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What Do New Texas Telehealth Rules Mean for Remote Care?

By Jennifer Bresnick

- Texas is taking a harder line on telehealth than some retail corporations could wish, effectively ending a tussle between the Lone Star State and Teladoc, which hoped to expand its remote care services into the region without the requirement for an ongoing patient relationship. 

Telehealth and telemedicine in Texas

The Texas Medical Board (TMB) believes its newly adopted rules ensure “the best balance of convenience and safety by ensuring quality health care for the citizens of Texas,” while Teladoc expressed disappointment over restricted prescription regulations and the inability for its physicians to see patients on a one-and-done basis.

Many states are wrestling with what constitutes a “patient-provider relationship” when telehealth is involved, with some requiring in-person consults and regular office follow-ups to ensure that patients do not wholly rely on brief video chats with an anonymous physician instead of maintaining a rapport with their primary care physician.  Other states do not strictly limit the means by which patients connect with telehealth providers, allowing commercial operations like Teladoc to flourish on consults for simple-to-diagnose problems like a sinus infection or skin rash.

Texas has previous required the establishment of a “proper professional relationship” between patients and their telehealth providers before remote physicians can prescribe certain controlled medications in an attempt to reduce prescription drug abuse and ensure high quality care.  While Teladoc does not believe the language of the rule required an in-person visit before these prescriptions could be written, TMB took a more conservative stance on the language. 

The issue has embroiled both organizations in a long-simmering battle over operations in the state, which took a dramatic turn in February when TMB passed an emergency rule prohibiting Teladoc from conducting any consults within the state’s borders.  Teladoc fired back by calling the Board out on its “bogus” emergency and asking the courts to dismiss the sanctions as invalid.

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In response, TMB has adopted new rules for telehealth care, which state that “a physician-patient relationship can be established through a ‘face-to-face’ visit held either in person or via telemedicine,” an announcement said.  “Essentially, the only scenario prohibited in Texas is one in which a physician treats an unknown patient using telemedicine, without any objective diagnostic data, and no ability to follow up with the patient,” the brief continues.

But Teladoc remains unhappy, especially with a line in the ruling that says “questions and answers exchanged through email, electronic text, or chat or telephonic evaluation of or consultation with a patient” do not establish an adequate patient-provider relationship. 

The service, like many similar outfits, is designed to take advantage of the widespread need for one-time consults that drive many patients to telehealth to begin with.  “Unfortunately, the Texas Medical Board’s decision to adopt a new rule takes away Texans’ access to a safe, affordable and convenient health care option that many have depended upon for more than a decade,” Teladoc said in a statement, the Dallas Morning News reports.

“As Texas’ population booms, health care expenses climb, and the shortage of primary care physicians grows, telehealth is a solution for patients dealing with common, nonemergency issues.  This rule change only serves to intensify these problems without providing any benefit to Texans.”

"If the rule change takes effect this summer, it will represent a huge step backward for Texas,” adds the Dallas Business Journal.  “California, Colorado, North Carolina, Kentucky, Virginia and dozens of other states have found solutions that embrace telehealth, and all of its benefits, while ensuring patient safety. We are hopeful that legislative leaders in Texas see the urgency in protecting patients and physicians and will be similarly forward-thinking and take action to deliver the benefits of telehealth in Texas.”

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Telehealth presents a number of difficult challenges for state rulemakers, who must balance convenience and access with the importance of engaging patients in a dialogue about their health and wellness with a physician who can manage their ongoing needs for care.  While Texas has chosen to put the primary care relationship ahead of business interests in this specific case, its rules for remote care are generally well suited to applications where telehealth can supplement existing patient-provider treatment plans.  However, if other states decide to follow its lead, telehealth vendors may need to adapt their strategies to focus on becoming a partner with primary care providers instead of a quick and cheap replacement for off-hours treatment.

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