Doctors, Telemedicine Companies Meet to Plot New Course

Though many expected a messy fight over Texas’ telemedicine rules next year, medical and industry groups are coming together to try to hammer out a compromise over how health care can be provided remotely.

The question is whether the coalition can keep the peace between doctors, telemedicine companies and health insurers until state lawmakers convene and take up the issue in 2017 — all while a federal lawsuit challenges the state's existing rules governing long-distance health care.

Texas, home to both a business-friendly climate and an influential physician lobby, has long grappled with the practice of telemedicine, in which remote, sometimes out-of-state doctors can make diagnoses and write prescriptions after consulting with patients by phone or on the Internet. Last year, the state passed a rule backed by doctors' groups requiring most physicians to meet patients face to face before treating them remotely. Business groups cried foul, saying the state was stifling innovation in health care. The regulations are currently tied up in court.

Now, some of those competing groups are hoping to present the Texas Legislature with a compromise. On Tuesday, their lobbyists held a closed-door meeting to discuss "modernizing our telemedicine statutes and reducing the regulatory footprint governing the provision of telemedicine services,” according to an email obtained by The Texas Tribune.

Representatives for the health care groups said the negotiations are still in their infancy but that they hope to reach a compromise by the end of the summer — largely to take advantage of new technologies that have made it easier for patients and doctors to exchange information without meeting in person.

Those advances have made telemedicine a more convenient option for consumers, they say, and a more palatable one for traditional doctors, who fear missing out on a business opportunity.

Tom Banning, chief executive of the Texas Academy of Family Physicians, said the negotiations signified a “thawing of tensions” between doctors and the telemedicine industry.

Telemedicine is “really an exciting area of medicine,” said Dan Finch, legislative affairs director for the Texas Medical Association, a physician lobby group. 

“What we used to be fighting about is, 'What can technology do?'” said Nora Belcher, executive director of the Texas e-Health Alliance, a health care information technology industry group. “Now we’re talking about what technology should do.”

Despite the optimism around reaching an agreement, Tuesday’s meeting comes at a tumultuous time for the state’s telemedicine regulations, which are tied up in federal court.

The Texas Medical Board, which licenses and regulates doctors, adopted a rule last year that would in most cases prohibit doctors from treating Texans via remote technology without an existing “doctor-patient relationship” — one first established face to face. That threatened the business model of Teladoc, a Dallas-based company that connects doctors and Texas patients over the phone, and led the company to file a lawsuit against the medical board. In May 2015, U.S. District Judge Robert Pitman ordered that the telemedicine rule could not go into effect while the lawsuit was ongoing.

Teladoc is sure to be following the current negotiations closely to see if they would resolve the lawsuit — or pose a new threat to the company’s phone-based model, which it refers to as “telehealth.”

A representative for Teladoc who attended Tuesday's meeting declined to comment.

The new regulations under discussion in Texas are said to be modeled in part on a law passed this year in Indiana. That law does not require an in-person visit to establish a doctor-patient relationship as long as remote telemedicine consultations meet certain standards of care. Teladoc supported the law in Indiana, according to legislative records.

Also looking on are health insurers, who have been vocal supporters of expanding patients’ access to telemedicine but are wary of mandates that would require them to pay a certain amount for telemedicine services. Doctors, on the other hand, hope to use the negotiations as an opportunity to draft laws requiring payment for care provided remotely.

Disclosure: The Texas Medical Association and Teladoc have been financial supporters of The Texas Tribune. A complete list of Tribune donors and sponsors can be viewed here.