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On January 1, 2017, the KHI News Service became part of KCUR public radio’s new initiative, the Kansas News Service. The Kansas News Service will continue to cover health policy news and broaden its scope to include education and politics. All stories produced by the former KHI News Service are archived here. Stories and photos may be republished at no cost with proper attribution and a link back to KHI.org.

Telemedicine experts split on necessity of interstate licensure

Business model a factor in whether doctors need cross-state license

By Andy Marso | April 13, 2016

Telemedicine experts speaking at a national health journalism conference were split on the usefulness of Kansas legislation aimed at expanding health care access in underserved parts of Kansans through videoconferencing technology.

House Bill 2456 would have Kansas join an interstate compact to standardize medical licenses with those of other member states. That would make it easier for physicians and other medical practitioners to treat patients across state lines.

Curtis Lowery, a gynecologist who has helped spread telemedicine throughout Arkansas’ rural hospitals, said during last week’s conference in Cleveland that such legislation would be a boon to physicians reluctant to practice telemedicine because of licensing hassles.

“It’s a big obstacle,” Lowery said. “It really is, mainly because each state’s (licensing requirements are) different right now. To get a traditional medical license in the state of Arkansas, it’s really hard and it takes a long time and sometimes they have to appear before the medical board to answer questions. It would help a lot to standardize.”

Photo by Andy Marso/KHI News Service Henry DePhillips, the chief medical officer for Teladoc, says state-to-state licensing is not a factor for his company, which provides a technology platform to connect health care providers with patients.

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Henry DePhillips, the chief medical officer for Teladoc, said state-to-state licensing is not a factor for his company because of its business model.

Teladoc is not affiliated with a specific hospital or clinic. Instead, it provides a technology platform to connect health care providers with patients — similar to ride-sharing or room-renting applications.

DePhillips said the company has doctors in all 50 states, so it matches patients with providers already licensed in their states. Interstate licensure is not a concern.

“We’re silent on the issue because it really doesn’t affect our business,” DePhillips said.

That prompted Lowery to ask DePhillips how he could assure that people using Teladoc were truly in the state they said they were in.

DePhillips said users were unlikely to try to game the system because Teladoc does not allow physicians to prescribe sought-after medications like controlled substances, “lifestyle drugs” or abortion-inducing drugs.

But he said there are safeguards. The Teladoc platform accesses address information from patients’ insurance coverage and patients must get prescriptions filled in the states they say they are videoconferencing from.

Photo by Andy Marso/KHI News Service Curtis Lowery, a gynecologist who has helped spread telemedicine throughout Arkansas’ rural hospitals, says cross-state legislation would be a boon to physicians reluctant to practice telemedicine because of licensing hassles.

View larger photo

“Is it a perfect system? No, but we use algorithms much like the banks use with multiple data points,” DePhillips said. “And if you have three or more data points, you have about a 98, 99 percent reconciliation rate with the truth, if you will.”

The split between DePhillips and Lowery was apparent at various points during the panel discussion, with DePhillips touting telemedicine as a revolution in areas like primary care and dermatology and Lowery envisioning it more as a new tool for the traditional medical system.

“It needs to be integrated,” Lowery said. “That’s the thing Henry’s company, Teladoc, is going to have to do is be able to integrate more with a traditional model.”

HB 2456 would not affect telemedicine networks that use providers in other states to help licensed providers in Kansas.

State Rep. Jim Kelly, a Republican from Independence who has pushed hard for the Kansas interstate licensing bill, said his views line up more with Lowery’s.

The local hospital in Kelly’s district has closed and the town’s remaining outpatient clinic has entered into a staffing partnership with an Oklahoma hospital just across the state border.

Having a license standardized across the state line would make that partnership smoother, he said, by allowing doctors to serve patients in both states in person or by videoconference.

He also said companies like Teladoc that recruit physicians in each state would be limited in what services they could provide to Kansans, especially in specialized cases.

“There may not be those specialists in Kansas, so it does absolutely no good whatsoever,” Kelly said.

The interstate licensure bill has been packaged with several other health-related measures in a conference committee report that Kelly said should pass fairly quickly when the Legislature returns for the veto session later this month.