During the COVID-19 pandemic, all U.S. 50 states were granted emergency authority to waive components of their state licensing requirements. Under these waivers, states could allow temporary visits from out of state physicians to provide services. However, as the Covid-19 pandemic winds down, waivers allowing for cross-state telehealth are expiring.
Hospitals with large amounts of COVID-19 cases were put under immense pressure and had their resources stretched thin. Under the pandemic waivers, overwhelmed hospitals were permitted to request help from physicians in other states to provide care via telehealth. The result of these waivers were extremely advantageous. Particularly to patients from rural areas, who were more likely to use virtual care from other states. The uptake taken by individuals who reside in rural areas indicates the potential of telehealth for individuals who face barriers to healthcare as a result of their location. The pandemic waivers are due to expire when the public state of emergency ends. The result of this will leave millions of patients without expanded access to telehealth. The consequences of this could be extremely harmful. Healthcare providers who utilized the help of out of state physicians during the pandemic may struggle to meet the demands of delivering healthcare remotely, which will only increase pressure on the workforce and cause staffing shortages as a result.
Despite these dire consequences, it will be incredibly difficult to establish the temporary pandemic waivers as permanent changes to the state licensing system. Cross state care was not a prominent concern of the public prior to the pandemic. As a result, there was little action taken to promote its use. In addition, since a significant share of the state medical board’s revenue comes from license application and maintenance fees, it is within the board’s financial interest to continue with the current licensing system. There are several methods which virtual care advocates can use to make cross-state care a permanent reality. One method is to utilize cross-state compacts like the Interstate Medical Licensure Compact (IMLC). The IMLC streamlines the application process for obtaining a medical license if a physician already holds a license within a participating state. There are currently 31 states involved in the IMLC. However, significant states such as California and New York have not joined the compact as their vocal workforces have expressed concerns regarding the compacts. The favorable method of solidifying cross-state telehealth may be to use reciprocal licensure arrangements. Under these arrangements, states are permitted to mutually recognize medical licenses granted by other states. In the state where the patient is located, physicians would be responsible for the patient’s care. These arrangements could be adopted by state bodies and brought into congress.
However, two bills advocating for cross-state licensing have already been brought forth by state representatives and have not made it passed the committee. It is unlikely that any ground will be made on a federal level given the disagreements of state legislatures on how to best implement these changes to the licensing system. Virtual care advocates must make a sincere effort to convince state legislators that it is within their interest and their constituent’s best interest to implement cross-state licensing into the current state licensing system.