Public Health Law Map - Beta 5 - Medical and Public Health Law Site

most medical enforcement actions.
The most troubling aspect of telemedicine, especially Internet medicine, is that it is
very difficult to determine if the provider is licensed anywhere, or is even
medically trained. When a kid in high school can produce a professional appearing
WWW (World Wide Web) site, all the traditional cues that indicate a legitimate
practitioner disappear. Even insurance coverage is not a good indicator as more
people turn to cash-based medical care, either because of the referral restrictions in
their health plans or to get alternative medicine. In theory, consumers could call the
licensing agency to see if someone with that name was licensed, but they would
have to know the state of licensure and have some way to verify that the Internet
physician was not an impostor. Even these protections fail for offshore operations.
b) Trade Regulation Issues
All professional licensing laws have some component of trade regulation that is
driven by the affected profession’s interest in limiting competition. State licensing
agencies for lawyers have fought to prevent nonlawyers from helping people with
divorce filings, to prevent the publication of self-help legal books on estate
planning, and to limit the extent that real estate brokers can assist with the
documents for selling real estate. In medicine, trade restrictions were the traditional
focus of regulations. It is only in the last few decades that medical licensing
agencies in many states have even had the legal authority to discipline a physician
for incompetence.
Telemedicine has been promoted as a way to deliver medical services to remote
areas that would otherwise not have access to expert physicians. Politically, this is
the best way to diffuse criticism because it does not threaten the livelihood of other
physicians. Realistically, however, it will be impossible to restrict telemedicine to
such areas. If I am an insurer, I can lower costs and perhaps improve the quality of
care for my insureds by contracting with a leading medical center for specialty
consultations with local general practitioners. Thus a patient in Atlanta might be
able to get a consultation from a Mayo Clinic physician, but at a lower cost than a
local specialist because the patient’s primary care physician will manage the
consultation. The specialists will be under pressure to price these consultations
attractively. They are already losing business because MCOs are unwilling to send
patients to regional centers for specialty care. The specialists can essentially extend
their franchise at the cost of a fast Internet connection, with no added office
expense or capital expenditures.
Given that many specialties have more practitioners than the patient flow warrants,
especially if the patients could shop over a broader region, telemedicine is very
threatening. This extends down to the primary care physician level: one of the
claims for telemedicine is that it will enable communities that can only support a
nurse to have physician care available under the direction of the nurse. Once this is
accepted, there is no reason why MCOs would not want to use it for all their
primary care patients.
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