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Arkansas Legislators: Telehealth Still Needs More Than a Telephone

An Arkansas House committee shot down a bill that would have allowed providers to meet with new patients via telephone, arguing that telehealth still needs an audio-visual connection to be valid.

Source: ThinkStock

By Eric Wicklund

- An Arkansas lawmaker’s effort to make telehealth “the least restrictive method to deliver healthcare services locally” has been shot down by colleagues who don’t believe the telephone is a good way to make that happen.

A House committee this week voted not to support HB 1220, a proposal that would have, among other things, allowed healthcare providers to meet with new patients via audio-only phone. Those voting against the bill argued that providers should at least use an audio-visual virtual care platform when establishing a doctor-patient relationship.

It’s not a new argument. Telehealth companies that deliver services via phone have long argued that the platform is acceptable for use, particularly in remote and rural regions where broadband coverage is weak or non-existent and a landline or cellphone may be the only reliable connection to a healthcare provider.

“There's no reason that your ZIP code should determine your health outcome,” Jason Tibbetts, Vice President of Health Services for Teladoc, told the House Committee on Public Health, Welfare and Labor during Thursday’s hearing, according to the Arkansas Democrat Gazette.

Teladoc, a Dallas-based telehealth provider whose many offerings include phone-based services, has been at the forefront of the battle to expand telehealth access. The company fought a pitched battle for several years with the Texas Medical Board over its efforts to mandate an in-person visit before any type of telehealth services for doctors and new patients, and its representatives have testified for or against telehealth bills in several states.

The most recent state to debate phone-only connected care was North Dakota. Lawmakers there had originally proposed amending the state’s telemedicine guidelines to ban any “examination or evaluation consisting only of a static online questionnaire or an audio conversation,” saying such telehealth services don’t meet the standards for establishing a doctor-patient relationship. Following a hearty public hearing, however, they changed – and passed – a bill that allows providers to use asynchronous (store-and-forward) telehealth for initial visits.

“Really, (the state’s Board of Medicine was) trying to open it up and say yes, you can do telemedicine here ... but when you're first getting started with a new patient, there are parameters we want you to use,” Bonnie Storbakken, the board’s executive secretary, said when the bill was first presented.

In Arkansas, meanwhile, State Rep. Dan Sullivan was seeking to open up those parameters for the state’s many rural residents.

His bill sought to enable providers to connect with new patients through an audio-only phone (as well as other channels) if that provider felt the standard of care would be maintained and he/she had access to the patient’s medical records. It would still have banned e-mail, text and fax communications, Internet questionnaires and a phone call without access to medical records.

State officials have been through this before. They amended their telehealth regulations in 2016 to eliminate the mandate that a doctor and new patient first meet in person before using telehealth, while keeping in place guidelines that mandate the use of audio-visual technology. One year later, they amended the law again to include the patient’s home as an originating site for telehealth services.

David Wroten, the Arkansas Medical Society’s Executive Vice President, referenced that action during this week’s hearing. He noted that lawmakers agreed to the changes three years ago to appease some of the state’s largest health plans and business, like Walmart and J.B. Hunt, who wanted to enable their member and employees to access healthcare services by phone from their homes.

But he drew the line at landlines.

“Any of y'all use FaceTime?” he reportedly asked the board. Holding up his own, he added: “This is two-way audio visual.”

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