FSMB
Compact Could Ease Multistate Licensing
Ken Terry
August 05, 2014
The Federation of
State Medical Boards (FSMB) has unveiled a draft interstate compact for
physician licensure that, it said, should make it easier to practice
telemedicine across the country. The compact, which the FSMB expects to
finalize in the next month or two, offers a "streamlined alternative
pathway" for physicians who want to practice in multiple states, according
to a federation news release.
Under current state
medical board policies, physicians must be licensed in the state where a
patient is located to diagnose or treat that patient, a stance that the FSMB
recently reaffirmed in its model policy for telemedicine. As a result, physicians who
consult remotely with patients in other states must be licensed in those
states. That can create barriers to telehealth consultations, especially for
on-call physicians who are not licensed in every state where patients may
contact them online.
The FSMB's interstate
compact would allow physicians to apply once and receive licensure in all
states that are party to the compact.
Once the compact is
finalized, individual medical boards can decide whether to endorse it and
submit it to their state legislatures for approval. Three state boards,
including the Texas and Oklahoma medical boards and the Washington State
osteopathic medical board, have already approved the compact in principle, said
Humayan J. Chaudhry, DO, president and chief executive officer of the FSMB.
"Many other
boards have it on their agenda and are waiting for the final language before
they can present it to their legislatures," he told Medscape Medical
News, adding that 15 states are expected to approve the compact in the near
term.
According to Chaudhry,
a house of delegates representing the FSMB's 70 member boards asked the
federation to study the concept of an interstate compact. What motivated the
boards, he said, was the need to address the nation's growing physician
shortage, to ease patient access issues related to the Affordable Care Act, and
to facilitate telemedicine in both rural and more populated areas.
In addition, he said,
the interstate compact could help physicians get licenses in metropolitan
regions that cross state boundaries. He cited the situation of Washington, DC,
physicians, many of whom have had to obtain separate licenses in Maryland and
Virginia to treat their patients.
The draft interstate
compact specifies that, to be eligible for multistate licensure, physicians
must have passed the US Medical Licensing Examination or the Comprehensive
Osteopathic Medical Licensing Examination, must be board-certified, must have
clean records, and must have been in practice for at least 3 years. Because
they must also complete a residency program, the latter requirement might be
dropped in the final version, Chaudhry said.
A "Baby
Step"
Jonathan Linkous,
president and chief executive officer of the American Telemedicine Association
(ATA), told Medscape Medical News that the draft interstate compact
falls far short of what is needed to promote telemedicine. "The federation
is taking a step. But it's a baby step, and what we need is a giant leap."
The key area where the
interstate compact falls short, he said, is that it would create a
"clearinghouse," rather than reciprocity among states. Physicians
would be able to apply for licensure to multiple states through a single entity
but would still have to pay license fees to each state and would have to
"follow every state's unique and peculiar rules regarding how you practice
medicine."
There are some large
differences in those rules, he noted. For example, 24 states allow physicians
to prescribe medications in telehealth encounters with patients. The rest
require prior patient visits, a presenter in the same room as the patient, or a
live follow-up visit.
State license fees are
also substantial, Linkous pointed out. The ATA performed an analysis in 26
states and found that for the fifth of physicians who had licenses in multiple
states, license-related fees cost them about $300 million a year. He granted,
however, that those costs might be reduced if physicians filled out a single application
and did not have to provide original documents to each medical board.
The ATA does not favor
national licensure of physicians. What it wants is reciprocity among all
states, similar to the way they treat driver's licenses today. If a physician
is licensed in one state, he or she should be able to practice in any state,
Linkous said.
Medscape Medical News © 2014
WebMD, LL
No comments:
Post a Comment