The Texas Medical Board (TMB) Telemedicine Committee met on Thursday, August 27, 2015. During the meeting they discussed potential changes to the on-call services telemedicine rule (174.11). At the end of the meeting, they instructed board staff to draft proposed revisions to the rule to allow for changes to the rule.
Although the direction to staff was verbal, they focused on several items: expanding the scope of on-call physician specialties a physician can choose from for their on-call services; a diminishing of the current requirement that the on-call physician provide reciprocal services to the original physician; and there also appeared to be consensus that the rule should include a provision which requires the original physician to have responsibility for the on-call care.
Staff will be drafting language for the Committee’s consideration, and likely the consideration of the Board’s Stakeholder Group. Given the rulemaking requirements under Texas law, the expectation is that the Board will have draft language to propose at their December 2015 meeting, followed by a public comment period, and potential approval during the Board’s March 2016 meeting.
The current TMB Rule 174.11 reads: “Physicians, who are of the same specialty and provide reciprocal services, may provide on-call telemedicine medical services for each other’s active patients.” During the August 27 Committee meeting the TMB Executive Director, Mari Robinson, referred to comments from the Texas Medical Association and the Texas e-Health Alliance suggesting revision of the rule. According to Robinson, the suggested changes were also reflective of a consensus of the TMB Stakeholder Group which met last month. As a summary, there have been concerns about the restrictive nature of the “same specialty” and “reciprocal services” requirements.
During the Committee meeting, there was a demonstration of the current telemedicine platform for Children’s Health, an integrated healthcare delivery system which includes Children’s Medical Center Dallas. The presentation included a mock telemedicine patient encounter by Dr. Ray Tsai, Senior Vice President Children’s Health; Medical Director of Network Development; and President and Chief Medical Officer, Children’s Health Pediatric Group. He and his team explained that they have a network of 300 pediatricians in North Texas with only two currently using their proprietary telemedicine platform. They are hoping to expand that service using the TMB on-call services rule and supported revisions to the rule in order to allow them to expand the functionality of their network and also potentially their Accountable Care Organization.
At the end of the Committee meeting, board members expressed comfort with existing telemedicine systems which are compliant with board rule. There also appeared to be comfort with changing the rule to allow for the use of an on-call physician within the same “or similar” specialty and the removal of the reciprocal requirement. Robinson articulated a concern that the removal of the reciprocal requirement may have a negative impact by potentially allowing “telemedicine call services for-hire.” There was strong concern expressed by Board members that the rule should somehow provide that the original physician should retain responsibility for the care provided by the telemedicine on-call physician. Given such an assignment of responsibility might be an expansion of liability beyond traditional on-call arrangements, and depending on how the revised rule is crafted it will be important to watch the rule-making process as it develops.