The medical establishment and telemedicine providers have a certain degree of wariness about each other.
While many doctors see the benefits of telemedicine in terms of cost and time savings and the potential for better follow-up compliance among patients, they have concerns. For example, will insurance companies reimburse them for telemedicine care as they do for in-person care? In some states, the answer is yes, since many state legislatures have enacted telemedicine parity laws, but that’s not the case everywhere.
Telemedicine providers worry that state medical boards will place so many restrictions on telemedicine that it might not be worth providing in some locations. The Texas Medical Board, for example, issued a rule earlier this year that would restrict telemedicine care in that state.
In early June, physicians and medical students gathered in Chicago for the 2015 American Medical Association (AMA) Annual Meeting, and telemedicine was a topics of discussion.
Fate of Telemedicine Ethics Guidelines
The AMA House of Delegates had planned to vote on proposed ethical guidelines for telemedicine during the meeting, but ultimately they chose to table the guidelines for later. The guidelines were based on a report put together by the AMA Council on Ethical and Judicial Affairs (CEJA) and focused on topics like patient privacy and telemedicine limitations.
Though many doctors spoke up in support of the guidelines, one delegate spoke up for the new rules established in Texas earlier this year that require patients to have an initial in-person consultation before receiving telemedicine services from a particular physician. In Texas, the Medical Board ruling did allow for an initial consultation via secure video conference, but only for patients located in a healthcare setting in the presence of a clinician who could interact with the consulting doctor.
What’s Currently Going on in Texas
After issuing its new regulations last spring, the Texas Medical Board was the recipient of backlash from Texas business groups and medical professionals who support expansion of telemedicine in Texas due to the state’s enormous size and large rural areas. In addition, a Supreme Court ruling having to do with tooth whitening kiosk restrictions in North Carolina could be the undoing of the Board’s rules, as the high court said state professional boards could not issue rulings that would serve to restrict competition with their profession.
A Dallas-based company called Teladoc, a leading telemedicine services provider, filed suit against the Texas Medical Board and got an injunction preventing the new rule from going into effect when it was supposed to. Teladoc and the Texas Medical Board have butted heads in the past over telemedicine, with Teladoc prevailing so far in every case. But that didn’t stop the Texas delegate at the AMA meeting from getting the House of Delegates to table their telemedicine ethical guidelines for the time being. The reasoning was, the AMA ethical guidelines could create a conflict with doctors in Texas, depending on how the litigation there is decided.
Best Practices for Medical Mobile Apps
But the AMA meeting didn’t shy away from telemedicine technology altogether. The organization was able to create a policy having to do with best practices in the development and use of mobile medical apps, which will eventually play a bigger role in telemedicine provision. An increasing number of physicians and patients use mobile medical apps for things like managing chronic conditions.
The marketplace for mobile medical apps is expected to expand quickly, particularly with the growing use of wearable devices like the FitBit that are able to monitor certain health-related characteristics like heart rate. In fact, the US Food and Drug Administration (FDA) says that half a billion smartphone users throughout the world will use a mobile medical app in 2015, and that number will rise to 1.7 billion worldwide by the year 2018.
Development of best practices for mobile medical apps may not have a big effect on telemedicine in the US right away, but the effect could be more pronounced as telemedicine use grows and more people invest in wearable mobile devices.
What Might Happen Next?
Much depends on whether the lawsuit between Teladoc and the Texas Medical Board is decided before November. That’s when the next interim meeting of the AMA House of Delegates is scheduled to take place in Atlanta, and it’s the next opportunity for the House of Delegates to vote on the proposed ethical guidelines that they voted to table in June.
Right now it’s up in the air whether the CEJA will bend to pressure from supporters of Texas’ strict telemedicine rules, or whether it will take an approach that is more in keeping with the inexorable rise and increased acceptance of telemedicine. Telemedicine providers using service models that don’t require an initial in-person encounter before telemedicine services can be rendered will be monitoring the lawsuit in Texas and the House of Delegates decision in Atlanta this autumn.
Teladoc’s Upcoming IPO
Teladoc does not seem very worried about the rules the Texas Medical Board established. They filed documents for an initial public offering (IPO) in April, though no date has been set for the IPO launch. The company hopes to raise $137 million, and has already been successful in previous rounds of raising venture capital. Teladoc serves large employers, offering telemedicine services on a subscription basis. Many employers have enthusiastically signed up in an effort to keep employee healthcare costs down and to reduce absenteeism. The company expects 2015 revenues in the neighborhood of $75 million based on first quarter results.
The fact that the AMA is tackling ethical guidelines for telemedicine bodes well for further adoption of telemedicine in the US. The issue won’t be resolved until certain things happen, in particular the outcome of the lawsuit between Teladoc and the Texas Medical Board. Once that outcome is known, developing ethical guidelines for telemedicine should be more straightforward.
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