The report, prepared by the AMA’s Council on Medical Service and accepted at the 2019 Interim Meeting last month in San Diego, called on the AMA to, among other things, work with state medical associations to encourage more states to join the IMLC. The council said the compact offers the best route to encouraging telehealth without stepping on the toes of state medical boards.
It highlights the challenges care providers face in embracing connected health at a time when telehealth vendors, stand-alone facilities and even the payer market are offering new ways to access care.
“It is increasingly challenging for physician practices to compete with large commercial entities that are contracting with payers to provide telemedicine services, including primary care services,” the report stated. “Commercial direct-to-consumer telemedicine enables patients to receive care from their homes, offices or mobile devices; however, these encounters are provided outside of a patient’s medical home and can lead to fragmented care. Where there is an established patient relationship, a physician should be able to use telemedicine to provide quality emergent or urgent care for a patient’s existing condition when that patient is traveling in another state.”
Launched in 2017 by the Federation of State Medical Boards, the IMLC offers a voluntary expedited pathway to licensure for physicians looking to practice in multiple states – for example, when using telehealth to expand their reach or connect with patients in other states.
The compact is currently live in 24 states and Guam, while Minnesota is an active member but not yet issuing licenses. Another five states and the District of Columbia have passed legislation to join the IMLC but haven’t taken that step yet, and three others states have seen bills introduced.
The council was ordered to produce a report following a presentation at the 2018 Interim Meeting by the American Academy of Pediatrics, which saw telehealth as a means of improving access to care through the developing concept of the patient-centered medical home. The report was designed to “develop model legislation to permit primary care physicians, who work in medical homes/primary care practices that satisfy the National Committee for Quality Assurance Patient-Centered Medical Home Recognition Program guidelines, and who have documented a face-to-face patient-care relationship, to provide telehealth services for the patient when the patient travels to any of the fifty states.”
With national telehealth adoption rates hovering around 15 percent for physicians treating patients and 11 percent for physicians connecting with other healthcare professionals, the council recognized that something needs to be done to reduce barriers – such as applying for licenses in each state.
“Historically, the process of obtaining licenses to practice medicine in multiple states has been burdensome and time-consuming for physicians, and some states formed interstate agreements to practice medicine across state lines,” the report noted. “The AMA has long supported solutions that make it easier for physicians to obtain licenses to practice across multiple states, while preserving the ability of states to protect patient health and oversee the care provided to patients within their borders.”
The resolution introduced in 2018 by the AAP sought to create an exception for primary care providers working in PCMHs, allowing them to use telehealth to treat patients no matter where they live. In its report, the council said that resolution would be too disruptive, and result in “national oversight of telemedicine provided across state lines (which would be) subject to influence by a variety of stakeholders including physicians … commercial telemedicine providers and retail health clinics.”
“Additionally, the Council believes it would be difficult to limit the suggested exception to primary care physicians,” the report continued. “It is possible that direct-to-consumer telemedicine providers would be able to become medical homes, which could in turn lead to other unintended consequences, such as the overprescribing of antibiotics.”
With that in mind, the council recommended that the AMA support efforts to convince more states to join the IMLC, while reaffirming current policy that requires physicians and other practitioners to be licensed in the state where the patient received services. The council also recommended that the AMA reaffirm its support for state medical boards to provide licenses for telehealth use, and that it support coverage for telehealth services comparable to coverage for in-person care.
The full council approved all the recommendations, and added two more: That that AMA lobby the IMLC’s governing committee and FSMB to reduce the application fees and secondary state licensure fees; and that the AMA work with stakeholders to encourage new state laws enhancing access to telehealth and improving state regulation of the services.
Not everyone feels that licensing compacts are a good idea, and some states have debated legislation before moving away from the compact. Opponents say the process creates unnecessary regulatory burdens, while others would prefer to see one nationwide license that allows a clinician to practice in any state.
This past September, the American Academy of Family Physicians voted to lobby states to join the IMLC – though the vote wasn’t unanimous.
James Taylor, MD, an alternate delegate from Louisiana – which has resisted joining the IMLC – said a compact might force states into accepting licensure guidelines with which they don’t agree.
“If there is a state that has a lower standard, we would have to accept it. I would ask that the AAFP be very careful,” he pointed out.