MEDICAL LICENSING: Mass. Proposal Has Big Implications
The Massachusetts Board of Registration in Medicine wants to "change the legal definition of what constitutes the practice of medicine, as insurance companies and technology prompt more patients to reach out to doctors and nurses across state lines." A preliminary proposal would require "that any insurance company decision to deny care, or to deny payment for care, to a Massachusetts patient must be made by a physician licensed in Massachusetts," according to Alexander Fleming, the board's executive director. Fleming said, "If a decision is made in Colorado about you in Massachusetts and you die, we have no recourse to do anything." He also noted that the state Legislature "has already empowered the medical board to enact the rule after public hearings," although the Boston Globe notes that the rule could be rejected by the secretary of consumer affairs or the secretary of administration and finance." Fleming said "no timetable for public hearings" has been set.
Confrontation Lies Ahead
The Globe reports that this proposal "could set up a confrontation with the insurance industry." Richard Coorsh, a spokesperson for the Health Insurance Association of America, said, "This appears to be an attempt by physicians to eviscerate managed care. There are many cases where you don't need a doctor making these decisions, and doing so has cost implications that would be passed on to patients."
Many insurers and managed care plans are employing "tele-nursing" services to direct patients to appropriate care. The National Council of State Boards of Nursing "maintains that under current laws, 'tele-nurses' should be licensed in each state where patients are located." However, employees of one of the largest tele-nursing companies, Access Health Inc. of Colorado, are only "licensed in the state from which they answer the phones." According to the Globe, Access Health's example and other companies' practices "suggests that a significant amount of improper nursing is likely taking place today." However, state nursing boards are working to create "a uniform set of rules that would allow nurses to practice nationwide" (Zitner, 7/27).