Testimony by Thomas Kim, MD, MPH
Committee on Public Health
Testimony on House Bill 2697
March 28, 2017
Good morning, Chairman Price and members of the committee. My name is Dr. Thomas Kim. I’m an internist and psychiatrist here in Austin who develops, evaluates, and practices telehealth and telemedicine. Today I’m testifying on behalf of myself and the Texas Medical Association, representing more than 50,000 physicians and medical students in strong support of House Bill 2697.
As you know, Texas has long been a leader in telehealth and telemedicine. House Bill 2697 and Senate Bill 1107 seek to codify the practice of telehealth and telemedicine, as they represent a meaningful solution to many of the health care challenges Texans face today.
One comment before continuing about the definitional distinctions that HB 2697 draws between the terms “telehealth” and “telemedicine”: To save a bit of time and narrow my testimony’s focus, I will use the term “telemedicine” as I testify on the appropriate use of technology by my peers in service to a patient’s health and wellness.
This bill represents more than a year of collaborative effort by stakeholders from professional associations, industry groups, health systems, and others. This coming together of groups from all corners of health care demonstrates an agreement in what telemedicine is and, by extension, is not.
Let me begin by stating that telemedicine IS NOT a silver bullet that can solve all the challenges we face resulting in Texas being ranked in the bottom quartile of health system performance1 and bottom fifth of care quality measures2. I believe we can do better.
Telemedical care IS medical care. Full stop. This is the first of two objectives that HB 2697 seeks to codify.
When I began working in telemedicine more than a decade ago, most people viewed my practice as something peripheral to and different from conventional care. And over the course of my career, I am so very grateful for the countless opportunities to have been the right physician at the right time with the right information because of telemedicine.
I often compare the history of telemedicine with that of emergency medicine. We used to toss crash victims from a racecourse into a repurposed hearse and transport them to a general practitioner who split his or her time between the hospital and clinic. Emergency medicine now functions as a mature care model with specialized physicians skilled in addressing emergencies.
Telemedicine is following this evolution and must transition away from just deploying technology to see what happens (the equivalent of tossing someone into a hearse) with well-intended, but largely marginalized physicians … towards a structured approach to ensure reliable, effective, and efficient care delivery.
Fortunately, the history of medicine provides a roadmap on how to proceed. We start by agreeing that telemedical care IS medical care and should be held to the existing standards and guidelines regulating such care service delivery. Put more simply, establishing a therapeutic care relationship is the first step towards considering how technology can then improve service delivery.
HB 2697 establishes the minimum expectation of a valid patient-practitioner relationship before realizing what I believe to be meaningful work yet to be done in telemedicine.
The second objective of HB 2697 is to provide clarity on the issue of payment. The bill makes clear that payers have an obligation to transparently communicate payment practices to credentialed physicians. Covered services, claim processes, and other practices allow both physicians and patients to better assess payer competitiveness in the marketplace.
Payers are an important and largely sympathetic stakeholder who have demonstrated an authentic interest in telemedicine to improve care delivery. Having said that, there remain several obstacles to paying for telemedical care both here in Texas and nationally. Without reliable payment, telemedicine cannot mature as a service option and demonstrate the promise it holds.
In our view, the promise of telemedicine is as a means of delivering a service. If such a service is both covered conventionally and possesses additional value in terms of cost, timeliness, or satisfaction when delivered telemedically, payment for said service is more than reasonable.
Candidly and speaking for myself, I advocated strongly over the past year to include payment PARITY as key to supporting future telemedicine development. Having established telemedical care as medical care meeting all regulatory requirements, physicians can and should be able to offer medically necessary care (to borrow from the payer lexicon) and be paid with parity.
To be clear, my recommendation for parity is far from a new idea, as Texas has had existing regulations supporting payment parity for 20 years. But like mental health parity established last decade and, more recently, Chairman Price’s efforts with telephonic payment parity, regulations do not result in realization. We must continue to try to do what we say after saying what we will do.
I believe HB 2697 establishes the minimum regulatory guidance to safely realize the value of telemedicine in supporting a quality-based care model driven by proactive outcomes rather than reactive encounters. It will support all participating stakeholders in recognizing telemedicine as a skill to be mastered, a powerful tool, and promising care environment to improve health care here in Texas.
I thank you for your time, and welcome any questions you may have.
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