On April 10th 2015, the Texas Medical Board voted to restrict the use of telemedicine in the state of Texas by requiring physicians to conduct Face-To-Face visit with the patient before a diagnosis or prescription can be provided via telemedicine. The decision has garnered a lot of discussion because Texas is the only state implementing a more restrictive regulatory stance in the area of telemedicine while many other states are busily updating policies to allow for the increased usage of the technology.
The ‘Face-To-Face” Requirement’
Details of the decision are as follows as reported by Hayes and Boone. Particularly contentious in this revised regulation is the requirement of completing an initial diagnosis through the use of “acceptable medical practices” which must include a face-to-face/in-person evaluation to establish a physician-patient relationship. Mental health services, as well as, scenarios where the patient is currently at a health facility, and attended by another healthcare professional, do not fall under the limitation.
The amendments also state “An online questionnaire or questions and answers exchanged through email, electronic text, or chat or telephonic evaluation of or consultation with a patient are inadequate to establish a defined physician-patient relationship.” (22 TAC 174.8(c))
Texas Retreating In The Face Of Growing Evidence
While the Texas Medical Board moves to restrict the use of telemedicine; Idaho, Utah, Montana and West Virginia joined the Federation of State Medical Boards’ interstate compact to remove barriers to telemedicine growth. According to Modern Healthcare, at least 11 other states have similar legislation pending. Thirty-seven percent of employers planned to offer their workers telemedicine consultations in 2015, and another 34% planned to do so by 2017.
To date, no research has been presented by the Texas Medical Board to legitimize the patient safety argument in the area of telemedicine misdiagnosis probabilities. And to the contrary, there are numerous studies identifying the cost effectiveness, time saving and patient care improvements.
- According to Becker’s Hospital Review, Phoenix-based Banner Health’s tele-ICU system significantly improved patient outcomes where telemonitoring saved 34,000 ICU days and close to 2,000 lives in 2013.
- A cardiac study at Partners Healthcare profiled 3000 congestive health failure patients who recevied in-home monitoring of weight, blood pressure, heart rate, and pulse oximetry where high-risk patients are identified with decision analysis support software.In 6 years readmissions dropped by 44%, saving the health plan $10 million.
- A case report from the Department of Vetran Affairs detailed findings on a home telemedicine program that was also adopted by the VHA in which the more than 17,000 patient participants had a 25% reduction in the number of bed days of care and a 20% reduction in the number of hospital admissions compared with traditional care.
- Another study from Health Affairs found that patients in telehealth programs had reduced spending of 7 to 13 percent or $312–$542 per person, per quarter compared to those that did not.
Texas: Most Vulnerable To Be Most Affected
This new restriction does not address the impact to rural patients, a large and growing problem in our nation, a challenge that is particularly acute here in America’s second largest state. With telemedicine access, rural hospitals in Texas have been gaining an affordable option to reach critical care specialists that are already scarce and often prove to be costly. It is sometimes impossible to recruit specialists to work in remote rural settings, where populations cannot support them and opportunities to interact with their specialist colleagues are limited.
Removing options for telemedicine simply reinforces the unfortunate situation that life altering specialists and subspecialist care will remain in the domain of densely populated urban areas. See the article by National Public Radio on how US Medical IT’s telemedicine solution has changed lives in rural Texas.
Evidence Based 21st Century Medicine
Telemedicine is offering new and innovative ways for business to extend affordable and convenient healthcare benefits to their employees. We believe that Texas, a state that prides itself on entrepreneurship, business development and employer enablement, has definitely taken a step backwards with these new regulations. We will monitor and post on new developments stemming from this decision. In addition, we hope there will be a return to evidence based regulatory practices so that Texas can return to the forefront of 21st century medical care.