Navigating the laws and benefits of telemedicine

Briefings on Accreditation and Quality, July 1, 2017

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This is the first year that all 50 states have adopted some form of telemedicine coverage. Telemedicine is the remote diagnosis and treatment of patients using an audiovisual platform—a doctor’s appointment over Skype, remotely monitoring a patient’s vitals, messaging pictures of rashes and illnesses, etc. And while certain issues will still require an in-person examination (e.g., setting a broken arm), the field is opening several new options for treatment.

Because telemedicine is still so new, the laws pertaining to it have yet to keep pace with the technology. The rules surrounding telemedicine vary greatly between states, and wading through the list of best practices and guidelines can be difficult.

So why should hospitals set up a telemedicine program? And what do they need to navigate the disparate laws and regulations around telemedicine?

Working between states

Part of the challenge of conducting telemedicine is that providers have to be licensed in whatever state they practice in, even if they are not physically in that state. For example, if you’re in New York and one of your patients is on vacation in California, you have to be licensed by the California medical board to treat that patient via telemedicine, and you have to meet the standard of care required under California law. While states will occasionally give limited waivers allowing physicians to provide telemedicine on a more ad hoc or infrequent basis, these requirements can be a major hurdle.

Jennifer Breuer and Fatema Zanzi, partners at Drinker Biddle & Reath, with backgrounds in telehealth laws, compliance, platforms, training and implementation, and quality, agree that state medical boards serve an important role even if they hamper the promulgation of telemedicine. 

There still needs to be some degree of control relating to state medical licenses; otherwise, you could have non-professionals practicing medicine. In addition, the needs of different states make it hard to come up with a universal standard that makes sense to everyone.

“Treating a patient in North Dakota can be very different than treating a patient in New York,” says Zanzi. “Because treating a patient in North Dakota, you may not have the same number of physicians, so you may allow your nurse practitioners to have a larger scope of practice in North Dakota because of the lack of licensed physicians. States do want some flexibility in how they manage the profession.”

While one can argue both sides of the “states vs. federal” regulation question for medical boards, as it stands, each state has a huge say in who can practice medicine within its borders. And each state has its own “physician lobby” that has no interest in giving up control of state medical licensure laws.

However, the burden on telemedicine providers is being lifted slightly by the Interstate Medical Licensure Compact (IMLC). As of this writing, there are 20 states and 23 medical and osteopathic boards in those states who are part of IMLC, with about five more states considering it. The compact is intended to make it easier for physicians to be licensed in multiple states.

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Briefings on Accreditation and Quality.

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