Telemedicine deal reached

Compromise to end longtime dispute over electronic doctor visits in Texas

AUSTIN — A yearslong fight over the use of telemedicine in Texas appears to have been resolved, with medical and industry groups agreeing to compromise legislation that, if it passes, could benefit patients, especially those in rural areas.

Senate Health and Human Services Committee Chairman Charles Schwertner, a Georgetown Republican and orthopedic surgeon, confirmed the deal Wednesday and said he will sponsor the legislation to resolve the longstanding feud over rules to allow doctors to see patients electronically.

“I think we will have a bill very soon,” he said, noting there could be “considerable benefits” to patients if the legislation is approved by lawmakers — as well as possible benefits to taxpayers if the electronic doctor visits can help curb spiraling costs for some state-funded healthcare programs.

Ironically, despite the heated controversy over telemedicine for most Texans, the concept of electronic visits was adopted successfully two decades ago in the Texas prison system in a program that is now credited for saving hundreds of millions of dollars.

While the announced agreement clears the way

“This is going to get us a fair and open market for telemedicine in Texas.” Nora Belcher, executive director of a telemedicine trade group

for Schwertner’s bill to move forward in the Legislature to passage, opposition could still materialize that could delay — or perhaps derail — it. Last session, well over a dozen bills were filed to allow telemedicine in Texas, but none became law, officials said.

The telemedicine concept already permitted in most other states works like this: Patients can consult with their doctors by phone or video, and doctors can order prescriptions based on those electronic visits.

In Texas, issues have simmered over telemedicine for years between doctors, telemedicine interests and insurance companies, among others. Schwertner said those interests were represented in the talks to explore a possible agreement on legislation that would allow the use of expanded technology in seeing patients. Expedite care

For rural Texans who may have to travel long distances to see their doctors, and for many others who may otherwise end up in an emergency room for minor ailments, telemedicine could expedite care and significantly cut costs for consumers — perhaps by as much as $12.6 billion a year, by one provider’s estimate.

Besides the possible cost benefit, primary care physicians are in short supply in the Lone Star State. In an April 2015 report by a health care study group, 80 of Texas’ 254 counties were listed as having five or less physicians and 35 had no doctors. The physician shortages were most acute in rural areas that are home to more than 3 million Texans, according to state statistics.

But amid horror stories of serious illnesses being misdiagnosed on the phone or during video consultations, the doctors’ lobby had been steadfast in its insistence that advancing technology would not necessarily provide better care.

In a business-friendly state where the doctors’ lobby wields considerable clout, the issue over those so-called e-visits has been a flashpoint for controversy, legislation and lawsuits for years.

The issues reached a boiling point in 2011 when the Texas Medical Board warned Texas doctors that using the telemedicine concept could jeopardize their medical license for “failing to establish a proper professional relationship with the patient,” which it said should include an initial face-to-face meeting.

Lawsuits followed, and the Legislature two years ago failed to resolve the issue with various interests still at loggerheads for a solution.

With the state’s rules tied up in court, representatives of physician, telemedicine, business and insurance interests last year began meeting privately to see if the sides could come to terms on legislation that would resolve the fight.

As those talks were ongoing, the Texas Association of Business — the politically potent lobby group representing most Texas businesses — weighed in to endorse an overhaul of state regulations to allow for the expansion of telemedicine services across the state.

“Texas has some of the most onerous regulatory hurdles for telemedicine technologies,” Bill Hammond, then CEO of the business association, said at the time, in a statement that was widely seen as a signal that the political pressure was increasing to resolve the long-running fight.

“The industry’s potential to help Texas patients and companies maximize access to care and reduce the cost of care is being held back by limitations imposed by regulators who accept the status quo as sufficient,” Hammond added. Agreement applauded

While providing few details on the settlement, Schwertner said Wednesday he believes the issues of disagreement have been addressed. Others familiar with the talks agreed.

They said doctors wanted to ensure proper patient care was maintained and that they would receive payment for services provided remotely.

Health insurance providers who had supported use of new technologies to improve care and cut costs wanted to ensure proper payments would be permitted. And companies that offer telemedicine services wanted to ensure they could operate without onerous restrictions.

“This is significant, and will be a winner for everyone,” said Nora Belcher, executive director of the Texas e-Healthcare Alliance, a telemedicine trade group. “This is going to get us a fair and open market for telemedicine in Texas.”

She and others involved in and familiar with the negotiations credited Schwertner with bringing the various sides together on the proposed legislation.

“(The Texas Medical Association) applauds Senator Schwertner for his leadership in helping us all pursue a compromise telemedicine bill on our patients’ behalf,” said Dr. Ray Callas, chair of the Texas Medical Association Council on Legislation.

“While we are pleased that the seed of a legislative agreement is in place, we acknowledge that more work remains before it can grow into a new law to guide this valuable form of patient care for the future.”