Online doctors enter a new era
Texas expands telemedicine’s reach to patients
The multimillion-dollar telemedicine industry is poised for a lucrative run across Texas now that some of the toughest restrictions in the nation have finally been lifted by the state.
A new law signed by Gov. Greg Abbott, who has championed the issue, opens a huge market that could potentially connect millions of Texans to doctors who can now diagnose patients more easily by video chat.
This is welcome news in a state where elbow room is measured in the hundreds of miles and doctor shortages are chronic. Texas dwells near the bottom nationally in per-capita access to a physician, and 35 counties — with a combined population of about 115,000 people — have no doctor at all. About 1.8 million Texans, or roughly the population of West Virginia, live in a county with no obstetrician-gynecologist.
“I see patients who drive an hour and a half to see me,” said Dr. Katie Blalock, a family practitioner in Navasota, population 7,500.
Often her patients work
on farms or live in remote areas. A trip to the doctor eats up much of day, so they skip it. That, in turn, can mean a minor ailment gets worse.
“I deal with that on a daily basis,” Blalock said.
The new law was written to address the shortage.
“This is a huge step forward, a real positive for Texas,” said Dr. Nancy Dickey, executive director of the Rural and Community Health Institute at Texas A&M University. She recently co-authored a report about the health crisis facing rural Texans amid hospital closings and other barriers to access.
Texas was one of the last holdouts in the rapidly evolving world of virtual medicine by requiring an in-person visit between doctor and patient in most cases before allowing diagnosis.
That requirement was at the heart of a bitter, sixyear legal battle between the Texas Medical Board, which cited concerns of insufficient patient care, and Teladoc, a national leader in telemedicine. 3 million Texans
Teladoc, headquartered in Lewisville, has more than 20 million customers nationwide, including 3 million in Texas. Previously in Texas the company used phones and high-resolution photos for diagnoses, as did other telemedicine companies in the state.
Teladoc has spent about $13 million in legal fees alone in the fight. The new state law presumably renders the fight moot.
The Texas Medical Board, made up of 19 regulators, declined to comment directly on the new law.
“The litigation, although abated, is still pending,” a spokesman said in an emailed statement.
“The need in Texas carried the day,” said Jason Gorevic, CEO of Teladoc. “This paves the way to expand.”
Or at least catch up with the rest of the country.
Texas currently dwells near the bottom of the nation in per-capita access to a physician, ranking usually between 46th and 48th, Dickey said.
In fact, 158 of Texas’ 254 counties do not have a single surgeon. In 185 counties, representing more than 3 million people, there is not a single psychiatrist. Eighty counties have five or less physicians.
While the traditional picture of telemedicine is one of linking a doctor to a patient in some isolated dot on the map, Dickey said it is equally useful for those in small towns who might be 30- to 45-minute drive from a specialist in a larger city.
Those patients, often older and poorer, may not have the time or energy to make a drive on rural roads, said Dickey.
“It is a way to take very specialized medical skills out to towns of 10,000 to 20,000 people,” she said.
Telehealth has become a force in medicine impossible to ignore. Kaiser Permanente, the national health system powerhouse, announced recently that its patients are now connecting with health-care professionals virtually more than they do through traditional office visits. Flip the switch
But it is more than just patients who stand to gain from the new law.
“We’ve been building a network for seven years. Now we can flip the switch,” said Ron Gutman, CEO of HealthTap, a privately held California company that touts its network of 100,000 doctors that patients can access online and through video chats.
Previously, his Texas clients could do an online search of symptoms or pose questions but could not connect with a live doctor.
The new virtual service went live in Texas on June 1. It can be purchased through a subscription for $99 per month for unlimited consultation, but it is not covered by insurance. It also offers a one-time chat starting at $49 that the company said can be covered, depending on the doctor.
Teladoc offers its services through insurance plans and does not include a direct-to-consumer option.
Other industry leaders, such as American Well, also applauded the new law and announced plans to enter the Texas market with its direct-to-consumer app called Amwell, which also went live June 1. The service is covered by some insurance plans or can be bought directly for $59 per visit.
“We join the industry in congratulating Texas on entering the telehealth era,” Dr. Roy Schoenberg, CEO of that privately held Boston-based company, said in a statement. Care at retail stores
Meanwhile, Hello Alvin, a mobile health-care network, plans to expand its footprint in Texas by offering prepaid access to medical care at retail stores. For $100 per year families can purchase unlimited online or phone access to a health professional at select stores. A video chat will cost $45 per visit.
The financial rewards appear as bright as the ground is fertile.
“Texas is a big state. It represents enormous opportunity for Hello Alvin,” said Arif Razvi, CEO and founder of the New Yorkbased company.
Before the new law — and any business bump it may create — Teladoc was already forecasting $180 million to $185 million in revenue for 2017, up 50 percent over last year.
While the reach into under-served areas is being lauded, concern remains that it is not a cure-all
“Simply deploying technology is not going to fix all our health care challenge,” said Dr. Thomas J. Kim, an Austin psychiatrist and internist. While a telemedicine enthusiast he acknowledges it will never completely replace a traditional exam.
It also will do little to curb the uninsured rate in a state that already leads the nation.
Often the uninsured in Texas live in the very regions that telehealth seeks to help. But if the subscription is too expensive or comes only through insurance plans, those people remain left out, Dickey said.
Still, she said, any boost in access to care is important and symbolizes a rethinking of how medical needs are met.
“I think the day has come when every little town cannot expect a bricks and mortar hospital,” Dickey said.
“But we have to find a way to not only get them access to care but quality access to care.”