What Telehealth Should Mean for Licensure

The temporary erasure of state borders for medical licensure related to telehealth should become permanent, a group argued.

At the outset of the pandemic, a number of states agreed to recognize out-of-state licenses and CMS temporarily waived its requirement for licensure in the state where the patient is located in to get Medicare reimbursement.

Both facilitated telemedicine, but maintaining the expanded use of these virtual visits beyond the pandemic will take more permanent reforms, argued Ateev Mehrotra, MD, of Harvard Medical School and Beth Israel Deaconess Medical Center in Boston, and two colleagues in a perspective in the New England Journal of Medicine.

“Although states have maintained the authority to license physicians since the late 1800s, the growth of large national and regional health systems and the increased use of telemedicine have expanded the scope of health care markets beyond state borders,” they wrote.

A federal solution could be feasible, Mehrotra’s group noted, given that the Constitution allows preemption of state laws that interfere with interstate commerce, and that states are required to allow out-of-state telehealth consults in the VA system.

However, respecting states’ historical control over licensure is “probably the best path forward,” because it allows for state boards to maintain disciplinary activities (and their vested interests against reform against federal-level control), the group pointed out.

The Interstate Medical Licensure Compact — a mutual agreement among 28 states and Guam for streamlining additional state licenses — hasn’t been especially popular, with just 0.4% of physicians in participating states having made use of it as of March 2020.

Congress could pass legislation to push the remaining states to join that compact, which would also benefit from lower fees and administrative burdens and better advertising, they noted.

The most promising and practical option, though, is to not rely on states to act on their own but to use federal authority to “encourage reciprocity, under which states automatically recognize an out-of-state license,” perhaps by leveraging Medicare, they suggested.

“Such a policy would most likely accelerate the adoption of state legislation regarding reciprocity, thereby affecting patients with other forms of insurance as well,” Mehrotra and colleagues wrote.