TMA-Supported Bill Clarifies Murkiness Surrounding Telemedicine
Charting the Texas Legislature: Telemedicine — August 2017
Tex Med. 2017;113(7):38–39.
By Joey Berlin
Over the past several years, static has clouded the screen displaying telemedicine's proper role in health care as musings, arguments, and litigation created a need for real clarity.
Now that the Texas Medical Association and other stakeholders put their collective heads together, the picture should clear up significantly.
On May 27, Gov. Greg Abbott signed Senate Bill 1107, which allows telemedicine practitioners in Texas to know their requirements when they serve patients via telephone or other audiovisual means.
"SB 1107 makes clear that a valid therapeutic relationship is the foundation upon which we can continue to develop innovative models of care through telemedicine, because at the end of the day, telemedicine care is health care and should be held to the same standards and guidelines," said Austin-based telemedicine internist and psychiatrist Thomas Kim, MD, who testified for TMA in support of the bill and helped craft its language. "With an agreeable framework, telemedicine can now emerge from the tall grass along the periphery and realize its long-standing potential to improve the timeliness, quality, and satisfaction of health care delivery here in Texas."
State Sen. Charles Schwertner, MD (R-Georgetown), the bill's author and chair of the Senate Health and Human Services Committee, brought the state's competing telehealth interests to the table for more than a year to negotiate the bill's principles. Rep. Four Price (R-Amarillo), chair of the House Public Health Committee, carried the bill in the lower chamber.
SB 1107 clarifies that the standard of care for a telemedicine visit is the same as when a physician sees a patient in person. The bill also gets to the heart of what's required to establish a legitimate relationship between practitioner and patient for the purposes of using telemedicine ― a point of contention that led to a still-active 2015 lawsuit between the Texas Medical Board (TMB) and telemedicine provider Teladoc.
The board told Teladoc in 2011 that a face-to-face examination of a patient was required before prescribing a dangerous drug or controlled substance. The dispute eventually took the form of the lawsuit in which Teladoc alleges TMB committed an antitrust violation. (See "Seeking Invalidation," April 2016 Texas Medicine, pages 51–57.) At press time, the case was on hold until September.
In June, after the passage of SB 1107, the Federal Trade Commission (FTC) announced it had closed its investigation into whether TMB violated federal antitrust law by adopting rules restricting telemedicine and telehealth.
In a statement, FTC commended lawmakers for overriding the TMB rules. "The Commission hopes … the new law will lead to many benefits for Texans, including increased competition among providers, more innovation in the delivery of care, increased access to health care services, reduced travel costs, and greater convenience," the statement said.
SB 1107 allows for the establishment of a valid practitioner-patient relationship through:
- Synchronous audiovisual interaction;
- Synchronous audio with asynchronous store-and-forward technology, which means the patient's clinical information is transmitted for review by a health professional at a different physical location than the patient; or
- Another form of audiovisual telecommunication technology that allows a physician to comply with the standard of care.
The bill also addresses insurer coverage for telemedicine services by requiring that health plans post on their websites an explanation of their payment practices for telemedicine. It also requires that services by a contracted physician be covered whether in person or via telemedicine.
"It does not require payment parity, but it does provide coverage parity," TMA lobbyist Dan Finch said. "And it's meant to include physicians who are under contracts to the plans to be able to participate in the provision of telemedicine services when the service can be provided and that service meets the standard of care."
Organizations that were instrumental in developing SB 1107 with TMA included the Texas e-Health Alliance and the Texas Academy of Family Physicians.
"Nowhere has telemedicine been more thoroughly examined and debated by all stakeholders than in Texas," Teladoc Chief Executive Officer Jason Gorevic said in a statement released May 19. "With the proven benefits that telemedicine has already demonstrated, and the rapidly expanding impact of virtual care, this telemedicine legislation should not only serve as the bellwether for all other states, but should be another indication for the federal government of the proven value of remote care models, benefiting patients across the country and the U.S. healthcare system as a whole."
Joey Berlin can be reached by phone at (800) 880-1300, ext. 1393, or (512) 370-1393; by fax at (512) 370-1629; or by email.