The battle over telemedicine in Texas rages on, with the state moving to prevent doctors from treating new patients via telephone.
The Texas Medical Board ruling, adopted at an April 10 meeting and due to take effect on June 3, gives the state the distinction of having one of the most restrictive telemedicine laws in the country. The amended law prohibits “questions and answers exchanged through e-mail, electronic text, or chat or telephonic evaluation of or consultation with a patient” until the doctor and patient have established a face-to-face relationship.
The move caps a four-year battle with Dallas-based Teladoc, one of the nation's largest telemedicine providers. The company reportedly does 90 percent of its business by phone, and says an estimated 2.4 million Texans will lose access to much-needed healthcare services through the rule.
Company CEO Jason Gorevic blasted the board's decision in a letter:
"Unfortunately, the Texas Medical Board’s decision to adopt a new rule takes away Texans’ access to a safe, affordable and convenient healthcare option that many have depended upon for more than a decade," he wrote. "As Texas’ population booms, health care expenses climb, and the shortage of primary care physicians grows, telehealth is a solution for patients dealing with common, non-emergency issues. This rule change only serves to intensify these problems without providing any benefit to Texans."
"As written today, the new rule also outlaws the longstanding practice of physicians providing traditional on-call services for one another, affecting every physician and patient in the state," he continued. "(This is) one of many unintended consequences of this change. If the rule change takes effect this summer, it will represent a huge step backward for Texas. California, Colorado, North Carolina, Kentucky, Virginia and dozens of other states have found solutions that embrace telehealth, and all of its benefits, while ensuring patient safety."
"We are hopeful that legislative leaders in Texas see the urgency in protecting patients and physicians and will be similarly forward-thinking and take action to deliver the benefits of telehealth in Texas," he concluded.
The Texas Medical Association has come out in support of the law, saying it “supports the use of telemedicine that can provide safe, high-quality, timely care, (but safeguards are needed) to protect patients and ensure telemedicine complements the efforts of local health care providers.”
The American Telemedicine Association, meanwhile, is questioning whether it's too much.
"(M)ost of the proposal takes the board deeper into an overly prescriptive, complicated and convoluted morass regulating a physician's use of telemedicine tools," ATA CEO Jonathan Linkous wrote in an April 8 letter to the board. "Such policies can only lead to limiting patient access, increasing costs and decreasing the quality of care for the residents of Texas. All healthcare students are taught primum non nocere, 'First, do no harm.' We are concerned that the proposed policies, although well intentioned, will violate that principle."
According to POLITICO, the Texas eHealth Alliance also took a stand different than Teladoc's. The alliance, which supports healthcare technology, told the board it sees a difference between "a video consultation done with the appropriate level of technology as needed, and ... as the rule states, 'An online questionnaire or questions and answers exchanged through email, electronic text, or chat or telephonic evaluation of or consultation with a patient.' This latter approach does not meet the definition of telemedicine as our organization recognizes it."
Only one member of the board voted against the new legislation, according to the New York Times. Frank Denton, an investment banker from Houston, said telemedicine was "the least desirable" method of delivering healthcare, but felt "the public should have the right to use that option."
Another board member, Austin physician George Willeford, said he worried that telemedicine would weaken doctor accountability to their patients unless properly regulated. "I'm terribly, terribly worried about the absence of responsibility and accountability," he was quoted in the Times.
