THCB

Texas Hasn’t Banned Telemedicine: Why The TMB Regulatory Approach Makes Sense

Screen Shot 2015-09-02 at 7.45.56 PMThere has been at least one report that the Federal Trade Commission (“FTC”) is looking into anti-competitive practices based on the Texas Medical Board’s telemedicine regulations.

As a telemedicine company operating in Texas, we maintain that the rules put in place by the Texas Medical Board are by no means insurmountable and do not seriously limit competition. The rules merely allow better integration of telemedicine offerings with existing medical services and help ensure a better patient experience.

Telemedicine is possible in Texas as defined by the guidelines of The Texas Medical Board (TMB), but it has to be telemedicine done right. Telemedicine must be provided in a way which conforms with modern clinical safety standards, including ensuring continuity between traditional care encounters and telemedicine encounters.

The TMB regulations mandate that:

1. An individual must have a face-to-face visit with the provider group providing virtual care to establish a doctor/patient relationship;

2. Doctors treating a panel of patients virtually must have reciprocity (communication, accountability) with each other and should be under common medical direction; and

3. Physicians engaging in telemedicine must be able to follow-up with patients and vice versa.

We view the TMB’s regulations as an attempt to establish value-based telemedicine in Texas – telemedicine that doesn’t rely on payment per visit or per incident, delivers continuity of care, better patient experience and better outcomes.

The version of telemedicine being practiced by many of the national telemedicine companies today is problematic. Many of these services create fractured, one-off encounters that are exclusively fee-for-service. The physicians providing care via this form of telemedicine are often in different states than the patients being treated. While the doctor will be licensed in the state where the patient resides, he or she likely also has licenses in many (or all) other states and knows absolutely nothing about the patient’s community. Physician taking calls on these services generally have little to no information on the patients they treat and will very rarely have an understanding of local follow-up pathways. If follow-up is needed, the patient has to find a care facility on his or her own, and that facility will have no knowledge of the telemedicine encounter.

The form of telemedicine practiced by the national services assumes that a patient’s medical issue can be fully addressed in a one-time-only snapshot encounter. Yet we know that’s not the reality. Each encounter is more like a single sentence in the narrative of the patient’s overall medical care. Each provider encounter or health event is part of a much bigger picture; every course change has downstream effects. Patients deserve virtual access to physicians that is congruent with their existing local healthcare experience.

Following these principles, we are showing that competitive, value-based telemedicine is possible in Texas following the TMB’s regulations. The TMB is developing protections for the safety of their constituent citizens and attempting to address specific limitations with the style of care delivered by the national telemedicine services.

Here’s how one regional medical group in Texas is delivering high quality telemedicine locally, powered by our company’s software platform:

1. Real Doctor/Patient Relationship: when on-boarding a new employer or payer client, on-site events are held for patients to establish a face-to-face doctor/patient relationship with a provider from our partnered medical group.

2. Reciprocity and Common Medical Direction: all physicians staffing this virtual care program are based in the same community as the covered population and have reciprocity with each other. Physicians operate under one medical director with common standards of care guidelines and well-established pathways for smart referrals, ancillary services and integration with the shared system-wide EHR.

3. Bricks and Mortar Follow-up: our partnered medical group is affiliated with local health systems through the aforementioned referral channels. This enables doctors seeing patients virtually to make referrals for follow-up with physicians in clinic as appropriate and ensures that patients receive the ongoing care that they need beyond the virtual visit.

4. Virtual Follow-up: staffing our program with one group of partnered physicians enables a patient to interact virtually with the same physician, or one of their colleagues, over the course of several hours, days or weeks. Patients can easily followup with the doctor on duty at any given time. Likewise, the original treating doctor can rely on his or her partners on duty later on to check in on the patient being treated conservatively, at home.

5. Continuous Loop Virtual Care:physicians staffing our virtual care program in Texas have access to patient health data before an encounter, and all data from virtual encounters are passed back to the patient’s EMR. Virtual and physical care become part of the same continuum of care within this locality, in the way that many pundits advocate but few health systems can actually deliver.

Evidence is mounting from our various implementations around the country that our local, integrated model of virtual care works effectively, outperforming national telemedicine models and falling well within the TMB’s regulations. Common sense connection to local providers can drive telemedicine in the right direction – towards care continuity.

As a practicing ER physician who co-founded a telemedicine company in Colorado, a company that is now operating in Texas in partnership with local health care providers, I can say that the TMB hasn’t taken an anti-competitive approach. They’ve just outlined specific, reasonable guidelines for patient care to operate within the state of Texas, as is their right and duty. We welcome competition from any telemedicine provider that chooses to operate within these guidelines.

Blake McKinney MD, is Chief Medical Officer / Co-founder of CirrusMD.

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John Irvine
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Telemedicine is the most important area in digital health right at the moment. The cloud, data, mobile, personalized medicine are overhyped. These rules are but foreshadowing of the tectonic changes that are in store.