Major Telemedicine Roadblock Could Clear With Proposed Bill
New law would set up national credentials database so telehealth providers would no longer need multiple state licenses.
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As telemedicine spreads, the regulatory barriers that restrain it are slowly crumbling--although not as fast as its proponents would like.
The latest evidence of this is the news that Sen. Tom Udall (D-Utah) plans to introduce legislation that would remove the need for physicians who provide telehealth consultations across state lines to be licensed in more than one state.
To ensure that these physicians meet state licensing requirements, the bill proposes to set up a national database that includes their credentials and other information, such as malpractice claims and hospital privileges, a Udall staff member said at a recent Capitol Hill briefing.
Last year, Congress passed a bill that would provide some portability of licenses across state lines to providers who treat military personnel or veterans for mental health disorders. And last summer, the Centers for Medicare and Medicaid Services (CMS) made it easier for hospitals to privilege physicians at other institutions who provide them with telemedicine services.
The need for multi-state licensure has been an obstacle to telemedicine for the past 20 years, noted Jonathan Linkous, CEO of the American Telemedicine Association (ATA), in an interview with InformationWeek Healthcare. But the issue has become more pressing in recent years as the use of telehealth has expanded, he said.
Rural telemedicine is still where multi-state licensure poses the biggest problem. Many community hospitals rely on telehealth consults with specialists at academic medical centers in metropolitan areas because they don't have such specialists in their own areas. Frequently, Linkous said, those medical centers are in other states, particularly if the community hospital is located near a state line.
The growth of healthcare systems and telemedicine companies also is bumping into state licensing requirements, he noted, because physicians in these organizations might provide telehealth services across multiple states or even nationally. He cited Virtual Radiologic, a teleradiology company that contracts with 1,500 hospitals across the country. "They have to handle 8,000 to 9,000 medical licenses every year, because they have this issue," he said.
Finally, he noted, many travelers and "snow birds" would like to consult with their own physicians when they're not at home. The latest telehealth technology would allow them to do so, but their doctors can't participate without getting licensed in another state.
The ATA recently held a briefing for Congressional staffers to raise awareness of the multi-licensure issue. Linkous said the ATA is cautiously optimistic about the chances of the Udall bill. Although he wasn't sure whether it would pass this year, he said, "I think the outlook is brighter than it's ever been."
Linkous noted that last summer's change in CMS rules on hospital privileging as a condition of Medicare participation had eliminated a big barrier to telemedicine. Previously, CMS had required that hospitals apply their normal privileging and credentialing procedures to telemedicine providers. That made it difficult for hospitals and critical-access facilities to get help from specialists located in other areas. Under the new rule, hospitals can rely on the credentialing procedures of other hospitals or telemedicine companies, as long as the hospitals receiving services take responsibility for the telemedicine providers.
The only problem with the rule, Linkous said, is that many hospitals leave privileging decisions up to their medical staffs, and those decisions are not affected by the new regulation. "So there are still nuances that have to be changed [in the Medicare rule], but it really made a big difference."
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