Is What the AMA Says About Interstate Medical Licensing True?

imgresThe AMA and AAFP are at odds with new legislation that affects interstate medical licensing. However, in Senate Bill 2943 which is a defense bill, a section on telehealth says the site of the provider rather than the patient determines the source for the consultation. In a letter to both the Senate and the Congressional Armed Services Committee , both organizations take issue with the point of service being the provider. Some excerpts from the AMA letter:

“We are therefore deeply concerned with the language in section 705(d) of the Senate version of the NDAA (S. 2943) that would alter the point of care from the location of the patient to the location of the provider. This provision would deprive TRICARE beneficiaries of essential protections by fundamentally subverting and undermining existing state-based patient safety protections that are currently in force, and remove an essential mechanism used by states to ensure medical care provided to patients in their state meets acceptable standards of care.”

Response: Why wouldn’t every state have the same protection in place? We don’t practice differently from California to New York. One driver’s license protects a person in an accident if they are from two different states. Rather than spending the money for the Compact why not spend it to promote better working reciprocal relationships among the states?

“Changing the applicable state laws from the location where the patient is located to the state where the health care provider is located for purposes of state licensure, medical liability, and reimbursement does not achieve the intended outcome. Namely, it would create confusion by altering well-established legal principles and open new conflicts of law questions, degrade important patient protections, and create confusion with regard to payment and coverage.” 

Response: Why shouldn’t we have the same laws for all states? We train in one state and practice in another. We have malpractice that extends across state lines.

“Section 705(d) would dismantle accountability mechanisms needed to ensure patient protection because (1) state licensing boards, where the patient is located, would lack authority over practitioners licensed in another state and (2) state boards where the practitioner is licensed would have no authority to conduct investigations in a different state where the patient is located.”

Response: Again, a driver has automobile insurance which works in every state he or she drives. Isn’t it time that artificial borders be removed when it affects patient care. We all want to ensure patient safety but what has been done to make this universal. After 100 years, state medical boards need a 21st-century model.

“The medical profession has long advocated that state licensing boards and the Federation of State Medical Boards (FSMB) streamline and simplify the medical licensure process. And, to that end, a workable solution is rapidly advancing through the FSMB’s Interstate Medical Licensure Compact”.

Response: the FSMB started this process in 2014, and to date, only 18 states have approved this. In fact, the state of Ohio came out against accepting the Compact. So how do we know if the majority of states will sign on?

My concern is that the telemedicine practitioners and clinical service providers are not being heard. When it takes 4-6 months for a license and 3-4 months for credentialing, just how many patients are not receiving the benefits of telemedicine? There has always been a concern that state medical boards face a conflict of interest when they control who comes into their state to practice medicine. In 2016, it is time these boards catch up with expanding medical technology that enhances patient access to healthcare. I still favor an unencumbered reciprocal license (drivers license model) or a national license so we can resolve this barrier to telemedicine.

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October 27th, 2016

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