Health Insurers Must Cover Physician Telephone Consultations

TMA Testimony by Thomas J. Kim, MD, MPH

House Insurance Committee
House Bill 2017
March 26, 2013

Good afternoon, Chairman Smithee and members of the committee. My name is Dr. Thomas Kim. I’m an internist and a psychiatrist here in Austin who develops, evaluates, and practices telehealth solutions. Today I’m testifying on behalf of the Texas Medical Association (TMA) consisting of 47,000 physicians and medical students in strong support of House Bill 2017.

First, I want to thank the chair and committee members for the opportunity to testify today on the use of telephone consultation with patients in Texas. Advances in technology including broadband Internet, smart devices, and social media have created an incredible level of connectedness. But even with the growing number of ways to share, message, or connect, the telephone continues to serve as an important way to communicate with one another, including health care service delivery.  

Even for a physician like me who takes full advantage of all communication technologies, I still rely on my phone to care for my patients. The nature of my calls can vary from simple medication questions to exploring whether a patient should go to the emergency department. In every case, being available by phone ensures my patients are supported in challenging circumstances such as after hours. Without telephone support, patient care can suffer in terms of rising costs and diminished quality of care. I am not alone in this, as many of my colleagues practice in this way.

In addition to being a common practice, telephone consultations are also extremely valuable. This issue reminds me of two encounters within a juvenile detention center I service. The first involved one of my patients who expressed suicidal thoughts late one afternoon. I happened to be out of town at a conference, but was able to work with my team by phone and quickly determine that the youth was upset and not suicidal, thereby avoiding a costly emergency department visit. The second involved a youth bailed out of the center by family immediately following my initial evaluation. The youth’s departure created a high-risk continuity gap, as there was no time to develop a discharge plan. Again with the use of phones, my team and I were able to identify the resources to ensure the youth received the care needed and hopefully reduced his risk of recidivism. In both cases, telephone consultation demonstrates incredible value with containing costs and ensuring high-quality care.

Insurance companies do, however, engage certain vendors with exclusive relationships to provide after-hours telephone access to physicians who aren’t necessarily part of the care team. While this is good, evidence to support how technology can improve care access, reduce costs, and improve quality, disallowing payment for this same activity with the actual care providers strikes me as running counter to the TMA mission of caring for all Texans. HB 2017 seeks to highlight the need for and value of parity with respect to telephone consultation payment. HB 2017 also aligns with current initiatives to develop cost-effective and coordinated care models by supporting community physicians with a coordinated means of caring for their patients.

By establishing parity for telephone consultation payment, all parties involved can realize value. Avoidable costs are removed from the system, patient satisfaction improves by lowering the access bar, quality of care rises with improved patient engagement, and community practices become more sustainable and potentially more effective. 
In closing, I ask that you support HB 2017 in order to support our community physicians willing and interested in providing adjunctive telephonic services. In doing so, HB 2017 will not alter the standard of care associated with the statutory and regulatory framework currently in place for telephonic services, specifically, demonstrating an established therapeutic relationship between patient and physician.

I’d be happy to answer any questions at this time.

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