Over the past year, the Federation of State Medical Boards (FSMB) and the American Telemedicine Association (ATA) have published documents regarding telemedicine that shed some new light on how state regulatory bodies view telemedicine. Taken together, the documents are generally cause for optimism underscoring the trend towards greater acceptance of telemedicine—but there are some notes of caution as well. By way of quick background, the FSMB represents 70 state medical and osteopathic boards and helps support member boards around the country. The ATA is the largest telemedicine-focused trade association made up of industry leaders and health care stakeholders.
According to a survey report issued in December 2016, telemedicine is currently the most important regulatory topic to state medical boards. The survey was completed by 57 of the 70 medical and osteopathic medical boards in the country. Interestingly, 75 percent of boards chose telemedicine in their survey responses as one of the most important topics “making it the topic impacting the largest number of boards.” Seventy percent chose resources regarding opioid prescription. The five most important issues were:
- Opioid prescribing (resources related to);
- Physician licensure compact;
- Physician re-entry to practice; and
- Medical marijuana.
Surprising in these survey results is the degree to which telemedicine continues to be top of mind for state boards despite the slew of state activity that generally facilitates greater use of telemedicine (discussed more below in the ATA Gaps Report section). A reasonable explanation is that despite all the recent progress in law and policy, many state boards continue to be uneasy about telemedicine. What that ultimately means for the industry will bear watching.
FSMB Overview & Trends Documents
The FSMB also published an overview of state telemedicine policies and found the following:
- Fifteen state boards issue a special purpose license, telemedicine license or certificate, or license to practice medicine across state lines to allow for the practice of telemedicine.
- Four state boards require physicians to register to practice across state lines.
- Almost 2/3 of states and the District of Columbia, require both private carriers and Medicaid to cover telemedicine services to the same extent as face-to-face consultations.
- Approximately 20 states currently require only Medicaid to cover telemedicine services.
In addition, the FSMB’s U.S. Medical Regulatory Trends and Actions 2016 report found that the vast majority of states have adopted specific telemedicine regulations or board policies, the vast majority of which in my view, loosen past restrictions on the use of telemedicine. While the FSMB notes that these documents are not intended as comprehensive statements of the law, they do provide an interesting snapshot regarding how states are approaching the issue of telemedicine. Ultimately, for telemedicine providers, the news here is encouraging.
ATA Gaps Reports
For its part, the ATA published its annual gaps reports earlier this month. In the reports, the ATA analyzes state coverage/reimbursement and physician standards/licensure policies and assigns letter grades to every state for each of these areas of focus.
The coverage and reimbursement report found that while there has been a “mix of strides and stagnation” in state policy, all states now cover telemedicine to some degree compared to just 24 states in 2005. The report also found that seven states have adopted policies resulting in improved coverage of telemedicine services since the ATA’s last report in 2016. No state received a failing composite grade, and there were more states with grades of “A” or “B” than was the case a year ago.
The physician standards and licensure report determined that states are generally eliminating restrictions and better embracing telemedicine as a viable delivery vehicle. Twenty-one states averaged the highest “composite grade” with three states Arkansas, Florida, and Louisiana, earning higher scores than last year’s update. The encouraging news notwithstanding, the report stresses that “state by-state comparisons still reveal great disparities in the ways licensing boards regulate clinical practice when telemedicine is used.”
All told, the reports clearly show that significant progress has been made at the state level in recognizing the viability of telemedicine. Given that telemedicine is the most important regulatory topic for many state boards per the FSMB survey, however, it appears that work still needs to done to put skeptics’ minds at ease.