TMA Interim Written Testimony by Thomas J. Kim, MD, MPH
House Public Health Committee
June 28, 2018
Good afternoon, Chairman Price and members of the committee. My name is Dr. Thomas Kim. I’m a telehealth internist and psychiatrist here in Austin. Today I’m testifying on behalf of myself and TMA, representing more than 51,000 physicians and medical students.
I wish to commend this committee for taking up the charge of improving Texans’ access to care, including how telemedicine may have a role.
For people with even a passing interest in telemedicine, bridging distances with technology to connect the right doctor with the right information at the right time is pretty self-evident. And telemedicine continues to mature with the Federal Communication Commission’s increased investment in the Rural Healthcare Program and the landmark passage of Texas Senate Bill 1107 last year.
SB 1107 is credited with highlighting the notion that telemedical care is medical care. This shines a light on the critical importance of the therapeutic relationship. With such a relationship, the tools a physician employs should matter very little as we determine how best to care for patients.
There is also a growing body of evidence confirming that telemedicine can improve the care of both acute and chronic conditions. Telemedicine has the potential of avoiding rehospitalizations, diverting unnecessary emergency department visits, and supporting health systems with specialists otherwise unavailable. And while all this is true … it also misses a much broader point.
Fourteen hospitals have closed in Texas since 2010, the most of any state. In my view, these closures represent a canary in a coal mine portending much worse things to come. If pressed to explain why, I submit it is because our health system does not keep people well. This is not to say that we can’t keep people well but that almost everything about our system of care waits for a crisis before acting.
It bears mentioning that SB 1107 also requires payers to publicly publish their telemedicine payment policies. It does not require them to pay but simply to share whether and how they do so. To date, I have yet to find a policy of any actionable value. Some payers have even elected to carve out a telemedicine benefit reserved for a dedicated vendor but not for their contracted physicians, which places us in an impossible situation.
I’d like to tell you about my friend, Dr. Stefan Walker, and his partners in Corpus Christi. As one of the few remaining primary care practices in the area, Stefan’s group represents the best of our profession … physicians doing anything and everything they can to maintain the wellness of their patients. I have helped Stefan’s group strategize on how to improve the care of their patients with telemedicine, and they have the following dilemma. If they deploy a telemedicine solution as a contracted physician to a patient enrolled in a plan without a payment policy … they will not get paid. If they charge their patients for said service, something most patients would happily accept if it meant avoiding lost wages, extended waits, and increased hassle, the contracted physicians are in breach and criminalized.
If we are to save critical access hospitals in Texas for those who desperately need them, we must do better at supporting those who keep people out of the hospital with telemedicine policies that do not handcuff contracted physicians.
To be clear, I would be delighted if the payers would pay a covered service delivered via telemedicine with parity, but I would be satisfied if payers simply allowed physicians to explore telemedicine options without risking their contract and negatively impacting their entire panel of patients.
I thank you for your time, and I welcome any questions you may have.
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