Texas, it seems, is an anomaly.
That's the opinion of Jason Gorevic, CEO of Teladoc, whose company is locked in a nasty battle with the state's medical board over how to define the telehealth visit – or, to be more precise, how a doctor should "see" a patient. To wit: Does a doctor have to be in the same location as the patient, or is it acceptable to use a platform that encompasses online communications, the phone and even a video system?
The Texas Medical Board is taking a strict approach to telephone-based medical consults. At a Feb. 12 meeting, the board moved toward adopting a rule that would prohibit that type of interaction as a first meeting between doctor and patient, requiring instead that a doctor and patient first communicate in person or by video to establish an appropriate relationship (a separate rule expands telemedicine use for behavioral and mental health cases). The rule could become law following the board's next meeting in April.
Gorevic, whose Dallas-based company has doubled in size each of the last two years and now handles roughly 50,000 telehealth consultations each month across the country, has been at odds with the board since 2011. His argument has focused primarily on the point that a phone call can be used as a first point of contact for prescribing.
He also argues that the telephone is only part of the Teladoc platform.
"A telephone by itself is certainly one way of looking at it, but that's not what Teladoc does," he told mHealth News. "There's a lot of technology. We're doing it very, very effectively and very, very safely, and there is no data that says we're putting patients at risk."
Gorevic points out that Teladoc's physicians review all patient records online, as well as information submitted online by the patient, and that this data is used by the physician in prescribing medication through a telephone consult.
The Texas Medical Board disagrees. Writing in Lexology, Robert M. Wolin of the law firm of Baker & Hostetler said the board is dead-set against the practice of "PhysTexting." It first wants a "defined physician-patient relationship," he said, and defines that as “diagnosis through the use of acceptable medical practices, which includes documenting and performing: … (a) physical examination that must be performed by either a face-to-face visit or in-person evaluation … and appropriate diagnostic and laboratory testing.”
One aspect of this debate is the nation's patchwork of telehealth laws. Each state is allowed to establish its own rules and definitions, and "the regulation of medicine is one thing that states protect ferociously," Gorevic said. That means he has to work with the medical boards of each and every state to make sure Teladoc can operate there.
Some states openly embrace the telehealth platform. Others – not so much. Teladoc has suspended its operations in Arkansas and Idaho, but Gorevic said he's working with both states and expects new legislation that would expand the scope of telehealth to embrace models like Teladoc.
That leaves Texas; ironically Gorevic's home base. The state ranks 47th in the nation in physicians per capita, he points out, certainly an argument for more access to medical services through telehealth. He says it's "puzzling" that the state's medical board has taken such a hard-line approach.
Gorevic also feels there is "a lack of education and a lack of awareness" as to the scope and effectiveness of telehealth.
"Most (state medical boards) are trying to figure out how to encourage the proliferation of telehealth in a safe and effective manner," he said, pointing out that Alabama's board requires a waiver for telehealth consults, which Teladoc has obtained. In addition, he said, Teladoc has more than 100 clinical guidelines in place to guide its doctors on what can't and can't be done according to each state's regulations.
"This is something that is certainly growing," he said. "And it's been proven that patients want this."
