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Texas Takes Heat for its Telemedicine Restrictions

The National Center for Policy Analysis sharply criticizes the Lone Star State for its efforts to curb mHealth access, citing its ongoing battle with Teladoc and a court ruling against a veterinarian's online practices.

By Eric Wicklund

- The National Center for Policy Analysis is slamming Texas for the state’s efforts to curb telemedicine.

The Washington D.C.-based think-tank singles out the Lone Star State and its officials in a new issue brief, calling the Texas Medical Board’s “protectionist policies … a dangerous bet against the future of health care in Texas.”

In particular, “The Doctor Will See You Now?” targets the TMB’s ongoing battle with telehealth provider Teladoc, set to make its way to a federal trial.

The five-year dispute came to a head last year when the board tried to enact emergency legislation barring telephone-based consults as a first means of contact between Texas doctors and patients for prescriptions and certain other diagnoses. Teladoc, which does roughly 70 percent of its business by phone, challenged that ruling, and successive court rulings have sided with the vendor, who is now suing the state board.

The argument centers on the definition of an appropriate physician-patient relationship. Those siding with Texas medical officials feel a doctor should first meet a new patient face-to-face before making diagnoses or issuing prescriptions. Those siding with Teladoc say today’s telemedicine platforms make phone-based and online encounters as reliable as face-to-face visits.

The report’s author, Jennifer Vermeulen, says there is “extensive evidence that telemedicine offers quality care on par with routine in-person visits, is well-received by patients and providers, and delivers considerable cost-savings.” Both the Centers for Medicare & Medicaid Services and the Federal Trade Commission have signaled their support for telemedicine, she says, and 25 states have revised their standards and licensure requirements since 2014 to pave the way for telemedicine.

“Yet, in order to protect established providers from competition, medical regulators in some states have tried to severely restrict the use of telemedicine,” Vermeulen writes. “This is especially the case in Texas.”

Vermeulen says the state’s rapid population growth – its population is expected to double by 2050 – is straining the state’s healthcare resources. More than one-third of the state’s 254 counties have fewer than 10 doctors, and 13 percent of the population has been designated as medically underserved. In addition, she notes, 21 percent of adults in Texas went without medical care in 2012 because of cost concerns.

All of these factors combine to place Texas dead last in the nation in access to medical care, according to a 2015 report by the Commonwealth Fund. In addition, Vermeulen notes that Texas was one of three states, along with Arkansas and Alabama, to be given an ‘F’ on the American Telemedicine Association’s state-by-state 2015 report card for physician-patient encounters.

Ironically, Vermeulen says Texas officials have sought to curb telemedicine in the private health sector while seeing success with the platform in the state’s prison system – a population, she notes, that “few doctors want to treat.” Since contracting with the state in 1994 to treat prisoners via telemedicine, the University of Texas Medical Branch, she says, has performed some 250,000 exams and improved clinical outcomes among prisoners, saving the state roughly $780 million.

Along with the Teladoc-TMB dispute, Vermeulen also mentions a 2015 ruling by the 5th Circuit Court of Appeals upholding the Texas Board of Veterinary Medical Examiners’ decision to severely limit the state’s veterinarians in their use of telemedicine. That ruling seemingly conflicts with federal attitudes toward telemedicine, she says, and may have to be resolved by the Supreme Court.

The NCPA’s report won’t likely sway any opinions, but it adds to a debate that has already caused the American Medical Association to twice postpone action on the establishment of standards for the use of telemedicine. 


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