ABSTRACT: Introduction: The Colorado Physician Health Program (CPHP) provides evaluation, diagnosis, treatment referral, and monitoring for physicians, physician assistants and anesthesiology assistants experiencing health or psycho-social problems. We examined trends in complexity of cases presenting to CPHP between fiscal years 2016-2017 and 2020-2021. Methods: Case complexity was rated as mild, moderate, or high based on clinical and administrative complexity. Differences in complexity were examined by year and participant demographic, practice, and case characteristics, using chi-square and logistic regression analysis. Results: Mild complexity cases declined from 57% to 14% and moderate cases increased from 25% to 73% (P<.001). Cases with high complexity (15% of cases) remained relatively stable. Complexity was higher for older participants (P=.04), primary presenting problem of DUI/DWAI (P=.01), mandatory referrals (P<.001), and longer participation (P<.001), and lower for participants with work stress/burnout (P=.04). Conclusion: Potential reasons for the changes in complexity observed include increased stress in work settings, proposed changes in the regulatory environment that could threaten confidentiality, and the emergence of in-house wellness programs. Physician health programs need to prepare for increases in case complexity and the accompanying need for more referrals for care, higher levels of monitoring, and greater skill in diagnosing and addressing health and behavioral issues.
ABSTRACT: Background: The COVID-19 public health emergency increased demand for healthcare services, prompting emergency policy changes that expanded access via telehealth. Objective: To identify determinants of state telehealth policies related to in-state licensure waivers and payment parity. Methods: A retrospective, longitudinal analysis of monthly state telehealth policy changes between January 2020 and December 2022 was conducted. Multivariate logistic regression was used to estimate the relative importance of public health, state health policy and socio-economic factors for waiving in-state licensure requirements or implementing payment parity. Results: Waiver implementation and maintenance were more likely in ACA expansion states, states with higher COVID-19 elderly mortality rates, and increased new health center market entry but less likely in states with Democratic governors, Interstate Licensure Compact participation and Certificate of Need laws. Payment parity was more likely in states with Democratic governors, higher elderly vaccination rates, and CON laws, but was less likely in IMLC states. Conclusions: The adoption and maintenance of telehealth policy changes was influenced primarily by public health shocks and health policy factors, as well as the political orientation of state governors. Comparatively, socioeconomic conditions were less influential.
ABSTRACT: Increasingly, for-profit corporations are delivering a greater portion of healthcare services. While this may enhance operational efficiency and organizational effectiveness, it may raise questions about safeguarding of patients’ interests and supporting the autonomy and professional judgement of individual professionals who may work as employees. In such corporate healthcare settings, there may often be leaders who themselves are licensed professionals. These individuals may not personally provide care to patients but direct the work of other professionals or establish corporate policies, practices, and cultures that shape the practice of others. In such situations, the problem of “dual loyalties” may arise, in which licensed healthcare professionals must simultaneously reconcile a professional/ethical and fiduciary responsibility to act in the best interests of patients with a corporate responsibility to maximize shareholder value. While many different agencies—including governments, accreditation bodies, and industry agencies—participate in the regulation of corporatized healthcare, the specific responsibilities and opportunities for licensing bodies to ensure appropriate management of dual loyalties has not been widely discussed. The multi-faceted and highly interconnected nature of this wicked problem opens opportunities for discussion and reflection within licensing bodies regarding how best to use mechanisms such as Codes of Ethics, Standards of Practice, and complaints/investigation systems in the context of dual loyalties in corporatized practice settings.
ABSTRACT: Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist that has been approved for use as a clinical and veterinary anesthetic since 1970. Although esketamine, a specific molecular form of ketamine, is FDA-approved for the management of treatment-resistant depression, regular ketamine is often used off-label at subanesthetic doses to treat depression as well as other psychiatric disorders and pain. Despite the lower doses of ketamine used for analgesia and depression, ketamine can cause dissociative, psychomimetic, and hemodynamic symptoms that require careful monitoring during and after administration. Over the past several years, rising public interest in ketamine has led to a “wild west” of so-called ketamine clinics, which offer off-label ketamine treatment, sometimes through compounding pharmacies, for a variety of conditions. These clinics are largely unregulated, representing a possible ongoing threat to the safety of patients which may merit action among state medical regulators. Regulations may be helpful for all of the stakeholders in the off-label ketamine marketplace, including distributors, compounding pharmacies, clinics, and providers themselves. In this article, the pharmacology of ketamine and evidence supporting off-label use are reviewed, along with suggestions for regulating the burgeoning ketamine clinic landscape.
ABSTRACT: Background: Interstate licensure portability has become a significant issue for US healthcare providers. Healthcare compacts have emerged as a promising solution to facilitate interstate licensure portability for many healthcare specialties while maintaining individual state autonomy. Objective: This study aimed to describe the landscape of interstate healthcare compacts in the US. Methods: We systematically analyzed compact and legislative websites to determine state-level healthcare licensure compact participation over time. Results: More healthcare compact bills have been passed over time, as established compacts recruit new states and new compacts emerge. Of the 15 active healthcare compacts identified, all 15 compacts saw the first state/territory to pass compact-specific legislation in at least 1 state/territory in the year of or following the approval of the drafted model legislation. However, the time between when compacts are first discussed to the approval of the drafted model legislation varied considerably between compacts, ranging from 1 year to 20 years. Very few states/territories pass more than 1 or 2 healthcare compact-related bills in any year. Conclusions: In the last decade, the landscape of interstate healthcare practice has changed dramatically, and state and territory participation in interstate healthcare licensure compacts has expanded over time.
ABSTRACT: Purpose: To combine the perspectives of health and commercialization experts on the ethical and regulatory needs for non-fungible token (NFT) implementation in healthcare. Design: Perspective Methods: For a multidisciplinary perspective by an interdisciplinary group, current event articles and research articles were interpreted and assessed. Results: Health data has become fragmented and disorganized, resulting in poor accessibility, increased administrative costs, and integrity vulnerability. Healthcare is uniquely suited to adopt blockchain and NFT technology as potential solutions. The incorporation of blockchain technology may offer multiple improvements in data-sharing through consensus, tokenization, and decentralization. However, the current regulatory infrastructure to support blockchain is poorly defined. Conclusions: Healthcare NFTs would revolutionize patient control over their health data and promote more ethical transparency of data ownership while also reducing administrative security costs. However, blockchain poses unprecedented requirements of healthcare regulation within the unique realms of patient privacy and data ownership. Large-scale implementation of blockchain cannot be achieved without regulatory collaboration.
ABSTRACT: This commentary highlights the Licensed Physician Censuses published biennially by the Federation of State Medical Boards between 2010 to 2022 and provides an overview of the forthcoming census, which will be featured in the next issue of the Journal of Medical Regulation. These censuses identify all actively licensed physicians in the US and the District of Columbia, offering critical insights into demographic, educational, and licensure trends. By analyzing physician workforce patterns, these comprehensive snapshots help inform policymakers and healthcare professionals about workforce assessments and strategic planning efforts.
