Sides debate telemedicine doctor change

Hearing keys on proposal to skip initial in-person visit

A proposal to allow doctors to treat patients they have never examined in person drew support Wednesday from businesses that want to offer phone-based services to their employees but objections from legislators and others who fear it would put patients at risk.

Addressing an advisory committee to the Arkansas State Medical Board, Rep. Michelle Gray, R-Melbourne, noted that the House of Representatives rejected a bill during this year’s session that would have given doctors similar leeway.

“It’s not the intent of the Legislature to take away that initial face-to-face visit,” Gray said.

The comments came at a public hearing on a draft proposal by the Medical Board’s Telemedicine Advisory Committee, which was created earlier this year to recommend policy to the board.

The advisory panel’s proposal would allow doctors to “establish a patient-physician relationship” using “real-time audio and visual telemedicine technology.”

The doctors would be able to diagnose the patient’s illness and prescribe medicine but also would have to direct the patient to seek follow-up care with a primary-care provider.

Under Act 887, passed by the Legislature this year, doctors can only treat patients they have examined at some point in person, have an ongoing professional or personal relationship with, have a referral from another doctor or when they are filling in for the patient’s regular doctor.

The law also allows the Medical Board to specify other ways the physician-patient relationship can be established.

The competing bill, sponsored by Rep. Dan Sullivan, R-Jonesboro, would have allowed doctors to establish a patient-physician relationship through interactive audio or visual technology or both.

Scott Pace, a Medical Board member and the advisory committee’s chairman, said the advisory panel will take the comments into account as it develops its recommendations.

Sen. Cecile Bledsoe, R-Rogers, a sponsor of Act 887 and chairman of the Senate Public Health, Welfare and Labor Committee, said

she’s concerned that doctors might miss symptoms during a videoconference that they would catch during an in-person exam.

She also wants to encourage Arkansans to visit primary-care doctors, who can help keep chronic illnesses from becoming worse and more costly, she said.

Gray; Rep. Deborah Ferguson, D-West Memphis, who also sponsored Act 887; and Sen. Missy Irvin, R-Mountain View, expressed similar concerns.

David Wroten, executive vice president of the Arkansas Medical Society, said his group’s board of trustees discussed the telemedicine proposal briefly last week, and the “overwhelming mood” was that “the in-person exam is very important to them.”

“They latched on to that very quickly and were very concerned that we not move too quickly, that we slow down and think about what we’re doing and make sure that the interests of the patients and safety come before everything else,” Wroten said.

Wroten and the legislators said they would support video-based exams if the patient had been examined by a primary-care doctor who approved the patient for the service.

But Henry DePhillips, chief medical officer for Dallas-based Teladoc, said such an arrangement wouldn’t be workable for his company because many patients who use the phone-based service don’t have a primary-care doctor.

“Most of the commercially available telemedicine programs would be gutted if that requirement were in place,” DePhillips said.

Ninety-one percent of the exams provided by Teladoc are conducted over the phone by doctors with access to the patients’ medical records, DePhillips said.

Six percent of the exams also involve photographs submitted by patients, and 3 percent involve a video connection, he said.

The company, which provides services under contracts with employers and health plans, suspended its operations in Arkansas last year in response to concerns raised by the Medical Board.

It has customers in every other state, DePhillips said.

Even before Act 887 was passed, Arkansas’ Medical Board contended that its regulations required an in-person exam to establish a patient-physician relationship.

Rick George, senior director of benefits at J.B. Hunt Transport Services in Lowell, said his company has used a service similar to Teladoc’s since 2012.

Late last year, the service was stopped for employees in Arkansas, but it is still available to those outside the state, he said.

The service gives employees access to a doctor in the evening and on weekends, providing them with a cheaper alternative to the emergency room, he said.

Some employees now cross the state line into Missouri when they need to use the service, he said.

Mike Ward, vice president of associate support at America’s Car-Mart in Bentonville, said his company’s employees list the Teladoc service as the company’s top benefit.

“It’s disappointing to our associates and our organization that we can’t use that benefit anymore” in Arkansas, Ward said.