Legislation would dismantle teleradiology licensure barrier

Federal legislation has been introduced to make it possible for out-of-state physicians to provide telemedicine services, as long as they are licensed in the state in which they reside. SB 1533, the Health Care Safety Net Amendments of 2001, could break down the licensure barrier obstructing the widespread practice of teleradiology.

Currently, interstate teleradiology is a complex and expensive proposition. Licensing, malpractice coverage, and insurance filing requirements add to administrative overhead and reducing profitability.

Pertinent language in the bill, introduced October 11 by Sen. Edward M. Kennedy (D-MA), states:

It is the sense of Congress that ... States should develop reciprocity agreements so that a provider of services ... who is a licensed or otherwise authorized health care provider under the law of 1 or more States, and who, through telehealth technology, consults with a licensed or otherwise authorized health care provider in another State, is exempt, with respect to such consultation, from any State law of the other State that prohibits such consultation on the basis that the first health care provider is not a licensed or authorized health care provider under the law of that State.

"If the law would allow physicians to be licensed only in the state in which they reside, it will make interstate teleradiology much more feasible for physicians," said Patricia Kroken, immediate past-president of the Radiology Business Management Association.

While technology is ready to support teleradiology practice, regulatory reforms to facilitate the practice lag behind, she said.

In the view of some radiologists, the legislation could improve patient care.

"Given the shortage of radiologists and the difficulties of providing coverage in remote areas or accessing subspecialty level expertise, this initiative would provide patients with more and better access to the services of radiologists," said Dr. James Thrall, chief of radiology at Massachusetts General Hospital. "When viewed from the standpoint of the patient, the remote facility, and the referring physician, this would be a step toward better healthcare availability."

Among other issues, it would facilitate 24/7 coverage, he said.

Kroken said the bill raises a number of legal questions:

?How does the bill relate to state law and the various state definitions of the practice of medicine?
?Does it supersede state law?
?Does state law prevail if there is a conflict?

Whether the bill can survive the congressional special interest grinder and become law is uncertain. Opposition from states that now make it difficult for the out-of-state radiologist to obtain licensing is likely.

"I'm not sure how the states, or even malpractice insurance carriers, will feel about the legislation," Kroken said. "In addition, some insurance carriers, including Medicaid, don't reimburse out-of-state radiologists, so this change could also be an issue with them."