Fees sore subject as Florida’s telehealth law moves forward

TALLAHASSEE -- The state panel that regulates medical doctors will begin putting in place rules next week that are designed to make the state's new telehealth law a reality.

But physicians who serve on the Florida Board of Medicine will have no say over one of the most-contentious parts of the law: registration costs for out-of-state doctors who can use telehealth to begin caring for Florida residents.

Florida-licensed doctors pay a $350 application fee and $355 for their initial licenses, according to a state website. But out-of-state physicians can register with the state to begin providing telehealth without paying a dime.

"It's patently unfair," said Jacksonville health care attorney and lobbyist Chris Nuland, whose clients include physician organizations.

Lawmakers this spring passed a bill (HB 23) that creates a regulatory framework for telehealth, including authorizing the state to register doctors and collect fees. But a constitutional amendment required the Legislature to include the new fees in a separate piece of legislation (HB 7067).

Gov. Ron DeSantis, however, vetoed HB 7067, which would have required the Department of Health's medical boards to charge a $150 registration fee for out-of-state health care professionals seeking to provide telehealth services to Florida residents. DeSantis said the fees would have undercut efforts to provide a cheaper way of delivering health services.

Florida law requires that the costs of regulating health-care practitioners be borne by people who receive licenses and licensure applicants. The bill also would have required a biennial renewal fee of $150.

Florida Medical Association General Counsel Jeff Scott called DeSantis' veto of the fee bill "interesting."

"We felt the fee was too low," said Scott, whose group represents doctors across the state.

According to the latest available data, it is expected to cost the state $33 million to regulate the 72,040 licenses under control of the Board of Medicine between July 1, 2018 and June 30, 2020.

Telehealth, a term insurance companies have coined, involves using the internet and other technology to provide services to patients remotely. Telehealth, or telemedicine as physicians prefer to call it, is not a type of health care service but rather is a mode to deliver services.

Florida providers and hospitals lag behind their peers nationally in the use of telehealth, according to a 2016 survey conducted by a trio of agencies. The results showed that 45 percent of hospitals responding to the survey said they provided telehealth, while only 6 percent of practitioners, such as physicians, did.

Physicians have argued the way to increase telehealth participation is to ensure payment parity, which would require insurance companies to reimburse for telehealth services no differently than if the services were delivered in person.

Insurance companies and managed-care plans are waiting for the Board of Medicine to approve the necessary telehealth rules, said Wences Troncoso, vice president and general counsel of the Florida Association of Health Plans. He added that there will be "new potential contracting opportunities" once the rules are in place.

The Board of Medicine will meet Aug. 2 in Coral Gables, a day after holding a series of committee meetings.

Paul Kluding, senior director of public relations for the health insurer Florida Blue, said out-of-state physicians haven't been contacting the company.

He said, though, that the company is "excited" to offer telehealth services to customers.

"It provides them with additional choice, convenience and access to care," he said, adding that by the beginning of next year telehealth services will be available to most Florida Blue individual and group insurance members.

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