Crossing Borders with Telemedicine

Cato Institute’s event “Removing Barriers to Online Medical Care” assembled experts to discuss legal and regulatory aspects specifically related to the field of telemedicine.

The panelists were Rene Quashie, Senior Counsel, Epstein, Becker & Green, Jeff Rowes, Senior Attorney, Institute for Justice, Josh Sharfstein Associate Dean, Johns Hopkins Bloomberg School of Public Health along with moderator Simon Lester Trade Policy Analyst with the Cato Institute.

Rowes reports “Regulations are not meeting today’s needs and puts limitations on using telemedicine technologies. For example, the requirement for licensing is a major problem since states license doctors and doctors are required to be licensed where the care is given to their patients.”

To help when providing care across locations, the Federation of State Medical Boards (FSMB) recently adopted new policy guidelines for the safe practice of telemedicine when connecting a patient in one location with a care provider in another location.

The policy guidelines state that there must be the same standard of care when the patient is in another location with the care delivered electronically plus a credible patient-physician relationship must be established. The guidelines are designed to provide flexibility in the use of technology by physicians.

According to the American Telemedicine Association, most states have telehealth parity laws in place so now 27 states and D.C. have laws enforcing coverage for telemedicine-provided services. Parity legislation is still active in other states such as Connecticut, Delaware, Illinois, Massachusetts, New Jersey, North Carolina, Ohio, and Pennsylvania.

The panelists discussed the difficulties that state medical boards face as they have to issue licenses for the practice of medicine and need to adopt policies and guidelines for each state. Today, state boards are becoming interconnected and cooperating to find new ways to share licensure information and move the licensure process forward at a faster pace.

States have been involved in the interstate Medical Licensure Compact legislation which affects telemedicine. According to the Medical Licensure Compact, telemedicine includes both synchronous and asynchronous settings plus devices worn by patients. It also requires that insurance plans are fair and pay the same rate for services delivered by telemedicine or in a face-to-face encounter.

As Rene Quashie commented, “The Compact solves some problems but most of the time small states are able to benefit, but the large states like California and Texas have not signed on.”

Dr. Sharfstein pointed out in his discussion on state medical boards that the operation of the boards mostly deal with local issues since medical boards are local in nature and deal with local standards of care and deal with local communities that may be dealing with unique diseases within their communities.

To look forward, there is a need for such technologies such as telemedicine to cross borders and provide medical care not only in the states but all over the world. To discuss the topic, the Cato Institute recently published a policy analysis titled “Expanding Trade in Medical Care through Telemedicine” authored by Simon Lester.

By enabling telemedicine to cross all borders will not only make medical care better, but will also make medical care more widely available, provide access to information on obscure diseases, address the shortage of medical professionals, and enable doctors to serve underserved and isolated areas better throughout the world.

The policy brief also points out that governments should promote cross border trade in medical services through trade negotiations so that competition will increase for products and technology which in the long run will probably bring down costs.

Go to to view the event on C-Span.

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