Licensing Issues Could Slow Telehealth Services

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Retail clinics and urgent-care centers offer patients flexible hours and convenience, but telehealth may be poised to take over as the easiest way for patients to get answers, advice, and prescriptions for their routine ailments.

But its spread could be slowed as the companies get bogged down in obtaining licensing for clinicians. Catholic Health Initiatives, a not-for-profit hospital system based in Englewood, Colo., is supporting a new service allowing patients access to physicians and nurses via webcam or telephone 24 hours a day, seven days a week.

KentuckyOne—a Louisville-based system in which CHI holds a majority stake—is launching Anywhere Care service, providing statewide access for a flat $35 fee.

The Kentucky system is partnering with Seattle-based Carena, which offers the same service with Franciscan Health System, a CHI affiliate based in Tacoma, Wash.


Common conditions treated include urinary, sinus and upper respiratory infections, and allergies, rashes and pink eye. Anywhere Care providers can prescribe drugs or recommend over-the-counter remedies, but cannot refill prescriptions or prescribe controlled substances. Patients using the service interact with providers from a Seattle company called CareSimple. The CareSimple providers are licensed and credentialed in Kentucky.


State licensing has been a barrier to the expansion of Carena. It’s not only the administrative burden, but state budget shortages are leading to higher licensing fees and staff cuts that make the licensing process longer.

Carena piloted its telemedicine services with Franciscan Health employees. It was estimated that over two years, 276 emergency department (ED) visits were avoided among the system’s 8,500 employees.

Patients are charged a $35 fee for the virtual visit, but if they are referred to the ED or to a primary care doctor, the fee is waived.

HealthPartners, a Bloomington, Minn.-based health plan, began offering a similar service in 2010. The cost for using its “virtuwell” system is $40, though it can be lower depending on the patient’s insurance. A study published by Health Affairs found that cases handled via virtuwell were generally $88 cheaper than an ED visit and resulted in an estimated time savings of 2.5 hours for the patients.

While Anywhere Care and virtuwell address minor concerns, telemedicine is also being used to address more serious issues. But as telemedicine patients’ conditions become more complex, so do other issues related to the technology.

Rural and community hospitals in underserved areas are paying annual subscriptions to consult with Mayo Clinic experts. Technology allows Mayo physicians to remotely look into patients’ eyes or use a stethoscope to approximate the experience of a physician exam. They generally work with institutions that have one or no neurologists.

As remote physicians provide more complex care to patients in other states, medical licensing issues come into play. It can take up to a year for licensing issues to be worked out.

There is a bipartisan bill in the U.S. House of Representatives to allow Medicare beneficiaries to be seen by a remote provider licensed in any state. The measure has been endorsed by the American Telemedicine Association.

However, the Federation of State Medical Boards is not endorsing the bill, arguing that it reverses the current generally held principle that the practice of medicine occurs where the patient is located and not the other way around.

Source: Modern Healthcare