Courtesy Dr. Russell Thomas Jr.
Family physician Dr. Russell Thomas of Eagle Lake, Tex. recently started using telemedicine to treat distant patients.
But how that relationship is created is up for debate. In Texas, disagreement over what creates a physician-patient relationship has led to litigation between national telemedicine company Teladoc and the Texas Medical Board. The case centers on a medical board rule that requires physicians to have a face-to-face visit with patients before treating them through telemedicine. The relationship can be created through telemedicine at an established medical site, but it may not be established through an online questionnaire, e-mail, text, chat, or telephonic evaluation or consultation. Teladoc sued the medical board in April claiming the rule violates federal antitrust laws. Teladoc provides access to medical care via phone or interactive video and treats patients for nonemergency conditions. A judge halted the rule’s enforcement in May.
The company sued to ensure patients have access to the same high-quality telehealth care they’ve received for decades, said Teladoc CEO Jason Gorevic.
“We have employers, health plans, and hospital systems who are coming to us because telehealth is a solution to access-to-care challenges as well as a mechanism to control the cost of care,” Mr. Gorevic said in an interview. “It was our responsibility and quite frankly, our obligation, to take action where there were regulations being adopted that were counter to the interests of patients, payers, and physicians in the state.”
In an April statement, Dr. Michael Arambula, president of the Texas Medical Board (TMB), said the rule represents the best balance of convenience and safety by ensuring quality health care for patients.
Mr. Jason Gorevic
“The board recognizes that as technology evolves, so too must regulations governing telemedicine,” Dr. Arambula said in the statement. “However, a telephone medicine scenario that allows a physician to treat an unknown patient without any objective diagnostic data and no ability to follow up with the patient sacrifices the patient’s safety for convenience.”
The Texas Medical Association (TMA) supported the TMB rule. Dr. Thomas, a former TMB member who is active with the TMA, said the rule’s logic is simple.
Without a face-to-face visit, “the doctor has no knowledge of the patient, except for what they tell you in that one encounter,” he said in an interview. “There are no follow-up opportunities, no mechanism for further assessment. It’s episodic care at its worst.”
However, Dr. Reed V. Tuckson, president of the American Telemedicine Association, stresses rules such as the Texas Medical Board’s are unnecessarily intrusive to doctors and diminish the range of possibilities for telemedicine care.
“We do not believe the restrictive covenants that are being applied by far too many state medical boards are appropriate,” Dr. Tuckson said in an interview. “We do not believe they should dictating to physicians, the tools that they should be able to use in partnership with their patients to meet [patients’] individual needs.”
Coming Tuesday, Sept. 29: Who leads the field on paying for telemedicine services?
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