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Streamlined doc-licensing process offered to states

In a move seen as facilitating the growth of telemedicine and speeding increased healthcare access to residents in rural areas, the Federation of State Medical Boards has released model legislation (PDF) that could be used to create a multistate agreement, or “compact” system, under which physicians who are licensed in one state can use a streamlined process to be quickly licensed in another.

If enough states get on board, it could quiet any calls to replace state-based physician licensing with a national program.

“The compact is a tried and proven mechanism to address a national issue with a state solution,” said Lisa Robin, the federation's chief advocacy officer.

The Wyoming State Board of Medicine spearheaded the effort, and Executive Director Kevin Bohnenblust said states like his are accustomed to interstate compacts. The management of the Colorado, Platte and every other river that flows through Wyoming is done through such agreements.

“Some may say we don't need another government entity, but this is keeping regulation of professions where it's been since this country was founded—at the state level,” Bohnenblust said.

The model legislation calls for at least seven states to participate in the compact and with participating states to have representatives on a governing commission. Once enough states have joined the effort, participating states would share credential and disciplinary information on physicians licensed by their states with other states so they could quickly issue their own licenses without collecting the usual load of paperwork normally required.

For example, if a physician licensed in Colorado wanted to practice in Wyoming and Nebraska—either via telemedicine or through a satellite office—the compact commission would get the Colorado medical board to attest to the doctor's credentials, collect the licensing fees required by Wyoming and Nebraska from the doctor and then complete the process for an expedited license. The commission would not have any licensing authority itself, but would serve as the information hub. The commission would charge the physician a handling fee.

“I'm cautiously optimistic that we will have the critical mass to get this rolling late next year and that it could come to life in early 2016,” Bohnenblust said.

Physicians still have mixed feelings about the compact approach, as described in a paper published in the recent edition of the FSMB's Journal of Medical Regulation by Washington (state) Board of Osteopathic Medicine and Surgery Executive Director Blake Maresh.

“For some, the interstate compact offers a tested Constitutional precept that could creatively forestall federal intervention that might otherwise supplant the longstanding authority of state medical boards,” Maresh wrote. “For others, the possibility of other state boards licensing physicians who practice in their states, coupled with the establishment of new governmental organizations, leaves them uneasy at best.”

Former Wyoming Gov. Jim Geringer, however, has endorsed the concept, and back in January a bipartisan coalition of 14 U.S. senators sent a letter of support to the FSMB that thanked it for its work in advancing telehealth and to speed up the licensing process for physicians who seek to practice in multiple states and underserved areas.

Part of the reason the compact would be necessary is that the FSMB approved a telemedicine policy in April that defines the location of the practice of medicine as the state where the patient is located—not the physician. This means that, if doctors in Las Vegas or Denver provide telemedicine services to patients in rural Wyoming, they need to obtain a Wyoming license.

This policy is reiterated early in the model legislation.

Some have criticized this policy, saying that it slows the growth of telemedicine and that its main purpose is to perpetuate state medical boards' authority.

Robin, the FSMB's chief advocacy officer, disagreed. “We've gotten very positive feedback from large hospital systems that operate in multiple states,” she said. “We're very optimistic that this will meet our mutual goals of ensuring patient safety while adapting to the changing delivery models.”

The American Medical Association released a statement supporting the FSMB's efforts. State-based licensure ensures appropriate review of physicians' education, training, character, and professional and disciplinary histories, AMA President Dr. Robert Wah said in a news release, and the compact model “aligns with our efforts to modernize state medical licensure.”

Bohnenblust, noting that Wyoming has some 3,000 licensed doctors but only 1,200 live in the state, said that participation in the compact could go in two directions. He said Wyoming would be importers of telemedicine services while states such as Minnesota or Ohio—through institutions such as the Mayo Clinic or the Cleveland Clinic—would be exporters.

Wyoming is increasingly relying on telemedicine for services such as child and adolescent psychiatry, intensive care and emergency medicine, Bohnenblust said. “We're finding the practice of medicine in Wyoming relies on physicians from all over the place.”

Follow Andis Robeznieks on Twitter: @MHARobeznieks



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