- The battle in Texas to ease one of the country’s most restrictive telemedicine laws may be ending, with a compromise bill reported to be heading to the Legislature.
State Sen. Charles Schwertner, R-Georgetown, told the Houston Chronicle he’ll sponsor the bill, which could eliminate the requirement that physicians meet with patients in person before using telehealth. Texas is one of the last states to mandate that the doctor-patient relationship be established in person before telehealth can be used.
"I think we will have a bill very soon," he said.
Others hailed the apparent resolution of a years-long dispute, which began in 2011 when the state medical board told doctors they risked losing their licenses if they failed to meet in person with a patient before doing business online or on the phone.
"This is significant, and will be a winner for everyone," said Nora Belcher, executive director of the Texas e-Healthcare Alliance. "This is going to get us a fair and open market for telemedicine in Texas."
"(The Texas Medical Association) applauds Senator Schwertner for his leadership in helping us all pursue a compromise telemedicine bill on our patients' behalf," added Dr. Ray Callas, chairman of the association’s Council on Legislation. "While we are pleased that the seed of a legislative agreement is in place, we acknowledge that more work remains before it can grow into a new law to guide this valuable form of patient care for the future."
In Utah, meanwhile, a bill to improve that state’s telemedicine rules also appears headed for passage – with one very noticeable restriction added.
Utah’s House of Republicans approved HB154 this week following heated debate from Democrats, who objected to a small passage near the end of the bill that bans physicians from prescribing abortion-inducing medication via telemedicine. Nineteen states currently ban abortion-by-telemedicine, with most requiring that a physician be physically present when the abortion takes place.
"I think it's sad that something as simple as saying you should have personal contact with a doctor to terminate a life has garnered so much outrage," the bill’s sponsor, Rep. Ken Ivory, R-West Jordan, said during the hearing.
Ivory, who submitted a similar bill last year, placed the abortion restriction at the end of a bill that focuses on improving the reimbursement model for physicians. The bill is expected to pass easily through Utah’s Republican-controlled Senate.
That may not be the end of the battle. According to the Deseret News, the Utah Legislature’s attorneys attached a non-binding memo to the bill noting “a very strong argument that, if taken to court, this provision would be found unconstitutional.”
In Iowa, where telemedicine-based abortions have been conducted since 2008, the state’s Supreme Court shot down an effort by lawmakers to stop the practice in 2015. And in Idaho, state officials agreed this past January to settle a lawsuit brought by the state’s Planned Parenthood chapter and will repeal one law and amend a second to eliminate restrictions to telemedicine abortions.
In Texas, telemedicine advocates have been battling the Texas Medical Board and a powerful doctors’ lobby over state guidelines that, among other things, mandate an in-person visit between a doctor and a new patient before a doctor can prescribe any medications.
In 2015, the board tried to amend its rules to make that restriction binding. Teladoc, a telehealth company whose model is primarily telephone-based, objected on the grounds that it would unreasonably interfere with the company’s ability to do business. U.S. District Judge Robert Pitman issued an injunction against the board, and a lawsuit filed by Teladoc against the board is expected to go to trial.
In mid 2016, reports surfaced that telehealth advocates and medical groups were quietly meeting to “to discuss ‘modernizing our telemedicine statutes and reducing the regulatory footprint governing the provision of telemedicine services.” Tom Banning, chief executive of the Texas Association of Family Physicians, said the closed-door meetings represented a “thawing of tensions” between the two sides that could lead to compromise legislation.
Another participant in the meetings, the Texas Association of Business, also called for a break in the impasse.
"Texas has some of the most onerous regulatory hurdles for telemedicine technologies," Bill Hammond, the group’s then-CEO, told the Houston Chronicle at the time. "The industry's potential to help Texas patients and companies maximize access to care and reduce the cost of care is being held back by limitations imposed by regulators who accept the status quo as sufficient.”
The dispute – and a since-resolved attempt to restrict mental health services delivered across state lines via telehealth - earned Texas a strong rebuke from the American Telemedicine Association and other pro-telehealth organizations. In its annual ranking of states, the ATA has given Texas the lowest grade for telehealth-friendly policies.