Wednesday, July 12, 2017

New Law Shapes the Future of Telemedicine in Texas

Texas physicians and telehealth providers are now playing by the same rules to treat patients by phone, computer, and other new technologies — the same as when physicians see patients face-to-face in a traditional doctor’s office visit. Senate Bill 1107, passed this session by the Texas Legislature and signed into law by Gov. Greg Abbott in late May, clarifies the framework to evaluate, diagnose, and treat patients remotely via telecommunication technology. Telemedicine can be a helpful tool for physicians to see some patients who cannot travel hundreds of miles — or even one mile — to the doctor’s office. Imagine “seeing” your physician via your computer or smartphone.

The bill-signing by the governor ends months of debate in the Texas legislature and caps more than a year’s worth of collaborative input by the Texas Medical Association (TMA), the Texas e-Health Alliance (TEHA), the Texas Academy of Family Physicians (TAFP), and numerous telemedicine stakeholders.

“I am happy and ecstatic for the patients of Texas,” said Ray Callas, MD, a TMA Board trustee and immediate past-chair of TMA’s Council on Legislation. “As technology advances, patients will have more access to physicians, resulting in fewer ER visits for minor ailments; and more patients, especially in rural areas, will have access to primary care at home via telemedicine technology.”

Sen. Charles Schwertner, MD (R-Georgetown), the author of SB 1107 and chair of the Senate Health and Human Services Committee, played a key role early in the session to bridge an impasse among competing telemedicine interests to define telemedicine and hold telemedicine services to a single standard of care. Rep. Four Price (R-Amarillo) sponsored the companion bill, House Bill 2697, and he also played a key role in crafting language to require health insurance plans to cover telemedicine as a service provided by the physicians they have under contract. If policyholders’ insurance covers this type of care, more physicians might be able to offer it to those patients. In fact, the law also requires health plans to post telemedicine payment policies — minus their contracted rates they will pay for this service — to their websites, to inform physicians.

The months of negotiation by TMA, TEHA, and TAFP to expand the use of technology in Texas medicine resulted in the core language of SB 1107, including:

  • The standard of care for a telemedicine visit is the same as a patient/ physician in-person visit;
  • The definition of a true patient-physician relationship to conduct telemedicine;
  • A physician must be able to access — and must use — clinically-relevant data in rendering a diagnosis in accordance with the standard of care; and
  • Health plans must cover telemedicine as a means of providing services to their insureds when a contracted physician performs the care.

“We are now seeing opportunities to access physicians and providers from anywhere at anytime for most any reason, thanks to technology. But technology by itself is not the solution to our healthcare challenges," said Austin-based telemedicine internist and psychiatrist Thomas Kim, MD, who testified for TMA in support of the bill, and helped craft its language. “At the end of the day, telemedicine care is medical care and should be held to the same standards and guidelines.”

The bottom line, doctors say, is telemedicine is a means of providing care to a patient; it is not a service in and of itself. It is a tool in the physician’s toolbox.

The new law is expected to expand the use of technology in health care. “Is this the end all, be all? No,” said Dr. Callas, “but it is the start of something that will allow patients to get the best care, and for physicians to be the captain of the ship to delegate and supervise the care of all Texans.”

Some of the law’s elements took effect when the governor signed it, while the insurance related provisions go into effect on Jan. 1, 2018.

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