Regulatory Requirements | 01.02.25
Multi-State Licensing Program: A Retroactive Review
By Evelyn Starr-High, CPCS, CPMSM
As any MSP who has been in their role for more than a year can attest, we never know when we will be asked to stretch our skill set and respond to a new challenge. That is exactly what happened to me. The chief medical executive reached out in November 2020 to offer a new challenge. She asked me to obtain licensing in 14 states for approximately 900 physicians without causing a burden for them or their administrative support.
I did not know the licensing requirements for these states, nor did I know much about licensing. I explained that we would need people and time to develop a plan. After a brief moment of panic, I sprang into action, requesting volunteers from my team to begin our research. This was the beginning of a journey that would result in the Department of Licensure Strategy at MD Anderson Cancer Center.
These events occurred as COVID-era mandates and the extension of waivers to provide care across state lines were ending. It was evident that telemedicine had become an integral part of caring for MD Anderson cancer patients, enabling our physicians to facilitate care regardless of the distance between the physician and patient. At the same time, the Texas legislature approved the Texas Medical Board’s participation in the Interstate Medical Licensure Compact Commission (IMLCC) on June 7, 2022. Participation in the IMLCC is an agreement between the participating state medical boards to streamline the physician medical licensing process. This paved the way for streamlined licensure process, significantly reducing the burden of obtaining licensure through state-specific processes.
We pulled a small team together to research and develop application tools and workflows that leveraged automation and existing information held within the medical staff credentialing database. We mirrored processes where possible and identified our knowledge gaps. It became clear that we did not know everything we needed to know about licensing, and there was a significant difference in credentialing processes. Their regulatory landscape is constantly evolving, resulting in frequent changes to our processes. But with the right team, all things are possible.
The successes realized are attributed to excellent teamwork and a close and constant focus on what is working and what is not by frequently meeting with the team for their input. This process allowed the team to learn from each other and pivot quickly when somebody identified new information. Each team member was assigned a state and made responsible for remaining current on any changes the state may make to its processes. As a result, team members developed relationships with key leaders from state licensing bodies. This ensured quick resolution to issues that arose along the way.
The program has changed slightly over the years and now focuses on eight member states of the IMLCC and Florida telemedicine registrations. The internal process created has proven to facilitate the timely licensure of our physicians in all nine states in an average of 35 days from receipt of the providers' information. To date, our team has obtained over 4,645 licenses for 506 physicians.
A study was conducted to determine the impact of telehealth regulation on telehealth visit volumes at MD Anderson from Jan. 1, 2020, to June 30, 2024. The study explored the impact of regulation on the volume of telehealth visits in Texas and four other states. As expected, increases in telehealth volumes correlated with the issuance of licenses outside of Texas.
As the demand for telehealth becomes greater, it is expected that further changes will occur that impact obtaining out-of-state licensure. The team continues to focus on daily challenges while researching expansion into licensing of advanced practice providers in the same nine states.
I must thank the team and UT MD Anderson Cancer Center for the opportunity to gain experience personally and professionally while leading this team and building this program. I look forward to what the future holds.
Evelyn Starr-High, CPCS, CPMSM