But if Valley decides to continue or expand its telemedicine program after its three-year grant ends, it may need to find the money elsewhere. Medicare, so far, has refused to reimburse for medical teleconferencing in any metropolitan area. That's an obstacle to any large expansion of telemedicine in the United States , as setting up such projects generally requires an outlay of cash. Another stumbling block to telemedicine's growth is that each state licenses its own health practitioners, which generally stops doctors and nurses from treating patients across state borders. Partly to encourage telemedicine, about 14 states have agreed to join a compact that allows their nurses to practice in all the jurisdictions, Lown said.
New Jersey has a bill pending to join the compact.
But states have shown more resistance to easing rules for doctors. The reason we have state licensure schemes in the first place is to assure our citizens that the person treating them is qualified. The Federation of State Medical Boards is considering ways to make doctors' credentials more easily transferable between states, said the group's president, Dale Austin. In the meantime, state licensing rules aren't stopping doctors from crossing national boundaries. Different doctors attend, based on the type of patients they're examining.