Who Should Regulate Telemedicine, and How?
Readers of this blog know that NCPA has long been a supporter of telemedicine. The question of who should regulate telemedicine, and how, is now coming to a head.
The practice of medicine is regulated by the states. For many years, advocates of telemedicine have pointed to inconsistencies in how medical licensing boards recognize out-of-state physicians as a limit to telemedicine. In 2012, health economist Jason Shafrin reviewed literature, which indicates that requiring a doctor to be physically present with a patient to prescribe reduces access and harms patients.
State-based medical licensing boards’ inability to overcome this problem, despite many years of effort, has led to frustration and the rise of a movement that has not quite come out for a federal takeover of telemedical licensing — but certainly looks like it might tip that way.
This has prompted a mighty effort by the Federation of State Medical Boards (FSMB) to propose an interstate compact for medical licensing. States that join the compact would have an easy pathway to recognizing each other’s physicians to practice telemedicine.
However, the recently formed Alliance for Connected Care has said the proposed compact does not go far enough. The Alliance, led by former U.S. Senators Tom Daschle, Trent Lott, and John Breaux, includes as members such giants as CVS Health, Walgreens, Anthem (formerly WellPoint), and others. The American Telemedicine Association, a long established trade association which includes Microsoft and Humana among its members, also has not endorsed the proposed compact.
I suspect that if the compact fails to gain headway, industry participants will increasingly look to the federal government to solve the challenges of telemedicine licensing and reimbursement.
That would be a shame. Do we want the folks who run healthcare.gov to be in charge of telemedicine? Let’s hope the FSMB succeeds in building a coalition that will support an effective compact to fix state telemedicine laws.
That’s a real dilemma. On the one hand, we don’t benefit from the good ole boy medical boards’ stodgy adherence to outdated standards and protectionism. On the other hand, HealthCare.gov (and federal oversight) doesn’t sound like it benefits anyone either.
In years past, I did quite a bit of work on telemedicine. Why is waiting for an hour in a physician’s office the standard of care? The potential for telemedicine is immense. Imagine a doctor willing to monitor your diabetes remotely from his or her own office. You could test your blood glucose and email it to a server. A diabetes nurse could monitor it and alert the doctor if your metrics are too high. There are numerous other conditions that could benefit from remote monitoring. Heart failure patients or asthmatics could communicate remotely. Why can’t I communicate with a doctor in India who recommends care for me. A local doctor could order the actual prescriptions if needed. For hypertension, diabetes, high cholesterol, blood tests could be ordered and the results communicated electronically.
The obstacles make no sense. I think they are falling. However, I think that if consumers controlled there own money, they would fall a lot faster.
With products like Telcare and Eos Health remotely reported diabetic meters with nurse supervision that are already here- it’s only a matter of time before telemedicine gets more utilization. I think with wireless communication and CMS forcing EHR use, in addition to the shortage of primary care physicians especially in rural areas, there’s almost no need to be in the same room as a doctor. Furthermore, true diagnosticians who can make medical decisions just looking at and hearing the human body are fewer and farther in between. We are indeed in a brave new world of medicine.
Technology and new business models are coming up faster than regulators can respond. The cost of sensors is falling. Many things can be observed remotely by a doctor.
I have even seen a demo of a telemedical visit for a sore throat. The doctor asked the patient to use her cellphone to take a photo down her open mouth with a flash. That allowed him to see the inflammation.