Minnesota is joining a new group that allows the state's doctors to practice in Montana, West Virginia and other participating states more easily.
Gov. Mark Dayton signed the licensure portability bill this week, after it was approved unanimously by the state House and Senate, moving Minnesota a step closer to the arrival of a national medical marketplace in which qualified doctors can practice in multiple states with less red tape.
The bill authorized Minnesota to join the Interstate Medical Licensure Compact, a novel, legally binding entity created last fall by the Federation of State Medical Boards, the association for the country's 70 medical and osteopathic licensing boards.
The bill is bipartisan, with GOP Sen. Carla Nelson and DFL Rep. Tina Liebling listed as co-authors. It had been endorsed by the Mayo Clinic, the Minnesota Medical Association, the Minnesota Hospital Association, the American Medical Association and both of the state's U.S. senators.
"We see this as extending care already given rather than replacing care," said Dr. Steve Ommen, cardiologist and medical director for Mayo Center for Connected Care. "If a patient in a small hospital in Iowa has a stroke, and if we have a neurologist licensed in that state, that patient can be quickly evaluated and receive stroke therapy where they are, rather than be transferred to a bigger hospital. That has the potential to save time and lives and function for patients."
In an article last summer, the New York Times specifically singled out the ease in which patients with complex illnesses could receive remote specialty consultation at facilities such as Mayo Clinic. The bill also is viewed as a way to ease doctor shortages created by the growing numbers of Americans receiving health-care coverage under the Affordable Care Act.
The bill was taken verbatim from model legislation authored by the nonprofit Federation of State Medical Boards. The compact is voluntary -- doctors can choose to participate or not participate, and states can choose to remain in or leave the compact as their lawmakers choose. What it does is create a second, faster pathway to interstate licensure. Currently, state medical boards need to individually review each new application to practice, a lengthy process repeating work already conducted in the doctor's home state.
"It recognizes that home state has already done due diligence in vetting a doctor in good standing," says Ommen. "It avoids states having to make a duplicate effort. It eases the burden of getting licensed, but it doesn't ease the responsibility of getting licensed."
Qualifying doctors must be certified specialists and free of reprimand in their home state. It is estimated that 80 percent of all doctors will be eligible to participate.
Chief among its provisions, the bill designates the state medical board in which a patient is located as the overseeing authority for medical practice affecting that patient.
That assures continuance of state-based regulatory and patient protections, rights that might have been lost in future federal telemedicine legislation. The bill is revenue neutral and even may offer states additional revenue from increased licensure applications.
To participate, doctors simply submit an application to an interstate commission established by the bill, a representative body with no disciplinary powers but that acts as a clearinghouse and middleman between participating states. To ensure states are protected from doctors sanctioned in their home state, the bill stipulates that penalties incurred by a doctor in his home state apply in all other states where he has applied for licensure. It also allows the transfer of confidential investigation material on participating doctors subject to disciplinary inquiries.
Since its proposal last fall, Wyoming, Idaho, Montana, South Dakota, Utah and West Virginia had moved quickly to join the compact. Because the measure required seven states in order to become formally established, as the seventh state to pass the bill, Minnesota effectively created the compact as a working entity.
Participation is of course a two-way street. With Minnesota joining the compact, it means Mayo doctors can practice in other participating states. But it also means , with the right telemedicine infrastructure, doctors from other states can practice here in Rochester.
Ommen doesn't see that outcome in the near future. Aside from the state-to-state needs of hospitals on borders, the says, the bill is simply a way to connect patients with specialists.
"There aren't a lot of hospitals looking to cross state lines, simply because most of them don't have the capacity," he says.