One of the final stumbling blocks to the unfettered expansion of telemedicine services nationwide was removed in late May with the signing of landmark Texas legislation. The new law abolishes a regulation that required an in-person patient-physician relationship before telemedicine services could be provided.
In signing the telemedicine bill into law, Texas Gov. Greg Abbott put an end to a long-running feud between the Texas Medical Board, which first promulgated the regulation, and a number of nationwide telemedicine providers, some of which are based in Texas.
More broadly, the new Texas legislation paves the way for large telemedicine providers to operate across state lines, providing services to patients in need regardless of where they might live and by medical professionals who could be based virtually anywhere in the United States.
Obstacles Remain in Two States
As this is written, two other states — Arkansas and Idaho — currently have regulations that limit the provision of telemedicine services by telephone only. However, they do allow video hookups and other forms of telemedicine, and both these states are much less populous than Texas and have regulations that are less draconian than those that were in force in the Lone Star State until recently.
Back in 2011, the 19-member Texas Medical Board began restricting the growth of telemedicine services by ruling that patients seeking telemedicine services must first have an in-person relationship with the medical professional providing those services.
This severely hampered the growth of telemedicine in the Lone Star State because it essentially required that patients living in Texas could receive telemedicine services only from physicians operating in the state. Among the most outspoken opponents of this new regulation was Teladoc, a nationwide telemedicine provider based in Dallas.
Rule Subject to Varied Interpretations
According to an article posted at MobiHealthNews.com, the TMB regulation as originally formulated primarily addressed telemedicine interaction via video hookups between patients and medical professionals. Citing this obvious loophole in the regulation, Teladoc maintained that it was free to provide telemedicine services to Texas patients via telephone, as was its primary mode of operation anyway.
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Not so fast, countered the TMB, which said that while its original regulation didn’t specify telephonic interaction, the clear intention of its new rule was to prohibit any form of telemedicine between parties that had no prior relationship. Ignoring the protestations of the TMB, Teladoc continued to provide telemedicine services via telephone to Texas residents.
Emergency Rule Issued
Angered by what it perceived as Teladoc’s flaunting of its regulation, the Austin-based medical board sent the telemedicine provider a public letter asking that it cease and desist providing telephonic consultations. The board followed that up by issuing an emergency rule to clear up any ambiguities that might arise about the intent of its original regulation.
Teladoc then went to court to protest the medical board’s re-interpretation of the rule in a letter, suggesting that the new interpretation constituted a new rule in and of itself. Furthermore, said the telemedicine provider, this new rule was promulgated in violation of the state laws governing rulemaking.
Teladoc Files Antitrust Suit
The legal standoff between the medical board and Teladoc escalated even further in April 2014 when the telemedicine provider sued the TMB over antitrust laws. Teladoc claimed that the board — made up of 19 members, 12 of whom are practicing physicians — shouldn’t be allowed to pass regulations restricting telemedicine because such action served to limit competition that the majority of its members faced in the marketplace.
In an interview with MobiHealthNews, Jason Gorevic, Teladoc’s president and chief executive officer, said that his company saw no alternative but to go to the courts in an effort to protect its clients’ rights to avail themselves of its services. He said the company saw the protection of those rights as its responsibility as a leader in the telemedicine sector.
Ultimately, said Gorevic, “we stepped up and took a stand, and we didn’t see any of our competitors doing the same thing.” It was a costly decision by Teladoc, he said, but one that won influential support when the Federal Trade Commission, the principal federal enforcer of antitrust laws, filed a friend-of-the-court brief in support of Teladoc.
The litigation dragged on for roughly two years, but eventually the two sides decided to seek a compromise settlement and late last year petitioned the court for a stay in the case. The law signed by Gov. Abbott late in May 2017 effectively brings to a close the ongoing legal battle between Teladoc and the medical board. It also opens the way for Texas residents to freely seek the telemedicine services offered by Teladoc as well as other telemedicine providers operating in Texas.
Texas’s Resistance Surprising
In many ways, said Gorevic, Texas seemed an unlikely state to restrict telemedicine services. He pointed out that the sprawling Lone Star State has 35 counties without the services of a single family physician. It is in such remote areas that telemedicine can bridge the gap between the growing demand for medical services and the static or dwindling supply of traditional medical professionals.
According to Gorevic, Texas ranks “46th in the country in terms of primary care physicians per capita at a time when the state’s population is growing faster than any other state. So the access issues are particularly acute.”
Texas Now Open to All Forms of Telemedicine
Under the legislation signed into law by Gov. Abbott, physicians can treat Texas patients via telemedicine provided they take into account previous medical records and test results. Under the law, such services will be paid for and reimbursed by insurers the same as in-person consultations.
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As the legal battle between the TMB and Teladoc raged over the last several years, Teladoc and MDLive continued to offer telephonic consultations to Texas patients based on Teladoc’s interpretation of the medical board’s original rule. Also operating in the state during this period was American Well, which cooperated with hospitals to provide follow-up care, and Doctors on Demand, which provided mental health services, permissible under an exception in the TMB’s regulation.
However, with the enactment of the new law, all four major telemedicine providers will now be able to offer Texans the full range of telemedicine services, and additional entrants to the market will be welcome.
Last Such Barrier to Fall
Texas was the last state to prohibit the provision of telemedicine services to state residents who had not first established an in-person relationship with the provider. The removal of this obstacle will clear the way for robust telemedicine growth in the state and across the nation as well.
To many observers, telemedicine offers a convenient and cost-effective way to deal with routine medical issues, increasing the time medical professionals and hospitals have to tackle more urgent health matters.
If you would like to read more about the growth of telemedicine and what it might mean for you, as well as other topics of consumer health interest, check out our blog.
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