Patient/Physician Relationship Needed in Telemedicine

Testimony by Doug Curran, MD

House Insurance Committee
House Bill 1806
May 19, 2013

Good afternoon, Chairman Smithee and members of the committee. My name is Dr. Doug Curran. I’m a family practice physician in Athens and member of the Texas Medical Association’s Board of Trustees.  Today I’m here representing TMA consisting of more than 47,000 physicians and medical students. I am testifying on House Bill 1806.

First I want to thank the chairman and committee members for the opportunity to testify today on the use of telemedicine in Texas. As a family physician in rural Texas, I use telemedicine to ensure my patients get the care they need. The operable words here are “my patients.” I know every single one of my patients that I treat using telemedicine. Many of these patients I’ve known for decades. I frankly don’t know how any physician could provide high-quality care over the phone to a patient the physician does not know or has not seen in person. That’s why we have several concerns about this bill in its current form.

As currently drafted, House Bill 1806 conflicts with and circumvents the sound public health and welfare protections adopted by the Texas Medical Board (TMB). Proposed changes could affect patient safety and quality of care for these reasons:

  1. The bill creates a new standard of care for telemedicine in the Insurance Code, which conflicts with the Medical Practice Act and TMB rules;
  2. It contains an overly broad definition of telemedicine, which does not contain necessary elements to address scope of practice and the specific exclusion of telephonic services;
  3. It does not require a distant site presenter;
  4. It allows a physician assistant or advanced practice registered nurse to provide telemedicine services, and as written, would permit those providers to make a diagnosis, which is outside the scope of practice of their licenses; and
  5. It specifically allows the creation of a patient-physician relationship during an initial encounter by telemedicine, which is not in accordance with the standard of care.

TMA supports current telemedicine medical services law.

TMB promulgated telemedicine rules pursuant to the Texas Medical Practice Act to ensure medicine is practiced consistent with public health and welfare.  The TMB rules on telemedicine medical services are comprehensive and were adopted after thorough stakeholder input. These rules address the requirement of a prior patient-physician relationship, protection of privacy, adoption of protocols to prevent fraud and abuse, the use of a patient site presenter, and the delegation of tasks and activities to a patient site presenter during a patient encounter. TMA recommends the following amendments to HB 1806 to ensure patient safety and high quality care:

  1. Ensure telemedicine services are provided in accordance with TMB rules and the traditional standard of care.
  2. Establish requirements for a true face-to-face consultation between a patient and a physician providing a telemedicine medical service.
  3. Establish a referral network and follow-up care for the patient from the physician providing the care.
  4. Establish requirements for a patient to continue to receive care from the same physician who provided the telemedicine medical service.
  5. Establish standards for adequate physician delegation and supervision of nonphysician health care professionals who assist in the provision of telemedicine services as distant site presenters.
  6. Establish the maximum number of heath care professionals to which a physician may delegate and supervise through a telemedicine medical service.
  7. Reinstate the repealed definitions of telemedicine and telehealth from section 57.042, Occupations Code, by placing those definitions in Chapter 1455, Insurance Code.
  8. Add language that would prohibit discrimination against local physicians willing to provide the same level of after-hours access whether through telephonic consultation or in-person visits.

We would like to work with the chairman and committee to develop a committee substitute that fosters telemedicine services that ensure access to care for more Texas patients and one that ensures health care dollars are spent locally, remaining in Texas communities to sustain care and access for patients.

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