The Texas Medical Board (TMB) delivered on its promise of a new set of rules defining the do’s and dont’s for the practice of telemedicine. The issue has been a highly charged one because the TMB has been in litigation with a private company related to the use of commercial telemedicine in the state. The aforementioned company has much at stake, with over $15 million in annual revenues from their practice in Texas alone, where they have provided care for over 140,000 clients.
The primary controversy has been related to the physician-patient relationship. The TMB has insisted that telemedicine services should be limited to patients with an established doctor-patient relationship through a face-to-face encounter. The use of phone service consultations for the delivery of health care to a patient unknown to the treating physicians and the lack of ability to offer follow-up services to the patient have been points of concern to the medical board.
The company had the following to say in an April 10th article from the Houston Chronicle: “Unfortunately, the Texas Medical Board’s decision to adopt a new rule takes away Texans’ access to a safe, affordable and convenient health care option that many have depended upon for more than a decade. 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.”
However in the same article, TMB President Dr. Michael Arambula is quoted as saying, “The rules represent the best balance of convenience and safety by ensuring quality health care for the citizens of Texas. However, a telephone medicine scenario that allows a physician to treat an unknown patient without any objective diagnostic data and no ability to follow up with the patient sacrifices the patient’s safety for convenience.”
In testifying against the rule, Bill Hammond, CEO of the Texas Association of Business, said, “There’s no question whatsoever that this is about doctors protecting other doctors’ income. It’s about dollars. It’s not about better health care. This regulation would be a death knell for telehealth.”
But on closer inspection, the policy may not be as bad as some would portray it. It in fact does expand access to telehealth technology to a greater audience. At the crux of the argument are massive amounts of misinformation confounded by generational and knowledge gaps in understanding the application of teletechnology. Many of the opponents to the expansion of telemedicine services largely base their argument on their perception that the quality of services is inferior to traditional office visits and see problems with the lack of an established doctor-patient relationship.
On the other side, proponents of the expanded use of telemedicine feel like traditional physicians are trying to protect their geographic turf and insulate their patients from intrusion of specialists. These individuals also see the benefits of the use of telemedicine’ including improved in quality of services, improved access, and decreased patient costs.
This week has also been “telemedicine bill week” at the Capitol. Multiple bills have been heard in the House Public Health Committee related to expansion of telemedicine services as the technology continues to be recognized for its potential to deliver health care and mental health services to hard-to-reach parts of the state in both an effective and cost-efficient manner.
Working in collaboration with the Office of Health Policy & Legislative Affairs, UTMB’s Dr. Alexander Vo, Vice President, Telemedicine and Health Services Technology, has created an effective working relationship with the TMB, the Health and Human Services Commission, and members of the Legislature regarding the expanding frontiers of telemedicine and health population management. Dr. Vo’s pioneering work in the area of telemonitoring in the management of population health is positioning UTMB to become more aligned with government programs that base reimbursement on improvement of patient health outcomes.
To reconcile the misunderstandings associated with the media’s reporting of the TMB’s actions this past week, the board put out the following press release.