Seeing Patients Across State Lines: Online Options for Health Care Practitioners

As a health practitioner, you have the wisdom and skills to make a meaningful impact on your client's overall health and well-being. But what if those client relationships could be just as impactful beyond state lines?

Running a physical practice can come with a long list of frustrations. Many of us are familiar with excessive overhead costs, long commutes, lack of patient engagement, mountains of paperwork, filing insurance claims, and restricted income ceilings.

What if an online practice could help you reach — and positively affect — more people than ever before without sacrificing your ability to provide compassionate care while also creating financial stability? If you have been thinking of taking the leap, you might wonder what it actually takes to transition your practice into the online space.

As you know, modern healthcare is constantly shifting, and now more than ever, it's essential that practitioners remain flexible while they navigate national or even international lines and develop new models of care. Creating an online practice is an exciting opportunity to improve access, increase the quality of care, and expand your client base. Making the switch from in-person to online, or even hybrid, models can be an intimidating process with lots of decisions weighing on you—but it doesn't have to feel so daunting.

In this article, we'll discuss how simple tools can help you stay ahead of the curve, make the transition smoother, and help you prepare for success as an online health practitioner, so you can provide outstanding client care no matter where they (or YOU!) call home. Luckily, the early adopters have paved the way, and now it's easier than ever for qualified health practitioners to offer their services from anywhere with internet access.

[signup]

Types of Practices

First off, let's get clear on some definitions for the purpose of this article. 

A physical practice: is your typical brick-and-mortar, where you see patients in-person under your scope of practice as a licensed healthcare provider. ‍

Telehealth or telemedicine: practicing under your license but utilizing video calls and/or phone consults instead of an in-person appointment. Typically, these are still held with patients within the borders of whatever state(s) you may hold a license. 

Virtual or online practice: you are operating as a non-licensed or unlicensed health consultant, and you conduct all consults via phone or video.

So who is qualified to take the virtual route? If you are reading this, you are likely qualified! Practitioners from various backgrounds, such as Naturopathic Medicine, Acupuncturists, Nurse Practitioners, Physician, Chiropractor, Registered Nurses, Physician Assistants, Dietitians, Nutritionists, and even seasoned Health Coaches can create a thriving virtual practice as online health consultants, wellness mentors, or whatever title feels most aligned for you.

That being said, there is a caveat. Sometimes I see health practitioners calling themselves "health coaches" without proper credentials. This is typically only recommended if you have an actual certification as a health coach because this is an established profession with its own regulations. We will discuss certifications more when we dive into the legal aspects involved in running an online practice.

The first step is deciding whether you want to maintain an active license.

Hybrid Model: In-Person & Virtual Practice

If you choose to maintain your license, you will likely decide to go this route. When choosing this model, it's highly recommended that you have one business entity (i.e., Limited Liability Corporation) dedicated to your in-person practice and one to your online practice. That being said, when operating within your physical practice and seeing patients in person or via telehealth, you will need to continue complying with all state, licensing, and regulating board guidelines, restrictions, and standards of care.

However, you may also want to expand beyond state (or even country lines) to see clients virtually. If this is the case, you will likely want to create a separate NEW business entity (usually a Limited Liability Company, but be sure to speak with your own advisor) dedicated to your online practice. This means for your new virtual practice, you will want to have a dedicated business license, tax ID, business bank account, and EHR or practice management software to keep things clearly delineated.

Fully Virtual Practice

If you choose to deactivate your license or let it lapse and are ready to leap into an entirely virtual practice, there are a few considerations. First, if you currently have a physical practice, I would choose a specific date to make it official. This will keep everything crystal clear on the backend. Second, you will also want to give your current patients plenty of notice. Third, ensure you update all your public-facing information to reflect the change — removing any information that may imply you are a licensed professional giving medical advice. Be sure to comb through your website, social media profiles, documents, etc.

If you are starting a brand new practice from scratch and want to be in the online space, you're in the right place. You may just need to make the decision regarding your license and follow the guidelines I have set forth here in this article.

Legal Considerations for Online Health Practitioners

The guidelines and recommendations I discuss here will apply to a virtual practice. Since the online space is rapidly growing and expanding for health practitioners (aka, it's the PERFECT time to take the leap!), there is a decent amount of a gray area. This means there are very few hard and fast standards to abide by and follow. This can feel both expansive and terrifying for practitioners because we tend to enjoy black-and-white rules and instructions, but instead, we are faced with endless variables and nuances.

That being said, it is essential that you speak directly with an attorney who can help assess your risk tolerance and make the best decisions for you, your business, and your clients. However, there are a few guidelines that I have learned over the past several years.

Legal Verbiage

First, let's talk about verbiage. The most obvious one is that when we are practicing in the online space, we are working with "clients," not "patients." We may "recommend" or "suggest" instead of "prescribe." We also do not "treat," "cure," "diagnose," or make ANY other health-related claims. We are simply educating and consulting.

Legal Forms

Second, you will want to ensure that you have proper legal forms that clearly state you are not operating as a licensed healthcare provider. My absolute FAVORITE resource for all things legal, including client agreements, disclaimers, terms and conditions, terms of use, consent forms, etc., is Lisa Fraley, JD, my personal legal coach, and attorney. She provides DIY templates that you can modify to make your own, and she also offers one-on-one consulting to ensure you have everything in order based on the exact business model you are creating.

Services Provided

Third, you may be wondering what you are actually allowed to do in the online space. Again, I highly recommend speaking to an attorney for your specific circumstances because there are nuances. However, since 2018, my online practice has been almost identical to my in-person practice, except for physical exams. This is the reason why I require all my clients to have a Primary Care Provider on board, and yes, I collect their contact information for verification purposes. That being said, nutritional guidelines vary from state to state, so again, depending on the services you provide, educating yourself is crucial. One resource to reference is this website.

Malpractice, Liability & Certifications

If you are maintaining your license, you will want to maintain your malpractice insurance for your physical practice. However, it likely will not cover your virtual practice, but you can always discuss this with your specific insurance provider.

Malpractice is usually not an option for those operating an entirely virtual practice without a license and is also not required. Liability insurance is something to consider, again not required, but it was the option I chose for my own practice. When applying, you can typically let them know that you will be operating similarly to a health coach, and they can find the plan best suited to you. My liability insurance is around $200 for the entire year.

Speaking of health coaching and certifications, it is recommended that you have a designated certificate if you choose to become an unlicensed or non-licensed practitioner. Being certified as a health or wellness coach can provide an additional layer of security for practitioners, but again, I recommend speaking to an attorney directly to assess your specific circumstances.

Essential Technology for Your Online Practice

After practicing exclusively in the online space for almost five years and mentoring over 85 practitioners, I have found that the most challenging aspect of running a virtual practice is figuring out which technology and software to use.

My basic tech stack for virtual health consulting includes Zoom and Practice Better. With these tools, I have been able to conduct potent, effective, and streamlined consults while creating a space where my clients feel seen, heard, and understood. Of course, some of this depends on the type of practitioner you are and the environment you want to provide for your client.

In addition to a basic tech stack, we cannot deny that having a social media presence is a huge factor when growing a thriving virtual practice. One thing to remember, especially if you're just getting started with social media, is that quality is much more important than quantity. You do not need 10M followers to build a thriving virtual practice.

That all being said, social media content and marketing is a vast and entirely separate topic, but I can share a few of my favorite ways to manage the tech aspect. For planning, scheduling, finding hashtags, and analytics, I use Metricool. For graphics, quote cards, and putting text on photos, I love Canva.

Summary

Navigating the modern healthcare landscape can be daunting for health practitioners, but creating an online practice can help improve access, increase the quality of care, and expand the client base. This article discusses the qualifications and requirements for creating a thriving virtual practice, legal considerations, and essential technology for online practice. With the right tools and knowledge, health practitioners can provide compassionate care to clients from anywhere with internet access.

This article provides some of the foundational steps health practitioners can take to ensure they are running a successful virtual practice. It's important to have the right tools in place to manage clients and communications and understand the legal requirements of running an online practice. Having the proper certifications and qualifications can also set virtual practitioners apart and ensure they provide quality care to their clients. Finally, having a strong social media presence can boost visibility for the virtual practice and ensure it's reaching the right clients.

I am looking forward to seeing your smiling face in the online space!