If pandemic-era telehealth gains are to be preserved, lawmakers must help ensure physicians are paid the same rates and held to the same documentation and medical record retention standards for telehealth visits as they are for in-person visits.
The Texas Medical Association delivered these and other recommendations to the Texas House Committee on Public Health on Sept. 13 as it deliberates its interim charges, two of which concern telehealth.
In the run-up to the 2023 state legislative session, which begins in January, the Committee on Public Health is tasked with:
Overseeing the implementation of House Bill 4 by Rep. Four Price (R-Amarillo), which would make permanent the pandemic-era allowances for expanded telehealth payment in Medicaid and in the Children’s Health Insurance Program, if the state determines those services are clinically sound and cost-effective; and
Recommending documentation standards for health care professionals when obtaining patient consent for treatment and data collection.
Through written testimony, TMA presented as a case study Austin Regional Clinic (ARC), a multispecialty group of more than 360 physicians and health care professionals, and its acute, on-demand telehealth service, NormanMD.
NormanMD hosted 3,966 telehealth visits in 2020 compared with 8,745 telehealth visits in the first eight months of 2022. A small minority of patients – just 4.5% – were redirected to in-person care, and patient satisfaction with the service was high, at or above 98.2%. Additionally, ARC projects NormanMD saved $4.3 million in health care spending by diverting patients from costly emergency departments and urgent care centers.
This success required advance planning and investment.
“As internet bandwidth and technology improvements have converged with new payment models and innovation, ARC has invested substantial time, energy, and financial resources into building new channels of telehealth access for patients,” TMA wrote. “The pandemic clearly validated those efforts and accelerated patient adoption of remote care options.”
To cement this success and allow others to replicate it, TMA encouraged committee members to codify payment and documentation parity between telehealth and in-person visits for the same service. Representatives from other health care organizations, including MD Anderson Cancer Center and the Texas e-Health Alliance, testified to similar effect.
This is because Texas law requires physicians to provide the same standard of care during telehealth visits as they would apply during in-person visits for the same service. To comply, physician practices and other health care facilities must invest in telehealth-related resources, including software, staff training, and expanded internet bandwidth.
Lack of parity, TMA argued, could disincentivize physicians and other health care professionals from offering telehealth services and rob patients of a newfound convenience.
TMA also asked committee members to prevent state health plans from unfairly favoring telehealth-only companies, such as by waiving copays. Such imbalanced pricing incentives, it wrote, could sway patients away from their established physician, disrupting the continuity of their care.
Read the full testimony.