Among the many promises of telemedicine, one of the brightest is its ability to bring together medical specialists and the patients who most desperately need their expertise. With the cutting-edge technologies of telemedicine, a patient suffering from a rare gastrointestinal ailment in rural Montana could be put in touch with top GI specialists in urban medical centers hundreds of miles away.
Shirley Svorny, professor of economics at California State University, Northridge, says that this utopian vision of telemedicine’s potential is threatened by the efforts of some state medical boards to protect in-state practitioners from out-of-state competition.
Congress Urged to Act
In an op-ed piece written for The Wall Street Journal, Svorny calls upon Congress to use its power to “sweep away the barriers to interstate telemedicine that deny patients access to top specialists from around the country.”
Svorny points to health policy reforms recently proposed by congressional Republicans. As spelled out in the GOP’s “Better Way” proposal released by Speaker of the House Paul Ryan in June, these reforms would prioritize legislation that encourages consumer choice through health savings accounts, or HSAs. One big weakness in the Republican proposal, according to Svorny, is its failure to take into account the network of state regulatory agencies that often limit the health care options available to consumers.
Motives of State Boards Questioned
Svorny’s op-ed column charges that state medical boards and the laws under which they operate “are supported by entrenched interests primarily concerned with protecting providers, not with fostering the competitive health care market that consumers so desperately need.”
Under the existing state regulatory framework, says Svorny, telemedicine providers who wish to operate in multiple states must first clear burdensome licensing and operating hurdles. Because regulations vary from state to state, telemedicine providers are often forced to hold multiple state licenses, pay fees to each of the states in which they’re licensed, and constantly stay abreast of changes in rules and regulations in multiple jurisdictions.
In one of the more publicized feuds between telemedicine proponents and state medical boards, nationwide telemedicine provider Teladoc, based in suburban Dallas, has brought suit against the Texas State Medical Board over rules Teladoc claims imperil its ability to operate in the Lone Star State.
Proposed Rule at Issue
At the heart of the conflict between Texas’s State Medical Board and Teladoc is the board’s proposed regulation that would require a patient and health care provider to have a face-to-face relationship before any telemedicine interaction could occur. Teladoc and other telemedicine providers argue that initial face-to-face meetings are unnecessary and moves to require them threaten providers’ ability to operate a viable business. Physician groups both in Texas and other states contend that such a foundation is essential to ensure responsible health care.
Indiana state regulators recently removed a similar stumbling block to the expansion of telemedicine in that state. Under regulations that took effect on July 1, 2016, telemedicine providers in the Hoosier State no longer are required to meet in person with patients before writing them a prescription. Interviewed by the Indianapolis Business Journal about the new law, Stephen Tharp, M.D., former president of the Indiana State Medical Association, said, “This is the future of things. We have to utilize new technologies to help people.”
Indiana Now More Hospitable
This simple — but meaningful — rule change in Indiana promises to open up the state to a sharp increase in operations by some of the nation’s largest telemedicine providers. Teladoc has already announced its intention to expand its offerings in the state, as has mega health care insurer Anthem, which began offering telemedicine services to its insureds in other states three years ago. A spokesman for Indianapolis-based Anthem said the insurer can now begin promoting this benefit for those insureds living in its home state.
Back in Texas, what started as a bitter battle between state medical regulators and telemedicine providers, namely Teladoc, could be headed for a compromise settlement. In early June 2016, TexasTribune.org reported that a coalition of medical and industry groups hopes to hammer out an accord to present to Texas state legislators when they convene in early 2017.
According to an email received by TexasTribune.org from one of the parties to the ongoing negotiations, participants are discussing “modernizing our telemedicine statutes and reducing the regulatory footprint governing the provision of telemedicine services.” They are hopeful that they can agree on a compromise settlement by the end of summer 2016.
An Important Step Forward
Both sides in the ongoing dispute acknowledge that these talks represent an important step forward. Tom Banning, M.D., chief executive officer of the Texas Academy of Family Physicians, says the talks represent a significant “thawing of tensions.” Nora Belcher, executive director of the Texas e-Health Alliance, notes that in the past physicians and telemedicine providers have argued about what technology can do. “Now we’re talking about what technology should do.”
In her op-ed article, Professor Svorny contends that previous federal efforts to resolve conflicts between telemedicine providers and state medical boards have been a failure. She points in particular to the Interstate Medical Licensure Compact, which is supported in part by funds from the Licensure Portability Grant Program of the Health Resources and Services Administration. Those funds went to the Federation of State Medical Boards, “whose members have a strong interest in preserving the status quo.”
Fails to Address Main Problem
Svorny argues that the interstate compact, which was a creation of the Federation of State Medical Boards, fails to solve or adequately address the key stumbling block to telemedicine expansion: “the requirement that telemedicine providers be licensed in every state in which they practice.”
Rejecting suggestions that telemedicine providers be licensed federally, Svorny proposes that Congress utilize its authority under the Commerce Clause of the U.S. Constitution “to define where a physician practices medicine to be the location of the physician, rather than the location of the patient, as states currently do. Physicians would need only one license, that of their home state, and would work under its rules and regulations.”
Utah Doctor Disagrees
Svorny’s proposals came under fire from some doctors, who characterized her recommendations as unworkable and a threat to the quality of health care available to Americans. In a letter to the editor of The Wall Street Journal, Richard Parkinson, M.D., of Provo, Utah, claimed that Svorny’s plan would create “a malpractice nightmare for every patient who received bad advice and is looking for justice.”
In Svorny’s defense, David Shimm, M.D., of Beckley, West Virginia, argued that while individual state medical-licensure requirements may have made sense in an age of much less mobility, “it makes little sense for a Massachusetts-licensed physician to be relicensed to practice in Arizona.”
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