A recent paper from the Healthcare Leadership Council (HLC) and Duke University’s Margolis Center for Health Policy identifies the need for regulatory reforms championed by The Council of State Governments
The Disaster Preparedness and Response Initiative, a project that convened leaders from the Healthcare Leadership Council (HLC) and Duke University’s Margolis Center for Health Policy, recently published National Dialogue for Healthcare Innovation: Framework for Private-Public Collaboration on Disaster Preparedness.
The paper outlines the project’s extensive review of the United States’ healthcare system’s response to COVID-19. The research includes accounts of public and private-sector challenges health care workers face and adaptations to the delivery system that proved most beneficial. An approach The Council of State Governments (CSG) has long advocated stands out as a particularly effective response tool.
Incompatibility between a state’s telehealth and occupational licensure requirements is the most consequential challenge in the public sector. Regulatory obstacles prevented available clinicians from providing relief to neighboring jurisdictions with capacity challenges.
“As public health emergencies often cross state and local government boundaries, health care organizations can face conflicting regulations and laws during their emergency response. Conflicting regulations can limit the ability of the health care system to quickly deliver supplies, human capital and direct care to areas with greatest need.”
Members of the Disaster Preparedness and Response Initiative commended virtual care, or telehealth, as a triumph for allowing clinicians to deliver care where it was needed most while encouraging social distancing.
Unfortunately, there is also evidence health care providers were unable to take full advantage of the technology due to a lack of uniformity in telehealth policies.
For example, site of service disputes, unclear guidance on allowable tools, variations in scope of practice and contradictory definitions of telehealth which do not include audio and video.
Novel proposals in the paper include emergency waivers and asking Congress to enact national emergency licensure policies. These approaches may be helpful, and even necessary, during future crises, but an existing solution, advocated by CSG would be more effective.
“State agencies and state legislatures should collaborate with state medical and pharmacy boards to identify areas where permanent regulatory flexibility and scope of practice expansion could improve public health emergency response and reduce inter-state variability to allow for a more consistent, comprehensive and efficient national strategy during a public health emergency…Professional associations should work with state health and human services agencies to identify best practices for workforce mobility given varying licensure and scope of practice laws, with the goal of developing processes that ensure health care delivery organizations have regular access to most recent scope of practice laws and regulations.”
Occupational licensure compacts are an effective means of achieving expanded license portability and therefore access to telehealth services.
In fact, the researchers describe part of CSG’s process for developing occupational licensure compacts in suggesting cooperation between professional associations and state agencies on permanent regulatory flexibility.
Interstate compacts are contracts between states and they are a proven, effective method for states to collaboratively resolve issues that span boundaries. Occupational licensure compacts are preferable to fleeting emergency waivers because they are permanent regulatory reforms, continuously benefiting member states no matter the circumstances.
Before the pandemic, CSG’s National Center for Interstate Compacts (NCIC) worked with physicians, physician assistants, nurses, emergency medical services personnel, physical therapists, psychologists and audiologists/speech-language pathologists in developing and enacting licensure compacts. More than 40 states and territories have adopted at least one of the compacts and over half have adopted three or more.
Before the end of the year, NCIC plans to create new occupational licensure compacts, potentially for other health care workers, through a partnership with the United States Department of Defense.
Compacts encourage efficient distribution of services by supporting practitioner mobility by establishing consistent standards for scope of practice, permitting practitioners to deliver in-person and virtual care to their full capability. Patients gain expanded access to care and safer services because medical licensure compacts require good-standing of practitioners.
Vaccines and mitigation measures appear poised to subdue COVID-19 in the next several months. Should infections recede, it would be tempting to return to normal priorities.
But at some point, there will be another public health emergency.
Providing a framework to evaluate proposals will allow state policy makers to maintain effective solutions, like occupational licensure compacts, for creating a healthier future.
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