by Katherine Restrepo
Director of Health Care Policy, John Locke Foundation
Recently, The Wall Street Journal featured a story about rural North Carolina’s perpetual economic struggle. Not even lucrative taxpayer-backed incentive packages can hard sell mega companies like Toyota, Mazda, or Foxconn to settle in the state.
While the article focused only on economic development, it certainly brings up for discussion that job shortages trigger other shortages, like health care. I wrote here that over 1.4 million North Carolinians live in primary care shortage areas. That’s 14 percent of the state population. Moreover, over 25 percent of counties don’t have access to an OB-GYN, and seeking a mental health provider is even more difficult.
Many state lawmakers who are adamant about improving access to rural health know first-hand that job supply and the availability of medical care go hand in hand. Fortunately, there are solutions to ameliorating the health care crisis – telemedicine being one of them.
Thanks to the advancement of technology, an increasing number of hospitals and medical providers are using telemedicine to treat and monitor patients from a distance. Apps like RelyMD allow patients to engage in a virtual doctor visit for a wide array of non-urgent medical issues, saving them from making an unnecessary (and expensive) trip to the emergency room or urgent care. There is even a virtual direct pay practice that prides itself on not needing a brick and mortar building when caring for patients.
What’s most powerful about telemedicine is that it saves lives. In understaffed emergency rooms across the nation, providers are connecting with neurologists located elsewhere for assistance in stabilizing stroke victims.
In my latest policy report, you can read more about how telemedicine expedites access to health care across rural areas of North Carolina and neighboring states.
It should also be noted that lawmakers and the North Carolina Medical Board have made instrumental policy changes that will help telemedicine extend its reach even further. And the good news is that more can be done.
For the most part, physicians can deliver telemedicine only to patients who are physically located in the state where the provider is licensed. To expand access across state lines, policymakers ought to consider legislation for North Carolina to become an affiliate of the Interstate Medical Licensure Compact (IMLC). Sponsored by the Federation of State Medical Boards (FSMB), the compact permits physicians to pursue a quicker medical licensure process if they choose to practice medicine – including telemedicine – in other compact states. The pathway to secure more than one state medical license is supposedly more streamlined because interested physicians can apply for multiple at one time.
While the IMLC speeds up licensure, physicians are still bound to each compact state’s rules on the practice of medicine and telemedicine. Having to navigate more rules and regs could indeed deter physicians from opting in. However, if there is, in fact, a decent uptake, think of how many more health care options patients would be presented with when more out-of-state providers are credentialed to practice medicine in North Carolina!
There is also a simpler, better, and more politically feasible policy solution, although it’s beyond the control of state lawmakers. Congress could pass a law stating that the practice of telemedicine be tied to where the provider is located, not to the patient. As previously mentioned, physicians can deliver telemedicine only to patients who are physically located in the state where the provider is licensed. If payment is instead tied to the provider’s location, then the provider could deliver care to patients anywhere.
Enacting such a monumental policy change would then obviate the need for the IMLC altogether because physicians would merely have to comply with one home-state medical license.
Let’s keep the momentum going to further democratize access to health care.