… is underway and is being accomplished completely under the nose of the patient public, physicians, and even the legal profession.  Over the past year, there has been an effort to create a national consortium or commission that would effectively centralize the credentialing of medical licenses among the states.  The new National Federation of State Medical Boards has spontaneous created a new commission, known as the Interstate Medical Licensure Compact.   The members are appointed by the member governors that effectively controls the interstate credentialing of medical licenses.  For example if I, as a licensed physician in Minnesota, seek to obtain a license in Wisconsin, I simply need to enter this new central credentialing process that is now “streamlined” for many so that I can obtain a license more easily than I could previously.  The theory is that now that I am “vetted” in Minnesota, it would seemingly be much easier for Wisconsin to dispense a license.  Of course, I have to pay the annual license fee in Wisconsin in addition to Minnesota.  There are currently 12 member states, but there is considerable political pressure to grow this to all 50.

“The purpose of the IMLC is to have a streamlined process that allows physicians to become licensed in multiple states, thereby enhancing the portability of a medical license. The IMLC creates another pathway forlicensure and does nototherwise change a state’s existing Medical Practice Act. The IMLC also adopts a uniform and stringent standard for licensure and affirms that the practice of medicine occurs where the patient is located at the time of the physicianpatient encounter. Upon licensure via the IMLC, the physician will be under the jurisdiction of the medical board in the state where the patient is located.”

This gets a little trickier when one also learns that the definition of a medical encounter includes phone and email.  So, if a patient in Hudson, Wisconsin, travels to Woodbury for an appointment with a physician from HealthEast, has some laboratory studies done, and requests a phone call for results, that physician/nurse practitioner/physician’s assistant will need to be licensed in Wisconsin now in order to do that.  This clearly will not affect many doctors as much as it will some.  If a physician is nationally known and attracts people from many different states and countries, is it now impermissible for that physician to make a phone call in between visits to Minnesota without having 20 or 30 different state licenses?  Remember, the annual license renewal fees average around $500 or more.  This represents a tax on physicians for being successful in that regard.

I attended the meeting of this new commission a couple of weeks ago in St. Paul and inquired about this seemingly nonsensical–and completely arbitrary–redefinition of the standard of care.  I could not imagine in what way this would actually “improve patient access and quality”.   Then it occurred to me that perhaps places like the Mayo Clinic, clearly with 100s of physicians attending patients from all 50 states, might actually be able to make a deal for some type of “industrial size hall pass” that would circumvent the need to buy individual licenses for all their doctors every year in every state (something that would clearly cost them millions annually).  I did ask the commission chair during the public comment session whether or not solo practitioners would pay the same price per license renewal per Dr. as a large facility such as the Mayo Clinic or organization such as Allina.  There did not seem to be a clear answer about that, although it is clear that this whole process is in the early stages.  This would seem to favor so-called “Big Box” medicine and health care over the small independent practitioner.  This would be particularly true in border cities and facilities.

Therefore, it makes me wonder just how this might dovetail into the now massive reorganization of healthcare delivery and payment known as the “Accountable Care Organization” (which is hardly “voluntary” for most physicians).  These are basically HMOs on steroids.  It is quite evident to those people following healthcare policy over the past five years that the ACO is greatly benefited when it becomes ponderously big and can control dollars and care across a very large population.  I fear that this new politburo-type of licensing authority is just another method of centralized control that effectively reduces health freedom and consumer choice in the interest of  Big Box profitability.

On the other hand, if there were some type of exception granted to the definition of an “encounter” such that audio or text communications (e-mail, fax, prescriptions) were permissible without Interstate licensing, that would solve everything and actually make for common sense.  We should hope and pray that this new licensing authority can come to this conclusion.

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