The American Medical Association spent some portion of the $3.87 million it spent on lobbying this quarter trying to kill part of a telemedicine provision in a Senate bill, as did the American Association of Family Physicians, which spent a total of $1.46 million. Politico broke the news.

The bill in question, S-2943, is a lengthy appropriations bill for the Department of Defense. In section 705, it allows for the military's TRICARE program to reimburse for telehealth, including mobile health applications. The AMA and AAFP generally support the provision -- their objection to the bill is limited to one subsection of 705, which reads "For purposes of reimbursement, licensure, professional liability, and other purposes relating to the provision of telehealth services under this section, providers of such services shall be considered to be furnishing such services at their location and not at the location of the patient."

In open letters to the bill's sponsors, including Senator John McCain (R-Arizona), the AMA and AAFP argued that the provision would essentially create a workaround to medical licensure and lead to physicians who aren't accountable to any board, since the board in the patient's state can't regulate an out-of-state doctor and the board in the doctor's home state can't regulate an interaction with a patient in another state.

"This provision would deprive TRICARE beneficiaries of essential protections by fundamentally subverting and undermining existing state-based patient safety protections that are currently in force, and remove an essential mechanism used by states to ensure medical care provided to patients in their state meets acceptable standards of care," the AMA wrote in one letter, co-signed by a number of state medical organizations.

"Allowing physicians with a single license to treat TRICARE beneficiaries in any state via telemedicine would create episodes of medical care that the state in which the patient resides cannot readily regulate, if at all," the AAFP letter adds. "Section 705(d) therefore portends a troubling scenario under which state licensing boards will lack the authority to discipline physicians who are practicing medicine within that state’s borders."

The two organizations suggested instead that the rapidly-growing interstate licensing compact being promoted by the Federation of State Medical Boards could provide a better solution to the problem.

The bill passed in the Senate -- with the subsection included -- but the House sent it back with an amendment that removes most of the telemedicine language entirely. The bill is currently in conference.