Tele-Doctors under attack

Telemedicine isn’t remotely under attack here. Certainly not the sort of circumstances you’re describing.

Individual states in the US have their own licensing requirements. Mostly all pretty much the same but also with a few variations…none of which are so ultra restrictive that would make it impossible for, say, the litigant in this case to obtain licensure in New Jersey in exchange for a bit of paperwork and $$$bucks…just like all the other states where she’s licensed.

This article … and a few others about the case I’ve spotted online … appears to be an example of the WSJ providing a platform for a legal test case brought by a libertarian organization to challenge Big Gubmint (evil villain) . Dr Macdonald (sympathetic client) is a convenient mouthpiece.

P.S…I’m sure folk with a better take on these sorts of things than I will have checked out the source of funding for this Pacific Legal Foundation and begun to smell fish about the alleged motivation behind the case.

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We are running into this problem now. We would like to keep our doctors when we move. Been going to them for years and they are great. Plus, being forced to get new health care insurance due to losing retiree healthcare now that DH is turning 65, I might be able to consider an HMO/ACA with telehealth appointments, as we will be on the road for 8 months a year. I don’t go to the doctor even annually, but if we get sick on the road, I would love to be able to reach out to the primary physician or cardiologist with whom I have a relationship, rather than start out all over again where ever we are. We have been told flat out they won’t do telemed because of the uncertainty of it’s legality.

This horse and buggy style of medical care was fine when indeed we traveled by horse and buggy. It’s not so hard to travel across state lines these days. Time to update it based on today’s freedoms.

IP,
whose sister recently traveled from GA to Boston for heart surgery, because he was the only doctor qualified and willing to do the job

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This horse and buggy style of medical care was fine when indeed we traveled by horse and buggy. It’s not so hard to travel across state lines these days. Time to update it based on today’s freedoms.

As others have note, this “case” seems to be one in a series of “manufactured scenarios” carefully curated to touch previously identified judicial nerves which could be useful in toppling prior legal decisions for the benefits of special interests and giant corporations. It points out the mutual logical exclusivity between two supposed goals of insurance companies:

  • capping costs
  • avoiding fraud

We live In an age where people can travel 1000 miles to a remote city and back on a $400 dollar airfare. We also live in an age which has identified treatments for extremely rare conditions that used to be untreatable entirely but now CAN be treated but the number of people versed in the treatment is as rare as the condition itself.

Those two conditiions seem to point to a solution which people have already adopted. Bring the patient to the treatment, wherever the treatment can be obtained. Concentrating the patients at the treatment site accelerates the learning that may likely improve the treatment even more, even to the point where the treatment becomes more routine and can become the norm in more facilities / locations.

But the insurance company wants to control costs. If you get a cancer that only ten clinics in the country have mastered, no insurance company wants to sign up to pay for the treatment AND an additional 10 round trips (10 x $400) and an additional 10 overnight stays in a hotel the night before the morning treatment (10 x $350). That’s an extra $7500 in cost right out of the insurance company CEO’s pocket.

It seems the insurance companies are in fact more willing to pay for quackery by allowing patients to use doctors and clinics not likely to successfully treat the condition rather than ensuring patients can see a specialist with a far-higher batting average. This could reflect an incredibly cynical financial judgement on the part of the insurance company. As the company sees it, they have these alternatives:

  1. pay for the best treatment at the best clinic with the best doctor and all ancillary expenses that come with that
  2. pay for the best treatment at the best clinic with the best doctor but if that option happens to be hundreds or thousands of miles away, require the patient to cover travel and lodging expenses for the shuttling back and forth
  3. only pay for treatments within the “local network”, even if the expertise locally available is not cutting edge or merely state of the art – essentially dooming most patients with rare conditions to death

The problem with choice #3 (for the patient) is that as long as the insurance company doesn’t outright deny coverage for the “routine” treatment – even though it is unlikely to save the patient’s life – it is unlikely a court would find the company liable for the patient’s death. Choosing option #3 doesn’t eliminate the costs to the company entirely but it certainly puts a predictable cap on them. If the patient still winds up dying, well… That hits the pocket of a life insurance company. “Somebody else’s bonus problem.”

Insurance companies and over-consolidated “health systems” are pushing “tele-health” out the ying yang. Their wilingness to include recurring status consultations between specialists and out-state patients in “tele-health” bans seems to reflect an effort to DISCOURAGE patients from seeking out high-dollar out-state specialists and an effort to ensure no precedent is set that will require insurance companies to pick up additional travel expenses that WILL be required to shuttle patients back to the specialist multiple times throughout an extended treatment.

But hey, isn’t it great you get to “pick your own doctor” in America’s free market healthcare system?

WTH

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That’s a really interesting issue. The federal government imposes national standards for being a licensed medical doctor, which includes completing medical school, accredited residency, and one time passing of USMLE testing. That’s the minimum. States add requirements on to that.

This allows the residents of one state to impose more stringent standards than another state, presumably improving medical care. Keeping local control of medical quality would seem to be an important goal of those who believe in “government by the people”.

If a state believes that a certain level of testing is needed to be reasonably sure that their doctors are qualified, can it in good conscience allow medical advice (via telemedicine) be given to its residents by doctors who are “less qualified”? If it does, then what is the point of having higher standards?

As one example, according to one website, New York is one of the easiest places to get an MD license. Hardest & Easiest States to get Medical License | Medical Licensing

Employment, malpractice, privileges, and medical licenses are not verified in New York, making it one of the fastest states to get medical licenses.

Compare that to one of the harder states, MA.

Massachusetts medical board has one of the highest rejection rates for the verification items in the entire country. They also perform malpractice history verification throughout the last 10 years. You will need to reach out to each of your malpractice carriers and ask them to submit the claim history report which can be very difficult and time-consuming.

Should MA allow NY doctors to do telemedicine in MA?

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Remember when most states has usury laws that capped the interest rate credit card companies could charge? DC “reformed” banking laws, so CC operations could cross state lines. South Dakota had no usury laws, so, suddenly, the CC operations were domiciled in SD, to circumvent the usury laws in other states. I would expect the same race to the least regulated place in any sphere that is taken out of state jurisdiction.

Steve

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Or vice versa. Both of these states belong to the group that’ve rescinded the temporary waver in force during Covid.

Individual quirks aside, I don’t think any states place barriers in the path of a would be applicant that are restrictive beyond paperwork, $$$bucks and a bit of footdragging. The website emphasizes the relative difficulty state to state for the simple reason that it appears to belong to a company that does all of the application processes for you (probably not out of the goodness of their hearts)

All that’s happening is that telemedicine is being held somewhat to the same standards as in person medicine being practiced in any given state…i.e. you need a license to do it.

Maybe the next case this foundation takes on will be the requirement to actually have a valid US license (send telemedicine offshore)…or the requirement to have a medical license at all

I wouldn’t have a problem with it, as long as I knew the doctor wasn’t licensed in MA, and I was willing to accept the risk in that, if any.

intercst

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The doctor should only practice medicine in states in which she is licensed. So if the NY doctor needs to practice telemedicine in NY. The patient can be anywhere but doctor needs to be in NY because that is where the practice of medicine is occurring. That’s where the doctor is gathering information from the patient, forming her opinions, writing the prescriptions, forming a course of treatment, keeping the patient records, and of course where the doctor’s insurance is located. The notion you can’t practice medicine in own state is mind-boggling.

The rationale behind this rule is incredibly cruel and mean-spirited. As Americans we’ve been conditioned to just accept expensive and substandard care for no reason. It is like being punched in the face and thanking the person who did it.

Which shows the system is working exactly as designed.

The patient’s healthcare outcome or even comfort doesn’t factor into this. Which is a feature, not a bug.

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But this is not about the doctor. It is about the location of the patient. Applying the law properly/rationally would require the patient to move to the state where the doctor was located. Or the doctor move to the state where the patient was located. In other words, doctors can only legitimately see and give medical advice to patients who live in the same state as the doctor.

If a person goes to see a doctor in person in another state, that is the definition of “telemedicine”. Just in a different form.

Out of interest, how many folk here with professional licences have true portability…i.e. reciprocity in every state?

Without resorting to Google, I know that medicine, dentistry, veterinary medicine do not, but physical therapy does (the latter from my PT back when I had therapy for shoulder impingement syndrome)

I’m licensed as a Professional Engineer in New York and Texas. It’s not uncommon for professional engineers doing consulting work to be licensed in 20 or 30 states. It’s just a matter of filing an application and paying a fee. Years ago California was regarded as the state with the stiffest regulations and they sometimes wouldn’t recognize reciprocity with states they deemed to have substandard licensing requirements. Don’t know if that’s still true today.

intercst

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There is nothing proper or rational about our healthcare system.

One national standard license should be good everywhere in the country.

Aha! Now we understand why the states want their own licensing system - revenue.

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I would love to have a Manila-based Filipino telemedicine doctor at 30% of the cost of the in-person Filipino doctor provided by my Private Equity-owned health care plan. And I suspect the Filipino doctor would welcome the chance to remain in his country and earn a living.

intercst

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That’s not even remotely true. If it were, and you were in another state and got into accident, you couldn’t be treated in the local hospital because you are residents of different states. People travel across state lines for treatment all the time.

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@syke6

Asking dad about this tonight. Over visiting them.

He says for rural people teledoctoring is important. A necessary thing.

As I have been saying diagnostics it is not a good thing. You can imagine people with major medical conditions can have complications that need to be diagnosed in the office. He has long seen it that way.

Preventive care saves a lot of money down the road. A doctor’s hands-on with preventive care is worth a great deal.

We all take our chances. Not seeing a doctor is not the better option.

In rural areas, telehealth is very important.

I saw telehealth for the pandemic but beyond? I have not seen that.

The patients think it is easier.

Bit like a heavy drinker talking about reform? LOL

Preventive care and diagnostics are better hands-on.

The states need to have jurisdiction over this license more than the other professionals. Doctors lose their licenses for very good reason. That is not the federal government’s power or jurisdiction.

Medicine is heavily regulated. I would not have it any other way.

People do not reinvent the wheel just because you are over 60 and you might personally have a flat.

So, since growth in telemedicine/travel medicine shows no signs of slowing down, I got to wondering if, in fact, the licensure process is still as cumbersome as it was a few years back. I assumed not judging by the number of calls/emails dh gets for highly lucrative locum gigs…seems I wasn’t wrong. Not only are there companies that smooth the path for a would be telemedicine/travel doc and multi state licensure, it appears there’s already more reciprocity than I was aware of. From another company site…

So, reading this article and the list of states already participating and the states who’ve applied to join, it looks to me like this Pacific Legal Foundation and Dr. Macdonald have chosen the wrong state. Looks like New Jersey is already on the list to join the states smoothing the path for those wanting licensure in multiple states.

I did not know this.

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Travel over state lines has been a problem for us with credit cards as well. When I lived in a tri-state area, with errands run in a single day spread across 3 different states, my credit card often refused payment until I called in and confirmed it was me. While this became easier with cell phones, I finally requested that they put a note on my account highlighting the fact that my billing address was very close to 2 other states, and multi-state purchases within a short amount of time was not to be a cause for concern.

Have car, will travel.

IP

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