- A proposal to allow telemedicine encounters between a doctor and a new patient are headed to the Arkansas state legislature – although a last-minute amendment could keep one of the nation’s largest telehealth vendors out of the loop.
The Arkansas State Medical Board this week signed off on amendments to Act 887 of 2015, which would allow clinicians to establish "a proper physician/patient relationship (via) real-time audio and visual telemedicine technology" as long as the platform "provides information at least equal to such information as would have been obtained by an in-person examination."
The proposed rules are a response to 2015 legislation that limited physicians to using telemedicine only if they had first seen the patient in person, had an ongoing relationship with the patient, had been referred by another doctor or were filling in as the patient’s primary care provider.
Arkansas is one of the last states to require an in-person meeting between a doctor and a new patient prior to the use of telemedicine, and this legislation, if passed, would put the state in line with much of the rest of the country. But there are some notable differences.
First, the legislation specifically excludes a patient questionnaire as store-and-forward technology – a last-minute change reportedly engineered by the Arkansas Medical Society. That would hamstring Teladoc, which has been active in lobbying for less restrictuve telemedicine rules. The Dallas-based telehealth company does a significant percentage of its business via telephone, and says its doctors receive medical information from patients prior to the phone call.
Second, the new legislation doesn’t specifically define where a patient can receive telemedicine. While some news reports had indicated the proposal mandates that a patient be in a health system or the offices of a healthcare professional, the so-called “originating site” isn’t clearly defined. That puts into question whether a patient can connect with a doctor while at home, in some other location or via a mobile device. It might also hamper any remote patient monitoring programs undertaken by healthcare providers.
The proposed regulations have drawn support from more than a dozen groups, including the Arkansas State Chamber of Commerce and the Arkansas Medical Society, which represents more than 4,000 doctors and medical students. Still, those groups said they were concerned about the lack of definition for an originating site, as well as the proposal’s "narrow definition of acceptable technologies that diminish opportunity and stifle innovative efforts to bring care to every corner of the state.”
Arkansas Medical Board Chairman Joseph Beck told Arkansas Online the proposal increases access to telemedicine without adversely affecting either the patient or the doctor.
"There's enough protection here to where I believe the board can feel comfortable that the patients are being protected, which is our No. 1 job," he said.
The proposal isn’t a done deal, as it must be approved by the Arkansas Legislative Council. An earlier version faced heavy criticism from state legislators during a public hearing in November 2015.
Legislators “were very concerned that we not move too quickly, that we slow down and think about what we're doing and make sure that the interests of the patients and safety come before everything else," David Wroten, of the Arkansas Medical Society, said after the hearing.
One of those legislators, State Sen. Cecile Bledsoe – who helped draft the 2015 legislation restricting telemedicine use - told Arkansas Online that the proposed regulations approved this week by the state medical board was “a good compromise.”