During a recent PW Podcast episode, we spoke with Ateev Mehrotra, MD, MPH, Associate Professor of Health Care Policy at Harvard Medical School; and Associate Professor of Medicine and Hospitalist at Beth Israel Deaconess Medical Center. Following is a summary of that interview below:
How can reform to medical licensure enable increased use of telemedical services?
I think there are two approaches to reform that will probably garner the most interest. The first is to expand the use of the Interstate Medical Licensure Compact (IMLC), which is a compact among 30 states and Guam in which a physician licensed in one of those states can pay an entry fee and “check the boxes” for the other states in which he/she wants to practice. It’s supposed to expedite the administrative burden of getting a license in each state. One idea is to mandate/coerce the rest of the states in the US to join that compact.
The other approach I think has a lot of interest is reciprocity, which is to simply say that if you’re licensed in one state, you have automatic reciprocity to take care of a patient in any other states as long as you’re in good standing. Certainly, in the era of telemedicine, the artificial lines of state boundaries with healthcare seem outdated, so a federal license has a lot of appeal.
The problem with a federal license is that it bucks hundreds of years of statutes and the law in terms of the line between state and federal responsibility, so it would be a big push to go to a federal license. There are also issues of censure; a patient who has a concern with the physician caring for them would go to their state’s board of medicine and issue a complaint. That whole process is state-driven, and people want it to be local. And so, a federal license would be problematic in that way.
Practically, I’m not sure there’s much difference, but there are some aspects that state boards implement related to scope of practice, as well as what can be allowed in the state, and one prominent example would be abortion. Whether a federal license would supersede those variations makes if difficult to go with a federal license.
So, my colleagues and I have advocated for Congress to push forward the reciprocity strategy. Congress cannot tell private insurers and states what to do within those states, but they do have substantial jurisdiction over the Medicare program. So, we advocated for Congress to pass a law stating that any physician in good standing and licensed in one state can care for a Medicare beneficiary in any other state, similar to laws already passed by Congress for the Veterans Affairs system and under TRICARE. My hope and thought is that if such a law was passed, states would move to create reciprocity for non-Medicare patients.
The other strategy would be to mandate or encourage states to enter the IMLC. The TREAT Act is currently before Congress and has bipartisan support for reciprocity to be established, but only on a temporary basis during the pandemic.