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Texas Puts Brakes on Telemedicine

Country’s largest provider files lawsuit

On a recent trip to Chicago, Patti Broyles felt like she was looking at the world from the bottom of a fish bowl.

Since she wasn't near her primary care doctor in Dallas, she called Teladoc, the largest telemedicine provider in the U.S., for advice. Patients whose employers or insurers have deals with the Dallas-based company can call any time and be connected with a physician on duty within minutes.

Broyles said the doctor on the call gave her a prescription for antibiotics that soon cleared up her sinus infection.

In Texas, hundreds of employers offer Teladoc’s services to more than 2 million employees. Nationwide, Teladoc reaches 11 million people.

But new rules from the Texas Medical Board could make it a lot harder for people like Broyles to get antibiotics through the service, according to a report from Kaiser Health News. In response to the board’s restrictions, Teladoc has filed a lawsuit that accuses the medical board of artificially limiting supply and increasing prices.

“The rules, as they’re written today, only allow a physician who has seen a patient in person to interact with them remotely,” Jason Gorevic, Teladoc’s chief executive officer, said. “That’s basically saying you can’t go shop anywhere else.”

The rules do allow for certain exceptions that would permit a physician to diagnose or prescribe medications via phone or video. It would be OK, for example, if the patient were at a medical clinic, or another health care worker were with the patient and could do a surrogate exam. There’s also an exemption for remote mental-health visits.

Mari Robinson, executive director of the Texas Medical Board, told Kaiser Health News that the rules aren’t meant to stifle competition, but to ensure patient safety.

“How can a physician make an accurate diagnosis when they have no objective diagnostic data?” Robinson asked. “All they have is what the patient has told them.” And that’s not enough information, she says.

“No one would think if they showed up at their doctor’s office they would go back to a room, have the doctor stand on one side of the door, they would stand on the other, tell the doctor their symptoms and the doctor would slip a prescription under the door. No one would think that was good care,” Robinson said. “That is exactly the same as doing it over a telephone.”

While the Texas Medical Board doesn’t think it’s good practice for patients to send photos, videos, and text messages to unfamiliar doctors, attorney Rene Quashie points out that other states permit all those activities.

“There’s a huge underinsured population in Texas,” Quashie said. “Even people who have insurance, sometimes have problems accessing care. So we’re balancing access to care along with patient safety issues — misdiagnosis and over-prescription. But we also want to allow companies to innovate in this space.”

Access to doctors is the main reason insurer Blue Shield partnered with Teladoc in California. Executive vice president Janet Widmann said that, at first, telemedicine was meant to help rural members reach specialists, but it has grown beyond just the rural market. By next year, 800,000 of the 3.5 million Blue Shield members will be able to use Teladoc in California.

In Texas, the medical board has already received more than 200 comments on the change of rules. It says key players, such as the Texas Medical Association, support the stringent rules. Teladoc points out, on the other hand, that the majority of the comments opposed the new rules. The rules governing virtual visits were supposed to go into effect June 3 but have been delayed until the case goes to trial, Kaiser says.

Source: Kaiser Health News; June 2, 2015.

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