Medical licensing reform sought to support telehealth growth, help fight pandemics

“There is a growing concern that the current patchwork of state medical licensing rules could slow telehealth’s growth and impair the nation’s response to the next pandemic since most states will likely return to their pre-COVID rules as the crisis subsides, experts said. Delaware, Michigan, Wisconsin and Washington, D.C., ended their licensure flexibilities earlier this year. At the same time, Idaho is the only state with concrete plans to allow out-of-state physicians to practice in the state permanently.

[..] But it could make sense for the federal government to take the lead on reforming medical licensing since telehealth and pandemic response efforts require substantial coordination across states, experts said. The basic standards for physician licensure are mostly the same across states, but each state has different requirements for getting and keeping a license.

Some experts said it could make sense to move away from state-based medical licensure now that medical standards are evidence-based and national organizations set medical training guidelines. All physicians have to pass the U.S. Medical Licensure Examinations or the Comprehensive Osteopathic Medical Licensing Examination to practice medicine. Several experts said it’s unlikely that requiring physicians to get separate in-state licenses offers added protection for patients, especially when many physicians are also board-certificated.

“We have a funny mix of federalism in U.S. healthcare,” said Barak Richman, a Duke University health policy professor. The federal government regulates products and devices, leads public health initiatives and pays for most healthcare, “but the practice of medicine is regulated locally,” he said.

[..] Some experts say it’s time to start thinking about policy changes outside the public health emergency. For example, Congress could require physicians to have a federal license to take part in federal healthcare programs like Medicare or Medicaid.

States could “piggyback” on the national licensing process to reduce physicians’ administrative work, lower healthcare costs and improve beneficiaries’ access to care, said Christopher Holt, director of healthcare policy at the conservative American Action Forum.

Though it would be a significant shift in medical licensure policy, it wouldn’t be unusual because the federal government often tries to change how providers and states behave by making them follow specific rules to take part in federal programs. For instance, Medicare requires physical therapists to have particular qualifications to bill for their services.

But “the risk in doing something like this is that instead of streamlining, you end up adding another level” of complication, Holt said.

Nancy Foster, vice president of quality and patient safety policy for the American Hospital Association, said that people inside the healthcare industry have talked about creating a federal licensing process for a long time. But it hasn’t happened yet because it would be challenging to implement.

“It requires more than just a law. It requires a whole infrastructure to do it right, and it’s not clear that the folks who were proposing this had thought through what that infrastructure would look like,” she said. Even if Congress created a federal licensing arrangement, it would be up to HHS to figure out the details.”

Full article, Brady M Modern Healthcare 2020.10.24