Faculty Disclosure. Presentation on Interstate Compact and FSMB Physician Re-entry Policies. The Need for License Portability

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1 Faculty Disclosure Dr. Rhyne has no disclosures to report. Presentation on Interstate Compact and FSMB Physician Re-entry Policies Janelle Rhyne, MD, MA, MACP Past Chair, FSMB Board of Directors President, FSMB Foundation 2015 FSPHP Annual Education Conference April 25, Federation of State Medical Boards Federation of State Medical Boards The Need for License Portability Interstate Medical Licensure Compact Health care rapidly changing Rise of telemedicine and new technology The Affordable Care Act and need for greater access to care Integration of health care delivery systems Increase in multi-state practice 16% of physicians are licensed in 2 states 6% of physicians are licensed in 3 or more Goal: Facilitate multi-state practice without compromising patient safety or quality 2015 Federation of State Medical Boards Federation of State Medical Boards FSMB s License Portability Initiatives Telemedicine Guidelines Support Expedited Endorsement of Licensure Policy and Legislative Uniform Application Interstate Medical Licensure Compact* Expand UA Utilization Credentials Verification * Improve FCVS *Supported by PDC Current Regulatory Environment Combating Aggressive Push for a National License Legislation in Congress calling for nationalized licensure system Proposals tie licensure to federal health programs (i.e. Medicare) Need for a Nationwide Solution, Implemented by the States, without Federalizing Licensure State solution would preserve proven regulatory approach State solution does not require overhaul or new federal program Licensing is constitutionally a state power Options for interstate cooperation Interstate Compact Federation of State Medical Boards Federation of State Medical Boards 1

2 What is an Interstate Compact? A contract between compact states Constitutionally authorized Retains state sovereignty on issues traditionally reserved to state jurisdictions Commission established to coordinate cooperation Interstate Compact HOD Directive in 2013 FSMB House of Delegates unanimously adopted Resolution 13-5: Development of an Interstate Compact to Expedite Medical Licensure and Facilitate Multi-State Practice (HOD 2013) Directed FSMB to study the feasibility of an Interstate Compact model to facilitate license portability Federation of State Medical Boards Federation of State Medical Boards Participation voluntary for both physicians and state boards of medicine Creates another pathway for licensure, but does not otherwise change a state s existing Medical Practice Act Regulatory authority remains with the participating state medical boards The practice of medicine occurs where the patient is located Compliance with the statutes, rules and regulations of state where patient located State boards aware of physicians practicing in the state Federation of State Medical Boards Federation of State Medical Boards Improved sharing of complaint and investigative information between medical boards The license to practice medicine may be revoked by member state once issued The ability of boards to assess fees will not be compromised Compact Eligibility Requirements Estimated 80% of physicians will be eligible Must meet the following requirements: Successfully passed USMLE or COMLEX-USA Successful completion of a GME program Specialty certification or a time-unlimited certificate No discipline on any state medical license No discipline related to controlled substances Not under investigation by any agency Federation of State Medical Boards Federation of State Medical Boards 2

3 State of Principal License Entry point for eligible physicians State must be a Compact State Physician must obtain (or hold) a full and unrestricted license What state can serve as State of Principal License? State of physician s primary residence State where 25% of medical practice occurs Location of physician s employer State designated for federal income taxes Proposed Interstate Compact Pathway Step 1 Step 2 Step 3 Eligible Physician is/becomes licensed in a Compact State (State of Principal License) Eligible Physician applies for expedited licensure in other Compact states via State of Principal License State of Principal License verifies eligibility State of Principal License sends attestation to an Interstate Commission Eligible physician transmits fees to Interstate Commission Federation of State Medical Boards Federation of State Medical Boards Step 4 Step 5 Step 6 Proposed Licensure Pathway Interstate Commission sends fees and physician information to other Compact states selected by Physician Selected member states issue physician a license ONGOING: Commission is used as a clearinghouse for shared discipline and investigatory information, renewals Interstate Compact Commission State Boards retain licensing authority, participate as Commission members Administrative Role Only Coordinate education and training Empowered to determine when a state has breached its obligations under Compact Can raise own funds to remain budget neutral Federation of State Medical Boards Federation of State Medical Boards Interstate Compact: Next Steps Growing interest among states for adoption 28 boards have formally endorsed (as of 4/23/15) Growing support from national and state medical/hospital associations, specialty societies, and hospital systems State Medical and/or Osteopathic Board Support (as of 4/23/15) 17 states have introduced legislation (as of 4/23/15) Enacted in Wyoming, South Dakota, Idaho, West Virginia, Utah and Montana Moving along in other state legislatures at the Committee level Late Summer 2015 projected for first meeting Federation of State Medical Boards Federation of State Medical Boards 3

4 State Introductions (as of 4/23/15) Alabama Idaho Illinois Iowa Maryland Minnesota Montana Nebraska Nevada Oklahoma Rhode Island South Dakota Texas Utah Vermont West Virginia Wyoming Available Resources Talking Points Endorsements State Medical and Osteopathic Boards National and state medical associations Specialty Societies Health Care Delivery Systems Federation of State Medical Boards Federation of State Medical Boards Compact Contact Jonathan Jagoda Director, Federal Government Relations Tel: (202) Physician Re-entry to Practice Federation of State Medical Boards 2015 Federation of State Medical Boards FSMB Reentry Policies 2012 Report of the Special Committee on Reentry to Practice Provides a framework of common standards and conceptual processes for reentry to practice for physicians who are neither ill nor have a license restriction 2013 Report of the Special Committee on Reentry for the Ill Physician Addresses return to practice for physicians who have a licensure restriction due to physical or psychiatric illness, including addictive disease. Impairment Related Issues Challenging State Boards Terminology confusion and consistency issues Illness vs. impairment License restriction vs. license limitation Unintended consequences when boards are forced to take action Limitations or restrictions placed on full license may trigger loss of specialty certification, hospital privileges, etc Lack of detailed information on disciplinary alerts Federation of State Medical Boards Federation of State Medical Boards 4

5 Recommendations Report of the Special Committee on Reentry for the Ill Physician Determining Medical Fitness to Reenter Practice Review on a case-by-case basis Global review of individual physician s situation (e.g., treatment, remediation, length of time away, personal & professional support system) Familiarity with relevant FSMB policies and other resources Consult PHPs when need further evaluation of physician Reentry plan after extended time out of practice Should be required to participate in a reentry plan as outlined in 2012 FSMB reentry policy Recommendations Report of the Special Committee on Reentry for the Ill Physician Common Terminology and Review of Relevant Information Common terminology FSMB should facilitate dialogue and education about terminology used as part of state boards licensing and disciplinary processes State boards should use standardized language to indicate a safe practitioner (e.g., license limitation rather than license restriction ) Sharing and review of state medical board orders Should be reviewed carefully to determine if action relates to medical fitness or competence/professionalism Federation of State Medical Boards Federation of State Medical Boards Reentry Contact Thank you! Questions or comments? Frances Cain Asst. Vice President, Assessment Services Tel: (817) fcain@fsmb.org Federation of State Medical Boards 2015 Federation of State Medical Boards 5