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Medical board seeks to restrict online, on-phone medical encounters


A four-year dispute pitting the nation’s largest telemedicine company against the Texas Medical Board is coming to a head next month when the board takes another crack at restricting doctors from diagnosing and prescribing drugs to patients they’ve never met.

The board already has telemedicine rules, but after the Teladoc company won legal challenges to the board’s rule-making processes, the board is considering a revised rule at its April 9-10 meeting in Austin. The goal is to safeguard patients, said the board, which is accepting comments on the proposal until April 4.

“In its current form, the Texas Medical Board rule would make it such that Texans in need of care would not be able to get care without a prior in-person visit with a doctor,” said Jason Gorevic, president and CEO of Dallas-based Teladoc. “We think that would be a terrible mistake.”

Texas is pulling against a rising tide of telemedicine use in other states as the nation grapples with a shortage of physicians, he said. At the same time, patient interest in telemedicine is rising.

In telemedicine, patients are diagnosed and receive prescriptions from a doctor they communicate with by phone or online video conference. The medical board says that without a face-to-face visit or an in-person evaluation to establish the doctor-patient relationship, a patient might be wrongly diagnosed and treated.

The board exempts doctors doing mental health consultations.

Teladoc handles all of its consultations by phone after the doctor accesses the patient’s medical information online, Gorevic said. Previous medical board rules forbid video interactions outside of a specific setting, such as a hospital or clinic, so Teladoc doesn’t do that, he said.

The Texas Medical Board has sought to clarify that encounters over the phone aren’t allowed unless a previous in-person visit established the doctor-patient relationship.

But Teladoc won a Texas Court of Appeals ruling Dec. 31 when it challenged that. The court determined the rule was improperly made, so the board then issued an emergency rule Jan. 16. It argued that the rule was urgent because a doctor’s ability to test and treat patients is “seriously compromised” without an in-person visit.

Teladoc objected, and a Travis County state district court judge last month stopped the emergency rule from taking effect, saying she saw no imminent public peril.

Now, the stage is shifting from the courtroom to the medical board room.

“We’re hopeful the board won’t adopt this rule,” Gorevic said. “All of the needs of the state point in the opposite direction.”

Teladoc, founded in 2002 and operating in Texas since 2005, is in all but two states, Idaho and Arkansas, Gorevic said. In its history, it hasn’t had a malpractice complaint out of 600,000 encounters — 10 percent of them with Texas patients, he said. The business is growing rapidly, and Teladoc plans to expand into mental health and dermatology services.

For now, its physicians mainly treat sinus problems, urinary tract infections, respiratory problems, pink eye and ear infections. Some insurance plans, including Aetna, cover the services, and co-pays range from zero to $40, Gorevic said. He says the visits cut medical costs by reducing emergency room and urgent care clinic visits.

The medical board says it is deeply concerned about doctors prescribing dangerous drugs without an established relationship. Gorevic said Teladoc physicians don’t prescribe narcotics, controlled substances or “lifestyle drugs,” such as Viagra. But the board says that even prescribing an antibiotic to someone who doesn’t need it can endanger the public health because of the increasing number of “superbugs” that resist those medications.

One Austin physician group is launching a telemedicine service next month that it believes meets the medical board’s requirements.

The new eMD Access service — consisting of primary care doctors at Austin Regional Clinic using CirrusMD telemedicine technology — has contracts with several businesses offering telemedicine as a perk to their employees, said Dr. Jake Childers, an ARC doctor who’s heavily involved in the effort.

With the Teladoc controversy in mind, Childers said he met with the medical board’s executive director to discuss plans for eMD. Its doctors will visit the companies and meet individually with employees to get medical histories and other information. After that, the employees can contact the doctor remotely, Childers said.

If the medical board raises a concern, “we will do whatever we need to do to put us into full compliance,” he said.

The board, which gave tentative approval to the rule in February and had it published, has received numerous comments on it, board spokesman Jarrett Schneider said.

The Texas e-Health Alliance, which advocates for information technology in health care, said it had “no specific objections” but recommended the board consider allowing some patients, especially those will mobility problems, to access care from their homes.

The Texas Medical Association, the state’s largest physicians’ organization, strongly backs the proposed rule, said Doug Curran, a family medicine physician in Athens and vice chairman of the TMA board.

“It’s just hard to treat somebody on the phone, and it’s really not good care if you don’t have some sense of who that person is or have a relationship with them,” Curran said.

A telemedicine patient he treated for pneumonia had been prescribed an antibiotic for a sinus infection over the phone, Curran said.

“That’s what the medical association and the board are worried about,” he said. “We want to make sure we protect patients. They want good care, they want safe care, and they want sensible care.”

Comments on the rule may be emailed to the medical board at rules.development@tmb.state.tx.us.


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