Blowback Hits Texas Over Anti-Telemedicine Measures

One of the biggest advantages of telemedicine is healthcare access for people in remote areas or who don’t have access to transportation.

Many lawmakers and medical professionals believe telemedicine is particularly useful in underserved areas and in large rural regions, like parts of Texas. But not everyone is enamored of telemedicine. Some physicians’ groups and state boards complain that telemedicine will reduce the standard of care because doctors simply cannot deliver the same quality of medical services over a distance as they can in person.

A growing number of people are embracing telemedicine, however. Today’s secure broadband video conferencing technology along with remote monitoring tools allow doctors to evaluate patients remotely and provide care that many patients might not otherwise receive. In Texas, the state Medical Board recently fought back against telemedicine providers and has received harsh criticism for it.

What Happened in Texas?

Earlier this year, the Texas Medical Board (TMB) issued a rule that only a physician who has encountered a patient in person can interact with them remotely. That means that Texans who use telemedicine service providers like Teladoc could be out of luck. The rule does allow for limited exceptions. For example, if a patient were at a medical clinic, a doctor in another clinic could assist with diagnosis by video conference. Also, remote mental health visits are allowed.

The executive director of the TMB, Mari Robinson, says the rule is not designed to quash competition, but to ensure patient safety. Not only is the Board receiving push-back from consumers and telemedicine providers, they may have trouble due to a recent Supreme Court ruling having to do with what state boards are and are not allowed to do.

Who Supports the TMB Rule and Why?

The Texas Medical Association, and other groups that represent Texas physicians support the ruling by the TMB. These groups also cite concerns over patient safety. The Texas Medical Association said in a letter to the board that it “supports the use of telemedicine that can provide safe, high-quality, timely care,” and that safeguards are essential “to protect patients and ensure telemedicine complements the efforts of local health care providers.”

Professor of medicine and biomedical informatics at Vanderbilt University Blackford Middleton, MD, says he believes the TMB made the right ruling, telling Medscape Medical News, “The rule of thumb always was you can’t provide care for a patient over the phone or any other way unless you have an established clinical relationship. I would stand by that to this day.”

Who Opposes the New Rule?

Telemedicine provider Teladoc is the most vocal opponent of the new TMB ruling. CEO Jason Gorevic says the new rule is strict enough that it would prevent doctors from covering for one another’s patients by phone, though the TMB says that’s not the case.

The Texas Association of Health Underwriters argues that the ruling opposes existing insurance law in the state. In a press release, the Association said, “The new rule, which is scheduled to become effective on June 3, goes against §1455.004 of the Texas Insurance Code which reads: ‘A health benefit plan may not exclude a telemedicine medical service or a telehealth service from coverage under the plan solely because the service is not provided through a face-to-face consultation.’”

Many consumers and businesses aren’t happy with the TMB ruling either, according to Teladoc. Chief legal officer Adam Vandervoort said that the TMB “failed to produce evidence during their rulemaking process to support the position that telehealth poses a patient safety risk. Additionally, the board offered no evidence of any harm done by telehealth during the federal court proceeding in opposition to Teladoc’s request for an injunction.”

Teladoc’s Lawsuit Against the TMB

On April 29, Teladoc filed a lawsuit against the Texas Medical Board demanding injunctive relief from the new rule, a declaration that the TMB’s rules are invalid and unenforceable, as well as “other relief as the nature of this case may require or as the Court deems just and proper.”

According to the suit, consumers want changes to the traditional model of medical care “that requires them to book an appointment days or even weeks in the future, travel to the designated location at the scheduled time, remain in a crowded waiting room at the mercy of the physician’s convenience, and pay a non-negotiable and ever-increasing price.” Telemedicine is preferable to many consumers, says Teladoc.

The suit alleges that the TMB has taken a series of anticompetitive actions in order to restrict competition, and that they did so in the face of overwhelming opposition. Of 206 written comments regarding the new rule, 203 of them opposed it, according to the lawsuit, because it would severely restrict telemedicine access in Texas, raise prices, and reduce access to care. Furthermore, of the three letters supporting the new rule, two were submitted by the Texas Medical Association.

Teladoc alleges that the rule does not accomplish any legitimate objective, and the only people to benefit from it will be established office and hospital-based physicians who would benefit from less competition should telemedicine be restricted in Texas.

Judge Delays TMB Rule Going into Effect

Judge Robert Pitman, US District Court for the Western District of Texas issued an injunction preventing the new rule from going into effect until the lawsuit with Teladoc is resolved. When issuing the injunction, Pitman indicated that Teladoc has a good chance of succeeding in demonstrating that the new rules would illegally limit competition. The injunction is the sixth occasion over the past four years in which Texas courts have sided with Teladoc against the Texas Medical Board.

By the time the lawsuit between Teladoc and the Texas Medical Board is concluded, Teladoc will probably be have gone public, and if it’s after November, the American Medical Association may have rendered its own telemedicine guidelines, some of which conflict with the TMB ruling. If history is any indication, Teladoc seems likely to prevail in court, expanding rather than curtailing telemedicine practice in Texas.

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