With the explosion of telemedicine use during the COVID-19 pandemic, several regulations have come under close scrutiny for hindering more efficient and effective use of the technology. In particular, telemedicine physician licensing has traditionally been managed at the state level, where both the physician and patient must physically be located during the appointment, but real-time consultations over the internet are not limited by state lines. With today’s technology and consumers’ rapid acceptance of telemedicine, providers and patients virtually anywhere can theoretically meet online for a medical appointment; in reality, they can’t because many states do not recognize medical licenses awarded in a different state. Temporary measures have been created to address this issue, but they do not comprise a long-term solution to the issue of telemedicine physician licensing.
Early in the pandemic, many states began honoring out-of-state medical licenses pro tem, and the Centers for Medicare and Medicaid Services waived their requirement that the provider be licensed in the same state where the patient is located. These concessions made it possible for patients to access health care regardless of their physical location and revealed the sizable impact of telemedicine as a health care delivery method.
Now, having three COVID vaccines available in the U.S. is bringing the end of the pandemic in sight—not immediately, but within reasonable distance. This begs the question: What will happen to telemedicine physician licensing when the pandemic is over?
A recent essay in the New England Journal of Medicine addresses this exact query. The authors, avowing that permanent licensure reforms are key to the continued high usage rate of telemedicine long-term, note that the Constitution permits the federal government to override any state laws that impede interstate commerce. Telemedicine, which relies on the ubiquitous internet, falls within this realm. The writers propose four types of policy reforms that could reduce or eliminate problems with telemedicine physician licensing. Some variants of these approaches are already in place.
1. Make it easier for physicians to obtain licenses from other states.
The Interstate Medical Licensure Compact (IMLC), introduced in 2017, makes it easier for providers to obtain an out-of-state license. So far, 28 states have joined. Physician participation rates remain low, however; the authors propose that Congress can pass legislation to encourage all states to join the compact.
2. Require reciprocity, which requires states to automatically recognize out-of-state medical licenses.
The concept of reciprocity isn’t new; federal legislation in 2013 suggested applying reciprocity in the Medicare program but was not ratified. Currently, the Veterans Affairs (VA) system already demands reciprocity across all states, and most states have implemented similar policies in response to the pandemic.
3. Administer licenses based on the physician’s location rather than the patient’s.
As specified in the 2012 National Defense Authorization Act, physicians within the TriCare (the military health plan) system only need to be licensed in the state where they are physically located. This allows interstate medical practice to occur within our military. Some legislators are proposing that this model should be applied to all civilians as well.
4. Replace state-level licenses with a federal license to practice medicine.
Some stakeholders have advocated either replacing the state licenses with one federal license, or retaining the state licensing requirements while offering the federal license for physicians who wish to practice in multiple states. However, critics fear that a federal licensing system would undermine the authority of well-established state-based medical boards and prompt them to resist cooperation in order to limit competition from clinicians in other states.
Of these options, the authors favor federal legislation that encourages reciprocity similar to that of the VA system and TriCare, beginning with Medicare. Such a move would push states to permit reciprocity for the benefit of all patients, they believe, rather than shielding their physicians from potential out-of-state competitors.
During the pandemic this past year, it has become clear that many existing regulations are outdated regarding the delivery of health care. With careful consideration, the issue of telemedicine physician licensing can indeed be removed, perhaps in gradual steps, as a barrier to health care. The increased ease and convenience of accessing health care can only be a boon to patients across the nation.
To learn more about telemedicine physician licensing, visit the New England Journal of Medicine here.