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Rat’s nest of state telemedicine credentialing laws holding back care

In interviewing a CIO at a major Florida pediatric hospital last week who has launched an amazing telemedicine project — story to come, soon — it was striking to see the international reach of his practitioners: they treat patients in Europe, the Caribbean, Central America, soon to be expanding to more locations around the world.

Meanwhile, his reach in the U.S. extends to Florida. That’s it. Why? Credentialing his superstar sub-specialists — who would be in demand, and could serve patients literally anywhere — to practice over state lines is too much of a logistical nightmare.

The hospital chose to expand to other countries, instead. Where governments not only permit physicians to practice, but also get reimbursed for care they provide. That’s a tough sell in the U.S., too; Florida, he said, is running a pilot program in which his hospital is participating. Reimbursement historically has been hard to come by for most telemedicine providers.

A telemedicine service provider, Specialists on Call, told us two years ago that its credentialing department is the busiest in the company, filling out paperwork and keeping licenses valid in order to avail its practitioners to patients in just 17 of the 50 U.S. states. What a rat’s nest of bureaucracy.

The fact is, the technology to accomplish complex telehealth clinics and services has been available for years. It only gets leaner, faster and better with each American Telemedicine Association annual show, with the next one to take place in early May down in Austin, TX.

In Austin, provider after provider will show the efficacy of their respective telehealth services — which now tend to serve rural populations and otherwise difficult-to-reach patients — and celebrate them. These practitioners bring specialists and subspecialists to patients who otherwise couldn’t make in-person visits, or could, but only at great personal and economic cost. Imagine what they could do if these practitioners were welcomed into healthcare’s mainstream instead of marginalized by the bean counters.

Telemedicine technology and healthcare innovations are advancing at a pace that far outstrips that of the billing and reimbursement wing of the business. It’s time the bean counters and licensing authorities pull their heads out of their ledgers and realize telemedicine could be that missing technological link between the present and a future environment of robust population health management, between-visit patient care and reduced costs of specialists.

Or, perhaps, federal officials should step in and harmonize state medical credentialing requirements and make it more possible for providers to treat patients across state lines. If a driver’s license permits someone to operate a car in all 50 states, how hard can it be to get this done?

If they don’t soon, we’ll miss a golden moment in healthcare’s evolution: Healthcare is building its IT infrastructure at breakneck pace, spurred on by government investment. Healthcare reform is trying new care models such as accountable care organizations. Telemedicine providers — and the patients they serve now, as well as the ones they could potentially treat if the healthcare system could just cut this red tape — shouldn’t be left in the dust because of these short-sighted powers that be.

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