Telemedicine Controversy in Texas

The Texas Medical Board views rules it adopted April 10 as “expanding telemedicine opportunities,” but business and industry groups insist they’ll instead serve to “drive a stake through the heart” of telemedicine in the Lone Star State.

At the center of the issue is whether a video consultation is enough to establish the requisite doctor-patient relationship for physicians to prescribe medication or provide a diagnosis. That convenience is critical if an overarching goal of telemedicine is to deliver care to the underserved, particularly in rural areas where geography and provider shortages create access issues. The board’s rules, however, require either an initial in-person visit, or a video conference where a separate medical assistant is physically present alongside the patient.

Though they don’t go into effect until June 2015, the rules follow from a legal battle initiated in 2011 when the board threatened disciplinary action against doctors working with the Dallas-based Teladoc, a 24/7 telemedicine company that provides $40 video and telephone consultations between doctors and patients for common health issues.

Ultimately, the debate comes down to the so-called “iron triangle” in health care: juggling the goals of access, cost and quality that are often at odds with each other.

“The rules represent the best balance of convenience and safety by ensuring quality health care for the citizens of Texas,” the board maintains. “However, a telephone medicine scenario that allows a physician to treat an unknown patient without any objective diagnostic data and no ability to follow up with the patient sacrifices the patient’s safety for convenience.”

“As Texas’ population booms, health care expenses climb, and the shortage of primary care physicians grows, telehealth is a solution for patients dealing with common, nonemergency issues,” according to businesses like Teladoc. “This rule change only serves to intensify these problems without providing any benefit to Texans.”

For others, however, the issue is about choice. The lone dissenting vote on the board’s rules, Frank Denton, an investment executive from Houston, said that while telemedicine was the “least desirable” way to for patients to receive care, “the public should have the right to use that option.”