Telehealth Faces Headwinds

We’ve cheered the telemedicine compact written by the Federation of State Medical Boards, and hoped that it would lead to a rapid collapse of the barriers facing telehealth providers’ ability to provide services across state lines.

Unfortunately, some medical societies and states are unwilling to move with the times. Last month Arkansas legislators voted down a bill that would have liberalized telemedicine within the state:

During the hearing, Sullivan pointed to several large companies including DirectTV, Kohl’s, Red Lobster, Pfizer, and Home Depot that use telemedicine services in every state except for Arkansas. He also referred to a map, created by telemedicine company Teladoc, which shows that Teladoc offers its services in 48 states, excluding Idaho and Arkansas, though he added that Idaho just passed a bill that would allow Teladoc to operate there.

Now. The Texas Medical Board has moved to stifle Teledoc, a leading telehealth provider – and a Texas company:

The question at hand is whether the Texas Medical Board will change its rules to prohibit physicians in the state from prescribing medications to patients whom they’ve interacted with via phone or online, but have never seen in person.

It is kind of embarrassing that this Luddite approach persists in 2015.

Comments (2)

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  1. Roger Downey says:

    There is a lot of hyperbole regarding the effect of the Texas Medical Board’s approval of the new rule. First of all, it restricts the “initial” use of the telephone in establishing the doctor-patient relationship. It is this relationship that is necessary for the imparting of medical advice, diagnoses and prescriptions. Once a relationship is established, which means the physician has examined the patient and knows the patient and his/her medical history, then the physician can interact with the patient on the phone and perhaps even prescribe medication. Granted, these telephone provider services deal with “minor” problems like earaches and sinus headaches, but even in these situations without the doctor-patient background a physician should not prescribe prescription medication to a patient who is unknown because of the potential for harm. Second, there is no process in place to provide the information about the “visit” to a patient’s primary care provider for continuity of care. The question will arise – Who has possession of the record of the patient’s call? The physician on the call, or the company the physician works for? Third, there is already concern in the medical community about the over-prescribing of antibiotics. Without a visual exam that may include a blood test, a physician on the phone would be guessing at whether the patient has an actual infection. Many patients with viruses mistakenly believe that an antibiotic prescription will help them feel better.
    The only kind of telemedicine the rule affects is that involving a physician who cannot examine a previously unknown patient. Some states allow the use of videoconferencing to apply as a substitute for the in-person examination. This real-time live videoconference occurs at a satellite office, urgent care or retail clinic with a nurse or well-trained medical assistant acting as a patient presenter.
    By the way, the Texas Medical Board rule is very similar to the policy guidelines advanced by the American Medical Association as well as those approved by the Federation of State Medical Boards in 2014.

    • Thank you very much Dr. Downey for the detailed clarification.

      From a business perspective, one of the issues – coordination of information between primary-care doc and telephone doc should not be difficult to overcome.