs are through the roof. The time and money invested in approving physician credentials for telemedicine could be used to train hospital staff and onboard patients instead.
Streamlining the credentialing process with a common set of requirements would allow physicians to apply for credentials at many hospitals in one fell swoop, in the same vein as the college Common Application that is used at U.S. universities. One initiative by the CMS and Joint Commissions supports credentialing by proxy. This allows for a network or system’s hub hospital to apply for credentialing, by proxy, to the spoke hospitals. This process would eliminate the overwhelming numbers of applications, and allow physicians to begin practicing more quickly. Although the long primary verification process is not addressed by credentialing by proxy, it definitely is a step in the right direction.
Insufficient capital expenditure and lack of reimbursements are serious financial issues for the telemedicine field. Similar to licensing laws, reimbursement models vary across the country. Certain criteria have to be met in order for practitioners to receive reimbursement. Our state-by-state policy guide has the most up-to-date information on these laws. When reimbursement is limited, patients in the affected regions are under-served. In many cases, the cost of telemedicine is a burden hospitals are expected to bear.
Grants from organizations and government entities such as the USDA can only do so much to help with the implementation of telemedicine, particularly when those grants are dedicated to specific initiatives or areas. Other types of funding, such as reimbursement from government and private payors, must increase in order for this issue to be solved. Physicians can take things into their own hands by advocating for reform in the health technology industry. Many of the problems surrounding telemedicine reimbursement can only be resolved through legislative action, so in the meantime, physicians are stuck finding workarounds.
The benefits are real, even if pervasive telemedicine barriers prevent widescale use. Patients deserve access to quality care, whether they’re in a metropolitan center or a rural community. With time, some of these issues will resolve themselves, but it’s never too late to petition for reform in the health IT industry.