By Sarah Wickline, Staff Writer, MedPage Today Originally published here
The Federation of State Medical Boards is now mulling a new framework for expediting licenses allowing board-certified physicians to practice in multiple states through an interstate compact — opening doors to telemedicine and more.
Using this agreement, licensed physicians could apply for rapid multistate licensure to treat patients residing outside their principal licensing state. Compact-friendly states could still choose to deny licensure to those physicians, but the mainstay of the compact is a “one-stop pathway” to multistate licensing.
The interstate compact would not replace initial licensure and would only be granted to board-certified physicians.
“This is the fastest moving initiative in the history of our organization,” Humayun J. Chaudhry, DO, president of the FSMB, told MedPage Today in a phone interview.
Chaudhry said the concept has also won bipartisan support in the U.S. Senate, even though the initiative is state-based rather than a Federal program. “Sixteen Senators have sent letters of support,’ he said.
Although the compact is not being directly designed to support telemedicine, clinical practice in the virtual health world would fall under the licensing purview of this state-level cooperative, Chaudhry said.
A committee of the FSMB House of Delegates is investigating the issue of whether or not specialty certification should be required for a telemedicine consultation. Chaudhry said there has not been a lot of consistency as to how to define that part of the compact yet.
And although the compact is still in draft form, Chaudhry said he hoped it would be completed and ready for submission to individual states by the end of the 2014 summer. Buy-in from a majority of licensing jurisdictions is necessary to make the plan work, and Chaudhry said he was confident that the compact will be quickly endorsed by all states.
Several interstate compacts for physicians are already in place in various areas of the country with large populations living near state lines. But, this proposal would tie together all of the states choosing to participate in the compact.
And an important difference would be a requirement that board-certified physicians seeking such licenses would need to be current in that certification. Traditionally, medical licenses do not address board certification.
Board certification, in most cases, also means participating in the maintenance of certification program administered by the American Board of Medical Specialties — a hot-button item for many physicians.
“The compact will not have anything to do with specialty certification per se,” Blake T. Maresh, executive director of the Washington state Department of Health, told MedPage Today.
“As it is drafted presently, a physician would need to be board-certified to apply to participate in the compact. As part of the compact application process, which would be separate from applying for a regular credential, an applicant would have to demonstrate board certification to be eligible,” he said.
“The rationale for it [board certification] in this situation is that it is one way in which we can help to ensure a high level of quality of practice,” Maresh said.
“This is especially important because the state of principal licensure will evaluate the physician’s credentials for participation in the compact and, once approved, other states will license the physician across the compact without further review,” he added. “So it is one proxy for demonstrating the physician’s commitment to provision of quality care.”
Physicians seeking the interstate licence must have a clean background devoid of any run-ins with disciplinary medical boards or agencies, courts, or the DEA. And, the physician will have to follow the rules of medical practice within the bounds of the state in which the patient resides, not the physician.
David Fleming, MD, president of the American College of Physicians, told MedPage Today he sees the compact serving a double purpose: to reach rural and underserved areas to bridge the gap in physician shortages and improve standards of care, and to standardize medical board practices.
Fleming said that the ACP feels the interstate compact is promising, and that they are positive about telemedicine as a whole.
One concern voiced among physicians, Fleming said, had to do with the potential for physicians to abuse the system for entrepreneurial reasons. “The sense of encroachment needs to be worked through,” he said.
Other questions about how the interstate compact will work with patient insurance and medical liability insurance remain unanswered.