The Alliance for Connected Care submitted comments in response to the Federation of State Medical Boards (FSMB) request for comments on the draft document entitled “Report on the Appropriate Use of Telemedicine Technologies in the Practice of Medicine.” The Alliance offered comments we hope the FSMB Workgroup on Telemedicine will consider as it finalizes this document in the coming weeks. We primarily offer recommendations around the provision of audio-only telehealth, reforming licensure laws and regulations, removing restrictive in-person requirements for establishing a provider-patient relationship, and addressing health equity through broadband access and affordability. Summarized below are takeaways from our response:
- Provision of Audio-only Telehealth – The Alliance proposed an edit to the definition included on “telemedicine,” specifically the provision that relates to audio-only telehealth. We encouraged FSMB to modify this definition to account for the fact that providers and patients should be the ones to make the decision about the most appropriate modality for a telehealth visit, not regulators.
- Reforming Licensure Laws and Regulations – The Alliance believes that one of the biggest barriers to telehealth becoming a regular patient and provider choice is the administrative burden caused by the variation in licensure requirements from state to state. The Alliance offered comments on the recommendations made in the draft document around exceptions that may be made to permit the practice of medicine across state lines without the need for licensure in a jurisdiction where the patient is located:
- Consultations and Screenings – The Alliance appreciated the inclusion of physician-to-physician consultations and prospective patient screening for complex referrals as exceptions to licensure. This is important for patients with rare diseases or chronic conditions that might need multiple consultations to ensure they find a provider who can meet their specific health care needs.
- Limited Follow-Up Care – The Alliance recommended an expansion to this section to acknowledge the need for continuity of care for certain populations, beyond the groups of patients listed who may need episodic follow-up care or follow-up care after travel for a surgical/medical treatment. Specifically, the Alliance encouraged FSMB to consider elderly populations and those in need of specialty care who cannot access it where they reside, in addition to those traveling for vacation, business or education. Telehealth has been critical for continuity of care for these populations to ensure they can receive the ongoing care they need where they reside.
- Clinical Trials – The Alliance recommended that FSMB consider an additional category to consider in this section to address state licensing limitations in clinical trials. State licensing limitations effectively prohibit clinicians working on clinical trials from recruiting patients outside the state where the clinician is licensed, thereby diminishing the impact of initiatives to decentralize and modernize clinical trials. State regulators have a role in breaking down additional barriers in using digital technology, and ensuring clinicians can recruit clinical trial participants across state lines can help improve recruitment, retention, diversity, and participation in clinical trials.
- Removing Restrictive In-Person Requirements – The Alliance and its members strongly believe that an in-person requirement is not necessary or appropriate for a telehealth service. The Alliance encouraged FSMB to maintain the provision in the Standard of Care section that asserts that a physician-patient relationship may be established using telemedicine technologies without the requirement of a prior in-person meeting.
- Addressing Health Equity through Broadband Access and Affordability – The Alliance believes telehealth has the potential to broaden access to care and improve patient engagement, and we agree it demands thoughtful consideration to ensure all Americans are provided equal and equitable access. We appreciated the section in this draft directly addressing equity in health care access via telehealth, and commented on the inclusion of broadband as a means to addressing equity in health care delivery via telemedicine. We provided several recommendations FSMB could consider adding to this section as states pursue broadband policies.
See the comment letter here or below: