- Michigan lawmakers have approved telehealth legislation that enables healthcare providers to use the technology with the patient's consent.
S.B. 753, introduced in February by State Sen. Peter MacGregor, passed unanimously in the House on December 1 and in the Senate on December 6. It will become law in 90 days, making Michigan the latest state to set guidelines for telehealth.
“This is a commonsense healthcare reform for a modern age,” MacGregor said following the bill’s passage. “Society has never been more connected, yet a patient’s ability to see a medical professional is becoming more and more constrained as hospital wait times grow. This bill would help improve access to care, which could lead to healthier patient outcomes.”
“Telehealth could transform healthcare in Michigan,” MacGregor added, noting the bill had been supported by groups including the Michigan Association of Health Plans, the Michigan Council of Nurse Practitioners, Spectrum Health and Ascension Michigan. “It allows healthcare professionals to extend their reach beyond a corner office to meet patients where they are. It enhances access to and use of healthcare in our state, reduces costs, encourages competition and, most importantly, could lead to healthier lives.”
Lawmakers say the bill balances the advantages of telehealth with concerns that the technology erodes the doctor-patient relationship and could harm patient privacy and quality of care. It requires providers to “consult with a patient or obtain the patient’s consent” prior to using telehealth (that requirement does not include telehealth care delivered to inmates).
An analysis of the bill prepared by the Senate Fiscal Agency last May noted the arguments raised during the bill’s discussion:
“As technology advances, the use of electronic information systems and telecommunication technologies in the delivery of healthcare, or telehealth, is becoming increasingly common,” the report reads. “These technologies now allow a number of opportunities for healthcare providers to conduct office visits remotely and monitor their patients at home. Many believe telehealth has significant capacity to reduce healthcare costs, expand access to care and improve patient outcomes. Along with the potential benefits, however, some people have raised concerns about patient privacy and the quality of care individuals receive, and have suggested that the State should enact some patient protections as the healthcare field evolves further in the direction of telehealth.”
The bill defines telehealth as “the use of electronic information and telecommunication technologies to support or promote long-distance clinical healthcare, patient and professional health-related education, public health, or health administration.” It defines the technology to be used as real-time, interactive audio and/or video telecommunications, and requires that the patient be able to interact with the offsite healthcare professional as the services are provided.
The bill also allows healthcare providers to issue prescriptions via telehealth as long as the drug isn’t a controlled substance. It also requires providers to comply with “applicable standards of care” and refer a patient to a local provider when needed.
Also supporting the bill were General Motors – one of the state’s largest employers - and the ERISA Industry Committee (ERIC), a national organization representing businesses on their benefit and compensation interests.
“ERIC believes Senate Bill 753 strikes the right balance of flexibility needed to maximize the benefits of telehealth, while maintaining a high standard of health care,” Annette Guarisco Fildes, the organization’s president and CEO, said in testimony before the state's legislature. “Most importantly, the bill allows Michiganders faster, easier access to healthcare.”
Even the U.S. Department of Justice chimed in, issuing a letter of support in November.
“The Department believes that SB 753 has the potential to enhance consumer options and improve health care competition for services appropriately offered through telehealth because it covers a broader range of services than existing law and limits or avoids certain unnecessary barriers to care<’ the letter stated. “In particular, SB 753 (1) specifies that permitted telehealth services extend beyond Michigan’s existing statutory definition of telemedicine, (2) provides for flexibility in how patients must provide consent for telehealth treatments, and (3) allows health professionals to prescribe drugs that are noncontrolled substances through telehealth services. These provisions have the potential to help telehealth become a more robust competitive option for Michigan patients and consumers.”
Other states are still grappling with telehealth regulations. In Arkansas, legislators debated long and hard over standards that allow physicians to use telehealth in meeting with a new patient, but they failed to approve a separate proposal that, among other things, defines “store and forward technology” and the “originating site” for a telehealth consult.
As a result, the state now permits so-called virtual visits, but only if the patient is receiving treatment in a healthcare facility, and it prevents providers from using online patient questionnaires as the basis for a telehealth consult.
In Texas, meanwhile, the state’s medical board is headed to court with national telehealth provider Teladoc over the board’s attempts to restrict phone-based telehealth services – though the case is stayed until April 2017 and rumors persist that the two sides are working behind the scenes on a settlement.
Several medical and telehealth-friendly groups have also been reportedly working on compromise legislation that would “[modernize the] telemedicine statutes and [reduce] the regulatory footprint governing the provision of telemedicine services.”
“What we used to be fighting about is, 'What can technology do?'” Nora Belcher, executive director of the Texas e-Health Alliance, told the Texas Tribune in June “Now we’re talking about what technology should do.”