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A recent JAMA Network Open Viewpoint article explored the frustrations resulting from the expiration of temporary regulatory changes that were implemented by almost all states to allow physicians to provide telehealth across state lines during the height of the COVID-19 pandemic. With the end of the public health emergency, many licensing waivers ended as well. Some argue that licensure should remain under control of the state while others advocate for a single federal license or full reciprocity so providers with a single state license can treat patients nationwide. The article explains how 4 different types of practical licensing exceptions can be used for telehealth: 1) for follow-up care after a relationship has been established; 2) in preparation for a visit; 3) for peer-to-peer consultation or care incident to a care plan; and 4) for care related to a clinical trial.Common sense prevails: “Telemedicine, when used for anything other than follow-up with an established physician relationship, like urgent care, is positioned as a front door to healthcare, in many cases, leading to referral,” says Alan Ayers, MBA, MAcc, president of Experity Consulting and Practice Management Editor of JUCM. “Telemedicine in particular creates a lot of referrals because of the limited ability to obtain a proper history and physical, acquire images, and conduct lab tests by video. In the marketing launch of one national retailer’s telemedicine offering, I researched the providers’ staffing the service, and they were all out-of-state. They also appeared to be contract labor, and an online search revealed they simultaneously staffed other telemedicine services. Common sense says it’s unlikely such a ‘work from home,’ provider is going to be connected to distant referral providers or want to be liable for the patient’s medical outcomes.”

Telemedicine Leads to Referrals