Over the past two years, policy makers across the nation have been actively adopting policies in support of the rapid adoption of telehealth. From states affirming that health insurance plans should appropriately cover care provided through innovative technologies, to Congress contemplating multiple proposals for telehealth expansion within Medicare – telehealth is fast becoming a permanent part of our healthcare ecosystem.
This movement has been most clearly demonstrated by state medical boards. It has been their job to answer the questions: can physicians use technology to extend the reach of their care? Can telehealth be used to create a treatment relationship, and if so, are their limitations to this relationship?
Overwhelmingly, the resounding answer to these questions has been a consistent one – yes, you can use robust telehealth technologies to provide care and the main limitation is simple – uphold the same standard of care. The Federation of State Medical Boards has upheld this concept.
But if you’ve been following this movement, you know there’s a rather large blip on the national map: Texasa state with more than 27 million residents and a clear need for increased access to care – was recently ranked “worst in telehealth” by the National Center for Policy Analysis. The good news: despite restrictive rules and a lawsuit that’s hindering progress, telehealth is working in Texas and changes, they are a coming.
Since promulgating rules back in 2011, the Texas Medical Board has upheld that a treatment relationship can only be created through telehealth when the patient travels to a clinical site, with a few exemptions. This rule has been the root of much controversy and ongoing lawsuits which have put the state under a microscope and created the false conception that the lights are off.
Not so. Telehealth is moving forward in the state. Texas Tech University has a robust telemedicine program including a school based clinic in Hart, a burn unit treatment site in El Paso, and hospital-based telemedicine care in the Big Bend region. Children’s Health in Dallas is offering on-demand, urgent care visits to their employees through virtual health kiosks at two of their locations, and scheduled home-based visits to their existing pediatric patients.
These are all legal use cases in Texas; providers and hospitals are taking full advantage of the benefits of technology, and it’s yielding results.
The Board itself has evolved as well, as much as the state’s codified process and the handcuffs of the lawsuit will allow. They now allow behavioral health providers to establish a treatment relationship through telehealth regardless of the patient location. The Board, in partnership with its telemedicine stakeholder group is creating a new call-coverage model to allow telemedicine providers to leverage after hour and specialty care that was sorely lacking. In 2016, they will meet again and ask, “What is the next step in telehealth expansion?”
So, when will the Lone Star State join the majority of the nation in embracing the concept that telehealth is not a separate type of healthcare, but a modality of care delivery? There’s no one answer. The pending legal cases certainly don’t help game the outcome. But, the Medical Board is listening; the Legislature meets again in early 2017, and the Governor’s office is aware. It’s just a matter of time before one of them gets to the finish line.
Kofi Jones is the Vice President of Government Affairs and Telehealth Evangelist for American Well– a national mobile and web based telehealth solution provider based in Boston. Jones focuses most of her efforts evangelizing on the power telehealth and collaborating with federal, state, and congressional leaders to ensure the proliferation of modernized and safe telehealth policies. Prior to joining American Well, Kofi spent 4.5 years working for the Deval Patrick Administration – first as a Public Affairs Director and spokeswoman for the Governor’s Economic Development Secretary, and then as the state’s first Chief Marketing Officer. She has also spent several years as a communications and media expert, including a decade in television news as a producer, reporter, and anchor