By Dr. Jason Hallock and Rebecca Kish
File this under silver linings: the COVID-19 crisis has made it easier for telemedicine doctors to practice across state lines. They are fighting this virus today alongside in-person providers in New York, California and around the country.
Before the current pandemic, it wasn’t always easy to get permission for doctors to work across state lines.
Telemedicine companies hire neurologists, psychiatrists, intensivists and many other specialists, and hospitals and health systems contract with these telemedicine groups for on-demand access to critical specialists via telemedicine.
The services they provide might be stroke care in a rural hospital, psychiatric assessments for adolescents arriving at emergency rooms, or rounds conducted in an ICU by a remote intensivist.
Depending on the needs of the patient and the setting they are in, specialist consultations via telemedicine are often available within minutes. With the right technology backbone, the time it takes an on-demand telemedicine specialist to get to the patient can be shorter than the time it takes an in-house specialist to get in the elevator and respond where and when they are needed. If the specialist doesn’t have to drive to the hospital, the windshield time vanishes.
According to research from the University of North Carolina at Chapel Hill, 170 hospitals in rural areas have shuttered since 2005. Those that remain open often experience specialist shortages. Naturally, this leads to the transfer of more complex care cases to better-equipped hospitals that have enough specialists. Telemedicine can help equalize the care gap and keep rural hospitals running by providing needed specialist care. In the fight against COVID-19, this matters; rural areas could be the hardest hit and more than 80 percent of rural counties across the country have already reported cases of COVID-19.
Telemedicine is a potential solution to the rural hospital dilemma, but licensing remains a bottleneck in many states, thanks to the patchwork of state licensing laws.
Those laws are often downright byzantine.
In Ohio, among several other states, the process of credentialing telemedicine doctors from out of state requires the state licensing board to verify the doctors’ credentials at every other hospital they have served in the past 10 years. Frequently that could be as many as 100 hospitals per doctor. So, making just 25 doctors in the state of Ohio available to a hospital or health system ‘in need’ could potentially require the coordination of interactions between the state licensing board and 2,500 other hospitals.
In other words, bringing an experienced telemedicine doctor online in Ohio takes 100 times more work, and significantly more time, than credentialing a vastly less qualified doctor whose background is entirely in one state and one hospital system. In states with less restrictive laws, telemedicine licensing takes a few weeks. In those with more stringent restrictions, the process can take more than 18 months to complete.
Of course, all of that began to change with the emergence of COVID-19. Most states loosened restrictions, making it easier for doctors to help across state lines quickly.
The most aggressive states – including California and New York—entirely waived licensing requirements, with licensing boards effectively taking the position that telemedicine organizations should “do what they need to do” during the state of emergency, with or without notifying the state licensing boards.
Others streamlined the process into a licensing operation that takes days, not years, as is the case with the emergency licenses and permits issued in New Jersey, Louisiana, Massachusetts and North Carolina, among others.
Yet, in a few states like Ohio, the loosened restrictions or temporary waivers needed for streamlined telehealth never came. Ohio hospitals are requesting help from telemedicine partners, but doctors aren’t gaining licensure in any expedited fashion. Because of state closures and licensing staff now working from home, it can take even longer than before the pandemic.
Perhaps we need to wait till we come out of this crisis to take a full measure of telemedicine and its impact on the crisis. But make no mistake: it plays a valuable supporting role in the states that ease restrictions. When the dust settles on this unprecedented national emergency, we should take note, and permanently make it easier for our doctors to gain licenses and work in telemedicine across state lines.
Dr. Jason Hallock is the chief medical officer for SOC Telemed, a leading national telemedicine company specializing in emergency department and ICU telemedicine. Rebecca Kish is vice president of provider network operations at SOC Telemed, where she oversees licensing, credentialing and privileging for all U.S. telemedicine programs.