Although lumped together into the category of telemedicine, the law of most U.S. states and territories treats episodic medical consultations (physician to physician consults or remote second opinions) differently.
Currently, 15 states and territories specifically permit an out-of-state physician to provide a consultation or second opinion directly to a local patient. An expanded number of 35 jurisdictions allow this consult to occur as long as this consult or opinion is done in conjunction with the local physician who maintains the physician -patient relationship.
Only 4 states actually prohibit these consults, leaving 15 jurisdictions silent on whether this practice is or is not permitted.
So, what do we mean when we say
'episodic' consultations?
Some states provide specific definitions for what is considered episodic, while other leave it open to interpretation. Watch or listen to clip (right) to hear how Purview's CEO provides a fuller description of episodic consultations.
Physician to Physician Consultations
Although we always suggest you check with your own legal counsel, we believe that most institutions will be well served to involve a local physician with a physician-patient relationship in all of their consults with patients in a state in which the physician is not licensed.
Understanding When to Leverage the Interstate Medical Licensure Compact (IMLC)
There are provisions in many states for the ongoing practice of telemedicine across those state’s borders, however many of those either require application for a specialized license or utilization of the state consortium organization. The Interstate Medical Licensure Compact (IMLC) works great for physicians who are regularly practicing in a particular state, but the process is time consuming and expensive for anyone providing occasional or episodic consultations.
Trending Policy Updates For Episodic Consultations
This area of regulation is dynamic but generally trending in the right direction. Many states are in the midst of adjusting their laws to "the new normal," post-pandemic, to accommodate the growing trend of telemedicine. While every state has its own medical board, the nationwide consortium of these - the Federation of State Medical Boards (FSMB), a consortium across all boards, issued its guidance in the paper, ‘The Appropriate Use of Telemedicine Technologies in the Practice of Medicine.’ The document promotes blanket permission of episodic consults and encourages physician to physician consultations.
International Second Opinions
In order to serve international patients, providers must abide by the laws in each individual country, including patient privacy laws and where patient information may be stored. Getting patient releases for handling of their PHI and forming institutional relationships in those countries is always well warranted.
For a more comprehensive overview,
read the recently published white paper and interactive map:
The Legal Reality of Issuing Second Opinions for Out-of-State Patients
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