Physician-Led Results: Steps Forward in Telemedicine
By Joey Berlin

Coming into the 2021 session, the Texas Medical Association had hope that telemedicine’s success in allowing for remote care during the COVID-19 pandemic would prompt lawmakers to permanently relax many state policies restricting its use.

That didn’t happen to the degree that TMA wanted. But with the House of Medicine’s urging, the legislature did advance telemedicine in some important ways, demonstrating an understanding of how valuable remote care can be.

During the early days of the pandemic, telemedicine’s acceleration was made possible by the temporary easing of state and federal restrictions, including in Medicaid. House Bill 4 by Rep. Four Price (R-Amarillo) helps keep telemedicine on the right path by making some of those changes in Medicaid permanent.

The bill requires the state to ensure that Medicaid and Children’s Health Insurance Program patients, among others, “have the option to receive services as telemedicine medical services, telehealth services, or otherwise using telecommunications or information technology,” with consideration of federal law and whether such services are clinically appropriate and cost-effective. Services listed in the bill include those for preventive health and wellness, case management, behavioral health, and nutritional counseling.

The bill also opens the door for continued use of audio-only services and physician payments for delivering home telemonitoring services.

“This was an agreeable allowance for a particularly vulnerable subset of Texas patients,” said Austin psychiatrist Thomas Kim, MD, an active advocate for telemedicine who testified for TMA on the topic at both the state and congressional levels during this session.

“Of all places to go, [the Medicaid program is] a great place to start,” he said. “These are the folks that typically struggle with social determinants of health more, and as a result, struggle with health and wellness.”

The legislature also aimed to take care of the technical side of telemedicine – specifically, the lack of broadband access in many areas – with House Bill 5 by Rep. Trent Ashby (R-Lufkin). HB 5 establishes a state broadband development office, which will create a program to award financial incentives, including grants and low-interest loans, to applicants (such as companies) that can help expand broadband in areas particularly lacking it.

Also encouraging for telemedicine’s continued advancement, the state’s budget included a rider that directs the Texas Health and Human Services Commission to pursue increased use of telemedicine and telehealth in Medicaid as a way to curb costs. (Although the two terms are often used interchangeably, under Texas law telehealth is the remote delivery of health care services other than telemedicine, while telemedicine specifically refers to remote health care services delivered by a physician, or under a physician’s delegation and supervision.)

For both physicians who’ve known telemedicine’s upside for a long time and those pleasantly surprised after being pushed into it by the pandemic, these steps are welcome news.

“I am amazed at how I have been able to see high-functioning autistic kids in a residential treatment center and develop a rapport and bond with them using telepsychiatry, and treat them,” said Fort Worth child psychiatrist Debra Atkisson, MD. “This has really freed psychiatrists to be able to expand and see more people in more places.”

Yet another measure related to physician licensing also could help those wanting to practice telemedicine. House Bill 1616 by Greg Bonnen, MD (R-Friendswood), authorizes Texas to participate in the interstate medical licensure compact, along with 29 states, which could facilitate licensing for physicians new to Texas and Texas physicians who want a license in more than one state. The expedited licensing process is voluntary, and at least 80% of applicants for Texas medical licenses are estimated to be eligible. 

Payment parity put off
However, one of medicine’s most important asks in the telemedicine realm – permanent payment parity for those services – didn’t get through this year.

House Bill 980 by Rep. Art Fierro (D-El Paso) would have required insurers to pay for a covered service delivered via telemedicine “at least at the same rate” as for an in-person service. It never reached the House floor.

The bill would have codified TMA’s long-standing position on telemedicine payments: As long as physicians meet the standard of care in providing a covered service, whether they delivered the service in person or via telemedicine should make no difference with regard to payments. If that’s not the case, telemedicine simply isn’t worth it to many physicians.

“To have a disparate payment structure only serves to continue to inhibit or limit telehealth’s continued growth or maturation as a critical and very useful tool that all physicians should take advantage of,” said Dr. Kim, who testified before the Texas House Insurance Committee in support of HB 980. He hopes convincing lawmakers to go for payment parity in future sessions isn’t a matter of proving telemedicine’s care value and cost-effectiveness.

“I know that there are still people who persist in that narrative. I think as far as demonstrating the value, you only have to look at the history of just this last year,” he said.

Diana Fite, MD, TMA’s president during the bulk of the session, says just highlighting the broadband deficiencies in rural areas made this session helpful on the telemedicine front, and she isn’t totally discouraged by the payment parity measure not passing.

“Some insurance companies may still pay equal to a clinic visit for telemedicine. Just because we didn’t get that passed doesn’t mean that all insurance companies won’t step up to the plate and understand that their patients need that as an option for getting their care,” she said. “And it does call attention to the fact that it’s an important part of practicing medicine now, since the pandemic occurred, and will remain an important part.”

Last Updated On

July 08, 2021

Originally Published On

June 23, 2021

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Telemedicine | Texas legislation

Joey Berlin

Associate Editor

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Joey Berlin is associate editor of Texas Medicine. His previous work includes stints as a reporter and editor for various newspapers and publishing companies, and he’s covered everything from hard news to sports to workers’ compensation. Joey grew up in the Kansas City area and attended the University of Kansas. He lives in Austin.

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