We’ve written about telemedicine frequently, including last week’s post about urban telemedicine. Today we’ll discuss how changes to state licensing requirements could help expand telemedicine practice.

Cross-state licensure is a major barrier to expanded use of telemedicine across the country. As the AMA Journal of Ethics summarizes, “The cost in time, money, and resources of applying for licenses in each state in which a physician seeks to practice is a serious deterrent to expanding medical services across state lines.”

The challenge is that each state has their own laws governing telemedicine licensure, as well as different Medicaid programs, private insurers’ business practices, and privacy and data security laws. Ten state medical boards have created a telemedicine license to accommodate practicing physicians, but participation is limited and clinicians still need to be licensed by the state in which their patient is receiving care.

There are two trends to address this problem. The first is an initiative taken up by the Federation of State Medical Boards (FSMB) called the interstate telehealth licensing compact, which expedites the licensure process for doctors who want to practice in multiple states. Just last month the compact was adopted by legislators in Alabama, passing the threshold of seven states needed for enactment.

Interactive map showing blue states that have enacted the FSMB compact, orange have introduced

The FSMB compact resembles the Nurse Licensure Compact (NLC), which was launched in 2000 and allows licensees to practice (physically or electronically) across 24 participating states. Similarly, the Veterans Administration only requires eligible physicians to have one state license to practice in all VA facilities. As AMA writes, these programs successfully facilitated cross-state telemedicine practice, suggesting that the FSMB compact should help.

Another solution would be federal legislation that changes cross-state licensing – an option that industry advocates are optimistic about. As American Telemedicine Association (ATA) CEO Jonathan Linkous noted before last month’s annual conference, 17 U.S. senators from both political parties recently showed up at a hearing where telemedicine was on the agenda. “It’s an interesting time in telemedicine. It’s an incredibly bi-partisan issue.”

The TELE-MED Act of 2013 would allow Medicare-participating clinicians licensed in one state to provide telemedicine services to beneficiaries in other states, with regulation and enforcement carried about by the state where the clinician is licensed. Another bill is the Telehealth Enhancement Act, which proposes that for Medicare liability purposes telemedicine services be viewed as being delivered at the location of the clinician, not that of the patient. As the AMA explains, each of these policies could change the licensing landscape.

Of course, legislative progress isn’t just a response to frustrated physicians wanting to expand health access to more Americans – it comes hand in hand with industry growth and lobbying from advocates like the ATA. The global telemedicine market is expected to reach $21 billion by 2020, and various business drivers increasingly make telemedicine an attractive investment.

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