On April 10, 2015, the Texas Medical Board (“TMB”) voted in favor of adopting amendments to the rules governing telemedicine. The revised rules, which will significantly limit the ability to treat patients via telephone and video consultation, take effect June 3, 2015.
TMB took its first steps to curb telemedicine in January 2015 by passing an emergency measure that prohibited prescribing drugs without an initial in-person visit. Then, in early March 2015, TMB proposed official amendments to Title 22, Chapter 174 of the Texas Administrative Code (“TAC”), which resulted in TMB receiving more than 200 public comments and culminated with a public hearing on April 9, 2015.
The biggest change under the new rules is that the physician-patient relationship requires “establishing a diagnosis through the use of acceptable medical practices, including documenting and performing patient history, mental status examination, and physical examination that must be performed as part of a face-to-face or in-person evaluation….” (22 TAC 174.8(a), emphasis added). There are exceptions for mental health services and for situations where the patient is currently at a health facility and is attended by another healthcare professional.
The amendments also clarify and re-emphasize that: “An online questionnaire or questions and answers exchanged through email, electronic text, or chat or telephonic evaluation of or consultation with a patient are inadequate to establish a defined physician-patient relationship.” (22 TAC 174.8(c), emphasis added).
Supporters of the new rules, like the Texas Medical Association, believe the changes help ensure quality care and patient safety. Opponents, like Dallas-based Teladoc, feel the changes restrict access to healthcare and prevent patients from having a more convenient and affordable option for their medical needs. Some even consider the TMB’s decision to be moving Texas backward in regards to telemedicine, based on other states recently joining an interstate compact for physician licensing whose goal is to expand the use of telemedicine.
TMB’s adoption of the new rules is likely not the end of the discussion on telemedicine. Warning letters, lawsuits and countersuits related to telemedicine, specifically involving Teledoc, date back to 2011, so court intervention may result in further changes. There are also a few telemedicine-related bills up for consideration in the current Texas legislative session.