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  Today in Health it, this story is state licensure around telehealth. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week in Health IT at channel dedicated to keeping health IT staff current and engaged. I wanna ask you to sign up for clip notes to stay current and while you're at it, get your team to sign up as well.

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Just hit this week health.com and click on the subscribe button. Alright, today's story is from Becker's Hospital Review, and it's about state licensing of telemedicine. And let me just give you a couple of excerpts. This came out yesterday. States currently define telemedicine by . The location of the patient, not the physician, which can create barriers for practicing via telemedicine in the July 20th.

Wall Street Journal, Op-Ed Joseph Bernstein, MD and Shirley Varney PhD. Shared insights on state licensing laws and why they believe the regulations are restricting virtual care practices, which of course they are. Dr. Varney and economics professor at Cal State Northridge. Referred to current state licensing laws as barrier to interstate commerce since they require physicians to be licensed in each and every state in which they treat patients.

Why not to find the location of telemedicine treatment via an act of Congress as the doctor's location? She wrote Seeking care from an out-of-State physician via telemedicine. Would be treated no different from traveling to the physician's office for care. Dr. Bernstein, an orthopedic surgery professor at University of Pennsylvania.

Wrote that state licensing laws should be changed since all the information a state may use to evaluate a physician is issued and verified by countrywide organizations. He pointed out that in his case, he passed the US Medical Licensing examination and has been certified by the American Board of Orthopedic Surgery.

For these reasons, he wrote. He believes the resistance to change licensing regulations to better accommodate telemedicine is based on states not wanting to push competition. Let's be honest, Dr. Stein wrote State opposition to medical licensure. Reciprocity is all about protecting local physicians from competition.

Well, that's not the only reason for it to be in place, but that is a reason for it to be in place. Here's what I'm gonna add. I'm gonna add two things to this conversation. The first is that. It's taxes, it's revenue for the states and it's oversight for the states. And this will come down to that whole thing of federal versus state and who should control what and those kind of things.

And, but there is some tax, not a ton, but there is some licensing and, and tax revenue that comes in. As a result of this, and you're essentially going to get into that problem that you have with e-commerce. Where do you charge taxes based on where it originates or where the person is when they're purchasing the goods or services?

It does create some commerce challenges, first and foremost. The second is. I, I think we're focusing in on the fact that the doctors do not want competition, and I think that's missing the boat. I think even though people within the health system are looking at it saying, Hey, we should open this up. It's gonna provide a lot more access, it's gonna provide a lot more options, and those kind of things.

There is a fear as they're looking out across this landscape that if we make it any easier. The amount of competition you're gonna have for that first dollar of care. That first dollar is gonna go digital, it's gonna go telehealth, and there are going to be a. Massive amounts of new entrants because all you have to do is get licensed across the federal guidelines and you can now practice in all 50 states.

So you could set up a warehouse of physicians in, I don't know, wherever you would set that up, that it would be advantageous to hire physicians and it would be, or clinicians of some kind, and it would be as cost effective as possible, and you could then practice in all 50 states and breaking down that barrier of competition.

Not only is good for physicians, it's also challenging for competition for physicians, but it also scares the jabbers out of health systems because once someone gets in between you for that first dollar of medical care. And the health system, they can then direct care, they can then start to use the data that's out there, contract for the data that's out there and say, you know what?

Let me tell you where the lowest cost best outcome place is to go get that surgery or, or to get that procedure done, or those kinds of things. And while it doesn't seem like a big deal when you're talking about these multi-billion dollar health systems, could they really care about this? The reality is they do because their margins are not that great, and every little piece that gets shaved off of there, it becomes harder and harder to make ends meet.

I don't want you to hear that. I'm not for this. I'm actually for this, I think it makes a lot of sense. I like competition. I like access for the patients. I think this is one of the areas where . I'm okay if we make this a lot easier of a process, if that's through state compacts, across all 50 states. I'm, I'm for that.

If it happens to be federal, I, I'm, I'm for that as well. I'm really, what I'm for here is better access for the patients, better options for the patients, lower costs for the patients, and I think this is one step in that direction. The other thing is to be honest with you. The companies that are coming after this right now, all this is doing is it's keeping these smaller companies from coming after this.

The larger companies have scale, so you're seeing Walmart scale up to do telehealth in all 50 states. You're seeing Amazon scale up to do telehealth in all 50 states. When you get to these larger companies, the barrier of entry is not that great. They're going to go through it. But if you were say, going to come to me, you had a medical group and you're saying, Hey, we wanna do this in all 50 states, the barrier of entry, we would have to raise an awful lot of money to do this, quite frankly.

I am for this, but I don't think it's going anywhere anytime soon. Alright, that's all for today. If you know someone that might benefit from our channel, please forward them a note. They can subscribe on our website this week, health.com, or wherever you listen to podcasts. Apple, Google Overcast, Spotify, Stitcher.

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