Saturday, May 2, 2020

Bigger Pie Forum: Medical Board Plays Games with Telemedicine

The Mississippi Board of Medical Licensure has largely been a protectionist group designed to protect the economic rights of physicians in the state and its reaction to the COVID-19 pandemic has confirmed this view.

Initially, when Gov. Tate Reeves issued his first emergency proclamation, the board issued one of its own that said it wouldn’t enforce its regulations governing telemedicine, one of which was a largely pointless requirement that the physician using the service be licensed in Mississippi. A week later, the board walked back this logical action and issued an amended proclamation that said the board actually meant that it was only approving the ability of Mississippi patients with an existing doctor-patient relationship with a physician outside the state to use telehealth during the COVID-19 crisis.

The original order was exactly what should’ve been done. Mississippi has had a doctor shortage for decades and needs all of the help it can get, especially since the at-risk population (those with underlying conditions that make them more vulnerable to the COVID-19 virus) in Mississippi is a higher percentage than many other states. According to the latest study from the American Association of Medical Colleges, Mississippi has the fewest amount of doctors (191.3 per 100,000 population) of any state.

This requirement for telehealth operators was designed to force out-of-state companies to either hire Mississippi physicians or not be able to provide service in the state. It also served to protect the University of Mississippi Medical Center’s burgeoning telemedicine operation.

Contrast this approach with the Mississippi Board of Nursing, which has been forward-thinking in this crisis. The board issued a proclamation that allowed nurse practitioners licensed in other states (but not Mississippi) to see patients via telemedicine. The board also made it easy, via a waiver form, for those nurse practitioners with an out-of-state license to practice in Mississippi for the duration of the emergency.


The two boards were in opposition for years over the so-called tether rule, which required a nurse practitioner to be within a certain radius (first 15 miles and later increased to 75 miles a few years ago) of their collaborating physician. The board finally scrapped the rule in 2018, allowing nurse practitioners to collaborate with physicians electronically. Some states allow nurse practitioners to practice independently without a collaborative agreement and this is a step that could easily be taken in Mississippi to help alleviate the shortage of primary care providers in rural areas. Attempts to do so have failed in the legislature as the state medical association manages to successfully lobby against them.

Healthcare reform could take the form of temporary, emergency actions and later, legislative action. Reeves has the power under his emergency declaration to do as the governor of West Virginia (a former Democrat) and shake off the shackles of protectionist regulation to help get more “boots on the ground” during the COVID-19 crisis.

It’s time for the governor to show some leadership and overrule the Board of Medical Licensure on telehealth. Doing so help people more easily obtain the healthcare they need in this crisis. Once this pandemic has abated, it also should lead to a conversation in the Legislature.

The Legislature has the power to put into statute and overrule the state Board of Medical Licensure on several issues, including telehealth (allowing out-of-state doctors to see Mississippi patients remotely) and allowing nurse practitioners full independent practice. The Legislature also needs to scrap the state’s Certificate of Need program and allow competition rather than central planning to determine the state’s healthcare needs. Doing so will help Mississippi’s underserved, mainly rural populations receive better care closer to where they live and improve outcomes.

Kingfish note: The column leaves out the Medical Board's dirty little secret in the telemedicine fight.  The rule excludes doctors who have a higher-level Board Certification but lack a Mississippi license.  That's right.  A doctor who can't pass his Boards but gets by with the bare minimum for a state license is deemed to be better qualified.  How Mississippi.  I'll put it this way.  Suppose you got a nasty version of the Covid-19 virus.  An expert such as Dr. Birx or some of the Board-certified docs who have been on the front lines at Mount Sinai are not allowed to treat you through telemedicine in Mississippi. 



This post is sponsored content provided by Bigger Pie Forum.

11 comments:

Anonymous said...

My experience working in healthcare has led me to believe that doctors and administrators are grossly overpaid.

Anonymous said...

2:24, administrators, perhaps; but when you are having a life-threatening medical emergency, see if you have that same opinion of doctors.

Anonymous said...

The bare minimum to get a state medical license includes a ton more hours of supervised patient care education than the minimum patient contact hours (some of which are forged) required by the online nurse practitioner diploma mills. They have also passed all of the required board examinations to become a physician, just not for a specialty.

Also, NPs can jump from subspecialty to subspecialty without any extra education or certification. Your arguments are not congruent, Kingfish.

Bill Dees said...

" The rule excludes doctors who have a higher-level Board Certification but lack a Mississippi license." So they're free to practice telemedicine, even if located outside the state. This seems contrary to the next statement that non-board certified doctors have greater rights under the rule". Which is it, or is this just more jabberwocky from Kelley Williams?

Anonymous said...

I am relieved. Was hoping from the get-go that we would get the learned opinion of Doctor Bill Dees.

Anonymous said...

"The bare minimum to get a state medical license includes a ton more hours of supervised patient care education than the minimum patient contact hours (some of which are forged)"

Some of which are forged?

Put up, or shut the fuck up. Seriously. If you believe someone 'forged' their patient contact hours, then it's your obligation to report it to the MS Board of Nursing on Monday.

I'll wait. (But I won't hold my breath)

Anonymous said...

Much ado about nothing.

Smart dudes know how to get real viagra from pornhub sponsors.

Throw in a some leeches or other parasitic worms, a couple of bowls of the good shit per day, and one is good to go . . . at fraction of the cost of a doctor visit.




Anonymous said...

No patient cares if the doctor treating him through telemedicine is licensed in Mississippi — just that he or she is properly licensed to practice medicine. This is a money and power grab by the Board of Medical Licensure, being territorial to protect the income of its members. Understandable if you're a doctor but asinine if you're a patient who needs treatment in an economical and efficient fashion.

searchingforreason said...

3:26 - the old saying that nurses keep doctors from killing you is very real.

Anonymous said...

@ 3:36, I agree on the NP diploma mills. They devalue the profession and should be shut down. You're statement about jumping from sub specialty to sub specialty is wrong though. NPs must practice within the scope of their specialty or return to school and complete a different track to treat an additional specialty.

Anonymous said...

@0959 -- so an FNP that's working with a pulmonary group can't just jump over to an ID group or to a rheumatology group? Yes they can, it happens all the time.



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If you get tired come relax at the Fox News Tent. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both will entitle you to free drinks.Get your tickets now. Since this is an event for trolls, no ID is required, just bring the hate. Bring the family, Trollfest '07 is for EVERYONE!!!

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