Texas Medical Board contemplates new rules that will determine the future of telescribing medications as the national debate over telemedicine rages on..
This month, the Texas Medical Board (TMB) will rule on recently proposed changes to licensing rules that would stop the telescribing of medications in Texas. The changes would, if adopted, prohibit physicians from telescribing prescription medications to patients whom have only connected with them via the phone or online, but haven’t met face to face. Such actions would clearly impede telehealth companies¬ and likely halt the industry. Texas joins the controversial interstate dispute over Telemedicine to validate its implications on healthcare.
An emergency rule issued in January of this year by the TMB barred physicians from telescribing controlled substances. The rule amends the Texas Administrative Code stating that online questionnaires or discussions over phone, email, text or chat are not adequate means to establish a valid doctor-patient relationship. The rule goes on to say that physicians are required to perform in-person exams.
Dallas-based health provider Teladoc, a telemedicine provider that allows patients to receive medical advice and obtain prescriptions from physicians in telephonic consultations, sued the TMB after receiving a letter from the board that claimed the company’s doctors were not adhering to the TMB’s policy. The suit claims that the board is in violation of the Texas Administrative Procedure Act¬, rendering the board’s emergency rule invalid. More than 900 small and large businesses and insurers use Teladoc to provide 2.4 million Texans access to telehealth physicians.
Last year the American Medical Association released telemedicine guidelines that resembled the policies proposed by the TMB. As several state legislatures are currently considering bills that could restrict or expand access to telemedicine, what happens in the Lone Star state may influence the course of how policies on telemedicine are decided.
Elsewhere, states like New York are doing just the opposite. New York passed a new law that requires telehealth visits to be reimbursed at the same rate as in-person visits. This legislation places New York as the 22nd state to pass telehealth parity laws.
According to the TMB, Texas ranks 45th in the nation for the number of physicians per person with roughly 43,000 physicians caring for about 23 million residents. At the national level, Forbes reports that by 2025 the US will face a potential shortage of as many as 52,000 doctors. Centers for Medicare and Medicaid Services and other government groups are touting telemedicine as a large part of the solution, but telemedicine alone can’t answer the purpose of curing the primary care physicians (PHP) shortage.
Great risks accompany dependence on telemedicine to resolve a physician shortage of that magnitude. There is debate about whether telemedicine will have any meaningful impact at all. Many doctor organizations contest that telemedicine won’t restore low PHP counts. Regardless of if a doctor is seeing patients in person or is managing cases digitally, he or she still can handle only so many cases.
Relying on telemedicine may overshadow a more fundamental issue—compensation of physicians. It is a tremendous commitment to attend medical school and complete internships and residencies in order to become a licensed, practicing physician. The financial cost and time invested suggests that doctors should in return receive the opportunity to earn a greater living. The Affordable Care Act is likely to put physician compensation in the crosshairs for a long time. Older physicians are considering retirement and some younger physicians are driven to sell their practices in pursuit of other interests.
The future of telescribing in Texas is still up for debate. The progress of telemedicine in the state will be determined by the TMB, which will decide whether to adopt the new rules in mid-April, following a comment period that ended April 4, 2015.Telemedicine has the potential to optimize how the healthcare industry functions, but it is not an appropriate substitute for a PHP. Legislation will continue to refine telemedicine’s jurisdiction and its impact on the industry’s most pressing issues.