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Is the Licensure Compact Good or Bad for Care Coordination?

Posted by Lawrence Kerr on Thu, Apr 13, 2017 @ 06:00 AM

Map-Blank-Notebook-Pen-and-Laptop-1.jpgIn the last week, 18 states signed on to a common licensure process, allowing physicians to apply for expedited licensure in all or some of the participating 18 states.

This has long been a goal of telemedicine and telehealth advocates. The lack of a common license has made it difficult to provide care from one state when the patient was in another. If a doctor had wanted to practice in all 18 states and filled out applications for each sequentially, it could have taken four to eight years, tens of thousands of dollars, and hundreds of hours of form filing and document gathering.Licensure certainly brings standardization and review of qualifications to protect the public. It prevents bad doctors from moving to be just a step ahead of the posse as they flee from misadventure. It also acts as an income source for states (via fees) and protection from competition for doctors already in the state.

A licensure compact is regarded as a great step forward for the patient. Access to care can be instantaneous and at a distance. It also solves the problem of mal-distribution of doctors. In theory, over populated cities could share their providers with sparsely served rural areas. This of course, assumes that already too-busy doctors want to work harder to care for strangers far away. Time will tell if this is valid or a mere shibboleth that sounds true but really is not.

We have other concerns, however. We know that three problems continue to grow and increasingly affect patient care safety and satisfaction:

1. Silos are becoming predominant
2. There is too much knowledge for any single person to absorb (never mind, master.)
3. No provider has enough time to struggle with telephone tag and HIPAA

Together these issues, combined with introverted personalities, result in a failure to collaborate. This failure results in outcomes that we have described before: lower quality, higher errors, and provider burnout.

Of course, licensure across state lines makes all of this worse. Teams cannot be built without trust and communication. When the caregiver is more important than the prescriber, an unknown, unproven and unrelated prescription can only be made on technical terms alone and not in concert with those who know the patient best.

However, what we advocate for -- true coordination of care and true medical collaboration -- doesn't necessitate licensure across state lines. The consulting physician who is geographically close to the patient remains responsible for the care, even as they collaborate with physicians from across the US or even internationally.

If a sore throat becomes a strep septicemia, when abdominal pain becomes an ectopic pregnancy -- then the patient needs to have a collaborating team somewhere that understands each other, trusts each other and is aware of the attitudes -- as well as ability -- of each member. Teams can always cross state lines, even when licenses can't. 


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Tags: medical collaboration, care coordination, regulatory issues

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