Texas Medical Board Unplugs Telemedicine for Some

April 19, 2015
Martin Merritt

A new rule in Texas aims to expand the use of telemedicine, but it may have the reverse effect for some patients who may need it most.

"I am a doctor, and I play one on TV," may replace the old slogan for Vicks 44, according to an April 15 press release from the Texas Medical Board entitled, "TMB Adopts Rules Expanding Telemedicine Opportunities."

According to the Texas Medical Board, the rule represents "the best balance of convenience and safety by ensuring quality healthcare for the citizens of Texas.  Essentially the only scenario prohibited in Texas is one in which a physician treats an unknown patient using telemedicine, without any objective diagnostic data, and no ability to follow up with the patient."

 Critics say the rule is specifically designed to devastate a growing number of businesses and entrepreneurs, whose business model competes with traditional brick-and-mortar doctors. One such company according to a report by the Dallas Business Journal, is freshbenies, a company that hawks health discount cards that include the ability to call a doctor 24/7 and get a prescription if needed via telephone without an in-person visit.

"It's crazy that Texas would do this [ban telephonic prescribing] at a time when it's growing so fast in other parts of the country," freshbenies owner, Reid Rasmussen, told the publication.

 The rules authorize the following types of telemedicine:

Patients can interact with their physicians via telemedicine beyond the traditional office visit including receiving appropriate care from their homes, between multiple healthcare settings, and from other medical sites like a school nurse's office, a fire station, or even an oil rig. 

• Once a physician has made an initial diagnosis of a patient through a face-to face visit held either in person or via telemedicine, the physician can treat a patient for their preexisting condition, via telemedicine, for up to one year in their home. The presence of another medical provider to assist in communicating the patient's diagnostic information to the physician is only required for the initial consultation.

• A physician can provide mental health services to a patient via telemedicine at the patient's home, which can include a group or institutional setting where the patient is a resident. No other healthcare provider is required to be with the patient to present the patient's symptoms to the physician unless there is a behavioral emergency.  

The press release notes that the rules do not:

• limit a patient to an in-person visit to establish a physician-patient relationship before receiving treatment, the relationship can also be established via appropriate face-to-face telemedicine;

• change traditional on-call coverage used by many physicians' offices (physicians, who are in the same medical specialty and provide reciprocal services, may provide on-call telemedicine medical services for each other's active patients); or

• severely restrict the types of telemedicine scenarios authorized in Texas (the rules expand the scenarios already allowed to include greater access to treatment from a patient's home and greater access to treatment for behavioral and mental health).  

Dallas-based telemedicine provider Teledoc has been engaged in a long-running litigation battle with the Texas Medical Board after the board sent Teladoc a letter challenging its approximately 90 doctors' ability to teleprescribe in Texas.

The board's limits, well-meaning though it may be, could place it on the wrong side of history, which is often written by the larger financial interests.  It is simply cheaper to treat patients by playing a doctor on TV, even if you've never seen that patient in-person before.  But for now, the new rule stands.