Virtual Doctors Are Making Medical Board Really Nervous

The Texas Medical Board will meet Thursday to consider a 21^st-century question: How should the state regulate doctor-patient relationships when they exist only in cyberspace and, in some cases, across state lines?

The meeting follows an intense legal battle between the state and one of its largest telemedicine companies. Three weeks ago, Dallas-based Teladoc won a temporary restraining order against the medical board, which had issued an emergency rule seeking to limit the company’s operations.

It’s the latest in an ongoing debate about the practice of telemedicine, in which doctors make diagnoses, and sometimes write prescriptions, after consulting with patients by phone or on the internet.

“They’ve been having this fight in the background for years now,” said Tara Kepler, a Plano-based expert on telemedicine law who represents telemedicine companies but not Teladoc. “The industry is exploding faster than they can even write the rules.”

The medical board, which licenses and regulates Texas physicians, has been at odds with Teladoc over whether its doctors may prescribe drugs to patients without ever meeting them in person. The board issued an emergency rule on Jan. 16 requiring physicians to have a “face-to-face visit” with patients, a move the board said was necessary to protect public health. 

But four days later, a Travis County judge approved a temporary restraining order Teladoc sought to prevent the emergency rule from taking effect, “because no imminent peril to public health, safety or welfare exists,” according to the order.

Now the board is expected to consider whether it should draft a formal version of the rule, emergency or no emergency. Some observers say the debate could prompt lawmakers this session to revisit how broad the medical board’s rule-making authority should be when it comes to the practice of telemedicine. 

“This is the way all the states are moving in these types of rules,” Kepler said. “All the medical boards are taking these types of actions. Texas is just a little more bold.”

While the state has been stuck in court with Teladoc, various public programs have made use of the company’s services. The Teacher Retirement System of Texas’ health plans cover Teladoc services, and about 800,000 Texas Medicaid enrollees have access to Teladoc consultations. Much of the service’s popularity comes down to its comparatively low price, CEO Jason Gorevic said.

“There’s no question that it is a lower-cost alternative, especially to going to the emergency room for things that don’t need to be treated in the emergency room,” he said.

But there is little consensus about where services like Teladoc’s fit in the general health care arena. Doctors’ groups, including the Texas Medical Association, say they support telemedicine if it’s “done right.” Often that means using the technology to expand access to care in hard-to-reach places, like rural counties, offshore oil rigs and state prisons — underserved areas that also pose little risk of competing with physicians’ practices.

For Russell Thomas, an osteopathic doctor in Eagle Creek and former medical board member, telemedicine allows his small-town patients to confer with faraway specialists. But as a stand-alone practice, he said, telemedicine services pose risks, especially when prescription drugs are involved.

“What can the quality of service be,” he said, “when it’s sight unseen and you have no relationship to the patient?” 

Gorevic said his company provides care to people who wouldn’t otherwise engage with the health system. Texas, which lags behind most other states in its ratio of physicians to patients, is a market with “really tremendous demand,” he said. 

However the Texas Medical Board chooses to proceed with its telemedicine rules, it will have seismic consequences for the future of the industry.

"Everything happening at the state and federal level matters right now," said Krista Drobac, executive director of the Alliance for Connected Care, a national telemedicine advocacy group. "What's happening in Texas is of keen interest to everyone in the telehealth world."

Disclosure: The Texas Medical Association is a corporate sponsor of The Texas Tribune. A complete list of Tribune donors and sponsors can be viewed here.