This Week Health

Why can't doctors practice telemedicine across state lines. That is a simple question with a complex answer. Today we explore this concept in depth. 

Transcript
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Today in health, it Kaiser health news takes us on a deep dive on the issue of cross state licensing for telehealth visits. My name is bill Russell. I'm a former CIO for a 16 hospital system and creator of this week in health. It. A channel dedicated to keeping health it staff current and engaged. I want to thank our sponsor for today, serious healthcare. They reached out about this time last year and said, we love what you're doing. Really appreciate your mission. To develop the next generation of health leaders. The rest is history, as they say, if you believe in our mission and want to support the show, as they have shoot me a note at partner at this week in health, it. Dot com. All right. The story today. Isn't so much about the, so what, but it's about the great detail this article provides. Around this often misunderstood issue. Therefore I'm going to read much more than comment today. So here is the story. Story comes from a Newsweek article. But it's written by Kaiser health news. Title is tele-health limit battle over state lines and licensing threatens patients options. Here's some excerpts. Most states and the centers for Medicare and Medicaid services temporarily waived rules requiring licensed clinicians to hold a valid license in the state where their patient is located. Now, states are rolling back. Many of those pandemic workarounds, Johns Hopkins medicine in Baltimore, for example, recently scrambled to no five more than 1000 Virginia patients that their telehealth appointments were no longer feasible. I said Dr. Brian Hassell, Feld medical director of digital health and telemedicine at Johns Hopkins. Virginia is among the states where the emergency orders are expiring or being rolled back. As of July 19th, at least 17 states still had waivers in effect, according to a tracker maintained by the Alliance. For connected care, a lobbying group representing insurers tech, companies, and pharmacies. As those rules end it risks. Increasing barriers to care said it. Hassle Feld. Johns Hopkins. He added hosted more than 1 million tele-health visits. Serving more than 330,000 unique patients since the pandemic began about 10% of those visits were from states where Johns Hopkins does not operate facilities. The rollbacks com. Amid a longer and larger debate overstates authority. Around medical licensing. That the pandemic with its widespread adoption of telehealth services has put front and center. Finding a way forward pits high-powered stakeholders against one another and consumers input is likely to be muted. State medical boards. Don't want to cede authority saying their power to license and discipline medical professionals boost patient safety licensing is also a source of state revenue. So hopefully you're starting to hear these various forces at work I'm going to keep going in this because there's just a lot of great detail in this article. Providers have long been split on whether to change cross state licensing rules. Different state requirements, along with fees, make it cumbersome and expensive for doctors, nurses, and other clinicians to get licenses in multiple states, leading to calls for more flexibility. Even, so those efforts have faced pushback from within the profession and with opposition from other clinicians who fear the added competition that could come from tele-health could also lead to losing patients or jobs. Again, another. Aspect of this, that is at work. The reason tele-health has been blocked across state lines for many years related fundamentally to physicians. Wanting to protect their own practices said Greenspun, but the pandemic changed the equation. Even though the initial spike in telehealth visits has eased utilization recently remained 38 times higher than before the pandemic attracting not only patients, but also venture capitalists seeking to join the hot business opportunity. According to a report from the consulting firm, McKinsey and company patient's experience with telehealth visits, coupled with the growing interest by investors is focusing attention on this formerly inside baseball issue of cross state licensing. The whole challenge is to ensure maximum access to health. While assuring quality said Barak, Richmond. A duke university law professor who said laws and policies, haven't been updated to reflect new technological realities, partly because state boards want to hang onto their authority patients and their doctors are getting creative with some consumer simply driving across state lines. Then making a zoom call from their vehicle still for some patients driving to another state for an in-person or even a virtual appointment is not an option. So physicians are worried about care being interrupted, Especially in the area of behavioral health, where. People may be reluctant to seek out new therapists. The article goes on, but will doctors whose patients have spent the past year or more growing comfortable with virtual visits, also be willing to take steps that could likely involve extra costs and red tape to get additional licenses. For instance, practitioners must submit applications in every state. Where their patients reside. Each of which can take weeks or months to process, they must pay application fees and keep up with a range of requirements. Such as continuing education, which vary by state. States say their traditional role as overseer ensures that all applicants meet educational requirements and pass background checks. They also investigate complaints and argue. There's an advantage to keeping local officials in charge. Doctors groups such as the American medical association agree. Allowing a change that doesn't put centralized authority in a patient's home state would raise serious enforcement issues as states do not have interstate policing authority and cannot investigate incidents. That happened in another state said then AMA president elect Jack Resnick. During a congressional hearing in March, but others want more flexibility and say, it can be done safely. Hassel Feld at Johns Hopkins said there is precedent for easing multi-state licensing requirements the department of veteran affairs, the VA for example, allows medical staffers who are properly licensed in at least one state to treat patients. In any VA facility, the Alliance for connected care and other advocates are pushing states to extend their pandemic rules. A few have done. So Arizona, for example, made permanent the rules. Allowing out-of-state medical providers. To practice telemedicine for Arizona residents, as long as they register with the state and their home state license is in good standing. Connecticut's similar rules have now been stretched until June of 2023. The Alliance and others also back legislation stalled in Congress that would temporarily allow medical professionals licensed in one state. To treat either in-person or via tele visit. Patients in any other state. Because such fixes are controversial. Voluntary. Interstate packs have gained attention. Several already exists. One each for nurses, doctors, physical therapists and psychologists. Proponents say they are a simple way to ensure state boards retain authority and high standards while making it easier for licensed medical professionals to expand their geographic range. The nurses compact and acted by 37 states and Guam. Allows registered nurses with a valid license in one state to have it recognized by all the others. In the pact. A different kind of modal. Is the interstate physician licensure compact. Which has been enacted by 33 states, plus the district of Columbia and Guam. And has issued more than 21,000 licenses since it began in 2017, said Robyn of the Federation of state medical boards. While it speeds the paperwork process. It does not eliminate the cost of applying for licenses in each state. The compact simplifies the process by having the applicant's physician home state. Confirm his or her eligibility. And perform a criminal background check. If the applicant is eligible, the home state sends a letter of qualification to the new state. Which then issues the license Robin said. Physician's must meet all rules and laws in each state, such as the requirements for continuing medical education. Additionally, they cannot have a history of disciplinary actions or currently be under investigation. It's a fairly high bar said, Robyn. Such compacts, especially if they are bolstered by new legislation. At the federal level could help the advances in tele-health may during the pandemic stick around for good expanding access to care for both mental health services and medical care across the U S. What's at stake. If we get this right, said Richmond at duke. Is making sure we have an innovative marketplace. That fully uses virtual technology and regulatory system that encourages competition. And quality. So a lot in that article, I did a lot of reading today. Here's my, so what as with many things in healthcare, not everything is as simple as it appears on the cover. You have to dig in and understand the interest, the money and the status quo and status quo is a very powerful force. I hope that with this review, you realize that this is a complex issue with many interests at stake. There are efforts underway to simplify it, but it will likely take some time. So it's important for us to really understand. All the things that are at work here, that's all for today. If you know someone that might benefit from our channel, please forward them a note. They can subscribe on our website this week, health.com or wherever you listen to podcasts, apple, Google, overcast, Spotify, Stitcher, you get the picture. We are everywhere. We want to thank our channel sponsors who are investing in our mission to develop the next generation of health leaders. VMware Hill-Rom Starbridge advisers, McAfee and Aruba networks. Thanks for listening. That's all for now.

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