Why is Texas Restricting Telemedicine?

Telemedicine offers convenience and cost savings to providers and patients.
Telemedicine offers convenience and cost savings to providers and patients.

Most states are expanding consumer access to telemedicine.

Patients, insurers, and employers like telemedicine because it saves time and money. Many doctors like telemedicine because it helps lower their overhead costs. But the state of Texas recently issued a new rule that would effectively put the brakes on telemedicine expansion in the state.

As a result, supporters of the rule are defending the actions of the Texas Medical Board while business groups and telemedicine providers have expressed strong disapproval of the changes. If the new rule is not struck down in court, it will go into effect in June of this year. Though telemedicine has been practiced in Texas for many years, the new rule will restrict it – a move that is in contrast to the actions of many other states, which are working to expand telemedicine access.

New Ruling by the Texas Medical Board

The Texas Medical Board has always required that doctors establish a relationship with patients before they can render a diagnosis or prescribe drugs. On April 10 of this year, however, the Board more clearly defined what it means by “establish a relationship with patients.” Specifically, the Board stated that doctors cannot establish a doctor-patient relationship via “questions and answers exchanged through email, electronic text, or chat or telephonic evaluation of or consultation with a patient.”

Texas already limited many telemedicine visits to patients who were in a healthcare setting, such as another doctor’s office, clinic, or hospital, and who had a physician on location with them. The new rule further restricts the practice of telemedicine.

Texas Medical Association Backs the New Rule

Texas’ new restrictions on telemedicine are supported by the Texas Medical Association (TMA). In an earlier letter from the TMA to the Texas Medical Board, the TMA said that restrictions on telemedicine were necessary for the protection of patients and to ensure that telemedicine “complements the efforts of local healthcare providers.”

The Federation of State Medical Boards has a different opinion on what constitutes a doctor-patient relationship. The Federation says that a physician-patient relationship is established “when an individual with a health-related matter seeks assistance from a physician who may provide assistance.” In other words, when a physician agrees to diagnose and treat a patient, and when a patient agrees to be treated, a relationship is established, whether in-person or electronically.

Texas Association of Business Opposes the New Rule

At a public hearing on the new rule in early April, Texas Association of Business CEO Bill Hammond criticized the proposed rule. In fact, most of the people at the hearing spoke out against the rule change. Said Hammond, “This proposal is bad for business, bad for health care, bad for consumers.” He also said it would be like driving a stake through the heart of Texas telemedicine at the exact time when consumers and small businesses are looking for innovative ways to curtail healthcare spending.

Growth in telemedicine has been unprecedented, with studies estimating that tens of millions of telemedicine visits took place in 2014, and predicting that hundreds of millions of telemedicine visits per year may eventually take place. More employers offer employees telemedicine consultations, and many more want to offer telemedicine as a perk within the next few years.

Long-Running Battle Between Texas and Teledoc

The recent rule change by the Texas Medical Board was far from the first shot fired between opponents and supporters of telemedicine in Texas. In 2011, Dallas-based telemedicine company Teledoc was threatened with discipline by the Board for prescribing medications to patients that had not established an in-person relationship first. Teledoc responded with a lawsuit, accusing the Board of making rules changes without due process. A Texas appeals court sided with Teledoc, prompting the Board to go through its formal rule changing process to issue the recent ruling. Teledoc hopes to expand its services throughout the US, and promotes itself as a convenient, cost-effective alternative to emergency rooms and retail urgent care clinics.

Teledoc Files Suit to Stop New Rule

Telemedicine provider Teledoc has sued the Texas Medical Board multiple times.
Telemedicine provider Teledoc has sued the Texas Medical Board multiple times.

Teledoc has also just filed another lawsuit against the Texas Medical Board asking for an injunction against the new telemedicine rule. This antitrust lawsuit alleges that the Board did not enact rule changes out of concern for patient safety, but out of concern over a competitive threat to physicians.

Teledoc President and CEO Jason Gorevic said, “It is clear that the (Texas) medical board acted only when Teledoc consultations became sufficiently numerous to be perceived as a competitive threat to brick-and-mortar physician practices.” Further, he stated that “not one shred of data was presented during the medical board’s comment period to support the position that telehealth poses a patient safety risk.

A Move Toward Streamlining Interstate Physician Licensing

The Federation of State Medical Boards has started an interstate compact for streamlining physician licensing, one of the biggest barriers to telemedicine expansion, since doctors are licensed on a state rather than national level. Utah and Wyoming have joined the interstate compact, and several other states, including Idaho, Montana, and West Virginia, have passed legislation authorizing their respective state medical boards to enter into the compact. These states, all of which have large rural and remote populations, are eager to embrace telemedicine to expand access to medical care for those who would otherwise have to travel long distances to receive medical services.

Once seven states enter into the compact, it will help deal with redundant physician licensing requirements by offering one place for physicians to submit credentials and other information in order to be licensed in multiple states.


Despite the opposition to unfettered telemedicine expansion by the Texas Board of Medicine, telemedicine is expanding rapidly throughout most of the country. Many state legislatures are tackling issues of defining how telemedicine will be practiced and how it will be reimbursed by private insurers and Medicaid. On the national level, expansion of Medicare reimbursement for telemedicine is ongoing as Medicare realizes the potential for savings and convenience that telemedicine offers.

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