Last Thursday, the Georgia Composite Medical Board took up its proposed telemedicine rule, one that would definitely limit telemedicine in that state.

As written, it would stifle the use of the technology by nurse practitioners and physician assistants because it would require that a patient be seen or examined by a physician in person or via electronic means before a NP or PA could provide care.

Frankly, when I first read about this rule, I thought ‘They can’t be serious!’  And in fact, there was a huge outcry against it.

Time to step back for a little background on the pecking order of practitioners.  Physician assistants have supervising physicians.  New patients who see a PA actually establish the doctor-patient relationship with the PA’s supervising physician.  So requiring a patient to first see a physician in person or via videoconferencing before they have the encounter with the PA via telemedicine is a step backward.  Also, nurse practitioners in most states (Georgia may be different) work in collaboration with physicians; they are not supervised.  So the rule threatened to usurp the limited autonomy that an NP has and once again put the physician in charge.

The explanation for the rule from the board’s medical director, a physician, was to ensure that mid-level practitioners are supervised by physicians familiar with telemedicine technology.  So for patient protection, care and quality, in a time when there is a shortage of doctors, the board was going to throw up a barrier that would limit access to healthcare.  Huh?!?!? And the Georgia Nurses Association and consumer advocate orgainizations had basically the same reaction.

In timely fashion, Kaiser Health News published an article written by Christine Vestal, titled “In Many Communities, Nurse Practitioners Fill an Important Void.”  The story focuses on the Central Virginia Community Health Center in Buckingham County where four physicians would be overwhelmed by the 200 patients who show up every day, were it not for the help of nurse practitioners.  There are roughly 5,800 U.S. communities that don’t have enough primary care doctors.  So a telemedicine rule that further limits access to healthcare would aggravate the situation – especially when the new federal healthcare law extends insurance coverage in 2014 to 30 million more people.

In their minds, board members probably thought they were acting in good faith because they were only talking among themselves.  I’m sure they were not expecting the firestorm of reaction the proposed rule created.  Wisely, the board voted last Thursday to send the rule back to the Rules Committee to consider the comments received.  Executive Director LaSharn Hughes expects it to be on the rules agenda in January where, if the board has any sense, it will be quietly laid to rest.