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Doctors Should Support Interstate Telemedicine

Shirley Svorny

Should licensed physicians be allowed to practice telemedicine
across state borders? Lawmakers in Congress have been reluctant to
move this forward. An exception is the recent VETS Act of 2017,
versions of which just passed in both houses of Congress.

Department of Veterans Affairs’ health care professionals will
be allowed to practice via telemedicine in any state, no matter
where the clinician is licensed or the patient is located. Why not
make this type of access available to everyone?

Lawmakers have introduced bills that included language to
reduced barriers to interstate telemedicine, but ultimately
pushback from state medical boards and physician groups have doomed
these efforts. Reps. Devin Nunes, R-Tulare, and Sens. Mazie Hirono,
D-Hawaii, and Joni Ernst, R-Iowa, tried to expand cross-state
accessibility for Medicare recipients via the Telemedicine for
Medicare Act of 2015. Sen. John McCain, R-Arizona, addressed the
needs of TRICARE beneficiaries by including a similar provision in
an early version of the 2016 National Defense Authorization Act. In
both cases, the provision was stripped from the final legislation.
Rep. Mike Thompson, D-St. Helena, included a provision in the
Telehealth Promotion Act of 2012 that would have allowed physicians
to practice across states on the basis of their home-state licensed
and would have applied to all Americans: “For the purposes of
[telehealth service] … providers of such services are considered to
be furnishing such services at their location and not at the
originating site.”

A greater awareness of
the benefits of telemedicine is needed to counter special interest
groups that benefit financially from the status quo.

In each case, well-respected and politically powerful groups,
including the American Medical Association, and representatives of
state medical boards opposed the language. As always, when it comes
to proposals that would inject competition into the market for
physician services, physicians raise the patient safety flag.
However, there is no evidence to support this claim.

So the existing laws stand. Physicians who want to provide
services to residents in another state must be licensed in that
state. Initial license fees (about $430 a state – double that if
the physician uses a private company to assist in the process) and
renewal fees (about $220 a year per state) limit the number of
out-of-state licenses a physician is likely to acquire and
maintain. Another complication to interstate practice under
multiple state licenses is that state requirements for medical
practice, including patient informed consent and continuing medical
education, vary. So do rules regarding such things as fee-splitting
and referrals. As health care lawyer Erika L. Adler put it, “Every
state has its own rules for just about everything.”

Setting aside costly state licensing requirements would allow
telemedicine practitioners to expand into each and every state.
This would allow large-scale providers, who are potentially more
efficient, to develop a presence across the country. This would
encourage patients to choose telemedicine over more costly sources
of care, including emergency rooms, urgent care facilities, and
even doctors’ offices.

Interstate telemedicine also offers options for patients in
small states without specialists, or for seriously ill patients who
have a rare disease and are too ill or too poor to travel across
state lines for care.

The irony of opposition by the largest physician organizations
is that telemedicine offers the scores of overworked, unhappy
physicians unprecedented flexibility. Telemedicine neatly solves
the problem of physicians who, increasingly, are unwilling to be on
call on evenings and weekends. Remote digital encounters improve
patient access to care and save commutes for both the physicians
and their patients. With remote medicine, physicians can see
additional patients without expanding their offices (saving money
on staff and facilities).

Via telemedicine, physicians may practice at the hours they
choose, allowing for more personal time. The ability to practice
remotely may keep some physicians active who would otherwise
retire, putting a dent in the expected physician shortage. When
necessary, or if they choose to, it would be legal for physicians
to talk with patients when the patient is vacationing in another
state. This would facilitate continuity of care for snowbirds who
travel to Florida or Arizona for the winter months.

The fact that private insurance companies are expanding the use
of telemedicine tells us that telemedicine saves money. Legislation
that would allow physicians to practice across state borders –
perhaps redefining the location of the practice of medicine to that
of the physician – would make telemedicine even more

A greater awareness of the benefits of telemedicine is needed to
counter special interest groups that benefit financially from the
status quo. Physicians’ increasing appreciation of the value of
telemedicine, both for themselves and their patients, could offer
politicians the leverage needed to open state markets to
out-of-state telemedicine providers. Such an opening would
normalize and strengthen a burgeoning practice that stands to
revolutionize the delivery of health care, potentially making it
more accessible and more affordable. For anyone who can see their
way through to put the needs of patients first, it makes all the
sense in the world.

is a professor of economics at California State
University, Northridge, an adjunct scholar at the libertarian Cato
Institute, and author of the study, “Liberating Telemedicine:
Options to Eliminate the State-Licensing Roadblock.”