By Jane Norman, CQ HealthBeat Associate Editor
January 31, 2012 -- Advocates of telemedicine said last week that they're mounting a new push to allow doctors to more easily practice medicine across state lines. And an aide to Sen. Tom Udall said the New Mexico Democrat is drafting legislation to create a national physician licensing system to operate in tandem with state boards.
At a forum, supporters of an increased use of long-distance medicine—using everything, from telephones to Skype—said the time has come for health policy to catch up with technology and allow doctors to treat patients no matter where they are located.
Jonathan Linkous, CEO of the American Telemedicine Association, said the circumstances can range from traveling businesspeople who want to consult with their doctors at home to elderly people who winter in the South but prefer to continue seeing their hometown providers. In rural areas, telemedicine can link multiple providers, including specialists, with far flung patients in numerous states.
As it stands now, doctors must apply separately to every state in which they practice remotely, said Bernard Harris, president of the association and a physician. Otherwise, "you can't prescribe, you can't treat, you can't read X-rays," he said.
The nation's 70 state medical and osteopathic licensing boards have the power to issue medical licenses and they charge from $110 to $1,300 for application fees. Fern Goodhart, a Udall aide, said the time it takes to complete the application process can range from three months to a year, though there is little variation in the standards each state uses.
Goodhart said Udall is concerned about the lack of coordination and cost of duplicative credentialing processes. He decided to act after hearing reports of problems in New Mexico. She said the bill he is drafting would set up a voluntary system in which doctors would be licensed by their state boards, who would retain control over disciplinary issues. At the same time, doctors could sign up for a national license that would allow them to practice any medicine—not just telemedicine—in any cooperating state.
Some incentives may be included in the bill to bring along states that might be "dragging their feet," Goodhart said.
All states use the United States Medical Licensing Examination and recognize credentials from nationally accredited medical schools and residency programs regardless of location, says the telemedicine group. Advocates say states differ only on such issues as how many times a physician candidate can take the exam.
Linkous said that advocates are not prescribing any one way to change the traditional system of state-by-state licensure but "we want to resolve it." The association has created a website called FixLicensure.org, where a petition is posted to be signed. It says that "the patchwork of state-by-state licensing creates a mire of costly red tape and has become an untenable barrier for both providers and patients."
Craig Sable, director of echocardiography and telemedicine at Children's National Medical Center, said a national system based on state standards, like a driver's license, is an option.
"I'm sure many of us have driven across state lines recently and we don't carry 50 licenses," he said.
Sable also said "there are two types of physicians—those who use telemedicine and those who don't like it." He said he believes it is effective and safe, and evidence-based studies have found that it works.
The Federation of State Medical Boards in March 2011 held a conference to discuss telemedicine's future. Freda Bush, the organization's immediate past president, said in a report on the event that the potential benefits are vast but at the same time questions are raised about patient safety, privacy of medical information and regulatory and licensing standards.
The federation "believes strongly in the potential of telemedicine to lower costs, provide health care to under served populations, facilitate health care delivery and enhance health," she wrote. "But it must be shaped in a way that ensures patient safety and medical quality, core concerns of the nation's state medical and osteopathic boards. The fundamental professional, ethical and scientific underpinnings of medicine must be preserved as telemedicine grows."
Goodhart said Udall had hoped that states would make faster progress on moving toward a better system but now believes Congress needs to legislate. She said his bill likely will be introduced this spring.