The Federation of State Medical Boards (FSMB) has published model legislation that would ease credentialing requirements for physicians who provide telemedicine outside their home state’s borders—while preserving the primacy of the states in licensing physicians.
Ben Strong, MD, chief medical officer, vRad, Eden Prairie, Minn., welcomed the news. He estimates that 80 percent of vRad’s business is telemedicine and its 371 teleradiologists maintain 8,000 state licenses, managed by a credentialing and licensure department of 38 FTEs.
“I think it will streamline things immensely, I welcome it on almost all fronts,” Strong says. “More widespread credentialing and licensing would improve our service parameters and our specialty matching and ability to deliver those higher end, more precise interpretations, faster. It also would improve the access to health care for all of our sites. There are a lot of small rural sites that don’t have access to experienced radiologists, and that access would be expanded significantly.”
The legislation formulated by FSMB, which represents 70 U.S. medical boards, maintains the medical practice acts of the individual member states and preserves the place of service as the location of the patient, not the physician. A minimum of seven states may form a “compact” that will grant physicians in member states a full and unrestricted medical license under an expedited process.
“The FSMB is pleased to have supported the state medical board community as it developed this compact to streamline licensure while maintaining patient protection as a top priority,” said Humayun J. Chaudhry, MD, FSMB president and CEO, in a press release. “We look forward to working with states that wish to implement this innovative new policy.”
The AMA immediately issued a statement supporting the approach. “State-based licensure is an important tenet of accountability, ensuring that physicians are qualified through the review of their education, training, character, and professional and disciplinary histories, said Robert M. Wah, M.D., President, American Medical Association. “The interstate compact…aligns with our efforts to modernize state medical licensure, allowing for an expedited licensing pathway in participating states.”
The national alternative
Health care providers are making greater use of telemedicine to compensate for physician shortages and improve efficiency and accountability, prompting calls for a national method of licensure, a solution Strong also supports but considers unlikely to happen, for political and practical reasons.
“Collecting fees is one of the only sources of revenue of state boards, so I think there will be some resistance on that point,” he notes. “Every state emphasizes a different aspect of the licensing process. Every state is going to have to feel like their state process is adequately represented in any national process, and I think this is a good thing. “
Strong, who holds 50 state licenses and a handful of international licenses, notes that Nevada, for instance, is adamant about showing a lack of bad debt. Strong’s application for licensure in Alaska was 200 pages and had to be sent in a box.
Nevertheless, he notes, vRad’s ability to manage the licensure process is a competitive advantage. Aside from the large number of credentialing personnel the company employs, vRad's software engineers have written software to partially automate the process. “It is a significant barrier to entry for other entities trying to provide the same service that we do,” he says.
FSMB’s model legislation for the state compacts stipulates that each physician applying for licensure through the compact must designate a member state that is either the state of primary residence, the state where at least 25% of the practice of medicine occurs, the state of the physician’s employer, or, if none of the above, the state designated as state of residence for the purpose of federal income tax.
Each compact will be required to create an Interstate Medical Licensure Compact Commission for the purpose of administrating the compact. The commission is authorized to develop rules regarding fees for expedited licenses and is charged with collecting and distributing those fees to the applicable state where the license is granted.
Each Interstate Commission would maintain a database of all physicians who are licensed or have applied for expedited licenses and may levy a tax on each member state to cover the costs of operation.