By Christi Barr
Last week, the Texas Medical Board issued new rules restricting the use of telemedicine in Texas, in effect pulling the state backwards at a time when many other states are pushing forward with telemedicine due to recent advances in technology that are making telemedicine an effective tool to increase access to affordable health care. The new rules reflect a protectionist impulse on the part of the board—a desire to restrict the use of new technology for the purpose of limiting competition under the guise of patient safety.
Texas deserves better. Telemedicine is exactly what it sounds like: doctors and patients interact over a live video feed that also transmits patient data, enabling the limited delivery of medical care without the patient and doctor having to be in the same physical location.
Current state law allows the board to establish rules for telemedicine in Texas, and it has adopted stringent rules that will limit its use in our state. The board allows telemedicine in an established medical site or from the patient’s home, with different stipulations for each location. An “established medical site” is a location with medical equipment and a licensed patient site presenter, who can perform medical tasks delegated from the distant site provider, a physician or a physician assistant or an advanced practice registered nurse with delegated authority. In order for a patient to use telemedicine in their home, they must first have had an in-person visit with the doctor, and must see a physician at least once a year.
While many of the restrictions put in place are to prevent abuse of services and to ensure quality care, they can also limit the use and effectiveness of telemedicine in serving those who need it the most. By reducing the regulation of established medical sites and allowing physicians to practice telemedicine across state borders, Texas can join the rest of country in making use of emerging telemedicine technology.
This session, SB 1177 and its companion, HB 3444, aim to expand the use of telemedicine by lowering restrictions on requiring face-to-face consultations between providers and patients. These bills still require a physician-patient relationship in order to use telemedicine, but would allow this to be established through telecommunication technology rather than a face to face meeting. They also prevent the board from requiring face-to-face consultations or examinations at established medical sites to be used in conjunction with telemedicine services. Getting rid of these stipulations would increase the use of telemedicine and would be especially beneficial for rural communities, where getting an in-person visit can be difficult.
According to Dr. Billy Philips, the Executive Director for rural and community health at Texas Tech University, the cost of creating telemedicine centers has gone down over the past 20 years, from $100,000 to about $30,000. This decrease makes it much more affordable to establish new centers, especially in rural communities that suffer from a shortage of physicians.
Telemedicine is also used effectively in our criminal justice system. Texas prisons have had a 24 percent increase in per-person spending on health care since 2007. As the prison population ages and inmates’ medical needs increase, costs are rising. Part of those costs come from transporting inmates to medical facilities outside state prisons to provide needed care. To help reduce costs, 26 of the 50 state prisons in Texas use telemedicine.
In 2011, Texas spent more than $581 million on health care for its prisoners. The state subcontracts with different medical schools in Texas to provide health care to prisoners to help lower these costs, and also uses telemedicine. Advancements in technology in recent years have increased the ability of telemedicine to provide high quality, cost-efficient care for prisoners, which in Texas has led to savings of $780 million over 14 years and increased the health of inmates.
In order to increase the use of telemedicine, Texas lawmakers should remove restrictions on its use across state borders. Currently in Texas, a non-Texas physician is able to get an out-of-state telemedicine license. However, they are limited to practice telemedicine only to interpret diagnostic testing and reporting to fully-licensed physicians in Texas, or to administer follow-up care for a patient that was primarily cared for in another state. By easing these regulations on out-of-state physicians, the use of telemedicine could be greatly be expanded, and would especially benefit veterans by allowing them to obtain services from VA doctors in other states.
Telemedicine is an important technological tool that is part of the emerging solution to problems with access to care and rising health care costs in Texas. Lawmakers should work toward expanding the use of telemedicine in Texas, not only to cut down on health care costs but also to provide high quality care to those who lack it. It won’t solve all our health care problems, but it’s a growing part of what will make Texas a leader in transforming health care to meet the needs of all.
Christi Barr is an intern in the Center for Health Care Policy at the Texas Public Policy Foundation.