Telemedicine Advice for Physicians
The contents of this article are based on general observations of the State Medical Board's reaction to Physicians seeking to license in the various States for the purpose of Telemedicine. We are limiting this article to Telemedicine / Telepsychiatry. We are not including Teleradiology, Telepathology, or Tele-Intraoperative Neuromonitoring because Telemedicine and Telepsychiatry can involve prescribing drugs whereas the others do not.
The largest risk associated with the practice of Telemedicine is directly connected to the prescribing of Controlled Substances Classes II, III, IV, and V. With the advent of the Internet and the endless possibilities which it opened, Internet Pharmacies sprang up as a way to avoid the micro-management of State Control and a way to reduce the cost of such Controlled Substances by importing from other States where the cost was lower or other Countries. In order to meet the Federal DEA Requirements, the online Pharmacies utilized Physicians who were willing to sell their DEA # at a price to them in order to make a quick buck. Quickly these online pharmacies became online drug dealers. The DEA aggressively pursued these online pharmacies and the physicians who had lent their DEA # and License # to them for a fee. The DEA prosecuted the various Physicians who are involved in these practice.
Because of the abuse of this medium, the State Medical Boards have taken a strong stance in monitoring Telemedicine Physicians. States like Arkansas will scrutinize the applicant and issuance is not a guarantee. South Carolina has a similar process. Each Medical Board has imposed its' own rules on this practice. There are some general guidelines, that if followed will help keep your Telemedicine License out of the Boards Microscope.
# 1 - Establish a direct patient - physician relationship. You need to be able to document this to the Medical Boards. The Boards are going to want to see that you have a personal, one on one relationship with your patients. How this is established can vary. I have clients who will use a locally, licensed Physician to provide a standard physical on the patient and then forward the report to the Telemedicine Physician. From there the Physician provides whatever type of Medical Treatment with the Patient. One visit does not constitute a Patient-Physician Relationship under most cases. Many times a patient will have to come back multiple times to a Physician's office for updated evaluations. Remember - if you do it in real life then it has to be done in Telemedicine.
# 2 - What ever you are required to do for your patients that would physically come to your practice / office, you have to do for those who are treated online, via phone, or teleconferencing. If you are required to maintain thorough records for your patients in an office setting, then you will have to do so for your Telemedicine Patients. If you do it in real life, then you have to do it in Telemedicine.
# 3 - The Law applies where the Patient is located and where you are located. Just because the State where you are based allows it does not mean that it is ok in the State where the Patient is located. If State A does not have restrictions on a Drug (non Controlled) and State B does, then you have to abide by State B's rules when dealing in Telemedicine. Your license is to precious to allow it to be placed at risk for an easy dollar. You have to abide by the more Restrictive State when dealing with Telemedicine. If your home State allows it and the Patient's State does not, then you have to follow the Patient's State Medical Board Rules. If you State does not allow it and the Patient's State Medical Board does, then you have to follow your State Medical Board rules. Period.
# 4 - Do not prescribe Controlled Substances Class II Drugs. Narcotics cannot be prescribed remotely through Telemedicine. Know your State and Federal Laws concerning Class III, IV, and V Drugs. Some may be unlawful to prescribe whereas some may be fully lawful. This will vary from State to State.
# 5 - Talk to your Malpractice Insurance Carrier / Insurance Agent before taking on a New State. Why? Insurance is regulated by the States Dept. of Insurance. The rules vary State by State. As such there is a good possibility that your insurance company might not cover new States. Some times they will. You have to call in advance to determine this. Having to face a malpractice lawsuit filed in a State 1500 miles away is not something you want to do without Malpractice Coverage.
# 6 - Do not trust a your Employer to do the right thing. Know what you are doing and what you are getting into. Ask the right questions. Determine if the company will be directing the medical care / treatment or will you. As a general rule, if you are not in control then walk away. I have seen multiple lawsuits filed against Telemedicine Companies because they used the Physician's license to offer services which were unlawful. The Physician paid the price with his/her license. It took you Hundred's of Thousands of Dollars and 9 to 15 years of training to get where you are. Why are you going to risk this for a easy dollar? Fully vet any offer presented to you and have your attorney review their practice plan against the Medical Board's rules. Have the Attorney call the Medical Boards' where you will be taking in patients. Have them determine if what you are being requested to do is legal. Get this information from the Medical Boards in Writing.
I hope this information has been helpful. It is based on continual research and the actual observation of our client's practices.
Services Included with Medical Licensing:
- Set up of the State Medical Board Application
- Set up of the required primary source confirmations
- Submission of the State Medical Board Application
- Submission of Reference Forms to References
- Submission of Required Forms to other State Medical Boards
- Requests of Transcripts from Medical Schools and Universities
- Submission of Required Forms to Hospitals and Institutions
- Submission of Temporary License Applications Completion of FCVS forms (if required or requested)
How Licensure Affects Telemedicine:
Advances in technology have opened new doors of opportunity for many medically underserved communities in America. Because of relatively inferior rural access to specialty health care providers, citizens in these communities must often travel great distances to receive care, or forego medical treatment until it becomes urgent. Telemedicine technology increases physicians' capacity to serve these citizens and improves their access to health care. Yet, when medically underserved patients and physicians are located in separate states the issue of practitioner licensure arises. Licensure laws that regulate interstate telemedicine practice vary from state to state. Categories of telemedicine licensure Restrictive licensure Restrictive licensure laws require a practitioner to obtain a full license to deliver telemedicine care across state lines. Typically, states with restrictive licensure laws also have several exceptions (varying from state to state) that may release an out-of-state practitioner from the additional burden of obtaining such a license. A number of States require practitioners who seek compensation to frequently deliver interstate care to acquire a full license. If a practitioner serves several states, obtaining this license in each state could be an expensive and time-consuming proposition. Even if the practitioner never practices medicine face-to-face with a patient in another state, he/she still must meet a variety of other individual state requirements, including paying substantial licensure fees, passing additional oral and written examinations, and traveling for interviews.
Additional Telemedicine License Information:
Advances in technology have opened new doors of opportunity for many medically underserved communities in America. Licensure laws that regulate interstate telemedicine practice vary from state to state. Restrictive licensure laws require a practitioner to obtain a full license to deliver telemedicine care across state lines.
A number of States require practitioners who seek compensation to frequently deliver interstate care to acquire a full license. If a practitioner serves several states, obtaining this license in each state could be an expensive and time-consuming proposition. MedLicense.com can reduce the burden and cost of obtaining the required licensure. Most States require the Physician to have a license where they are physically located and where the patient resides.