Collaboration in Texas: Ensuring patient access to virtual visits
Tuesday, February 28, 2017
The Texas Medical Board has wrangled with telemedicine companies on policy covering virtual patient and practitioner visits. It came to a showdown in 2015 after the Medical Board adopted a policy requiring physicians to meet with patients in person prior to providing virtual medical care.
One of the telemedicine companies impacted, Teledoc, then filed a lawsuit against the Medical Board for antitrust violations. Last fall, after both the U.S. Department of Justice and the Federal Trade Commission sided with Teledoc, the Medical Board dropped its appeal.
The result is newly proposed legislation in the form of S.B. 1107, championed by Sen. Charles Schwertner, M.D., Chair of the Texas Senate's Health and Human Services Committee.
The goal of the legislation has been to answer the question: How do we provide for the establishment of a new patient-physician relationship in a telemedicine environment that adheres to the standards of care in order to write a valid prescription? The bill delineates requirements for establishing a valid relationship between the practitioner and patient, as well as a provision for adopting rules that define valid prescriptions for telemedicine visits.
According to S.B. 1107, a valid practitioner-patient relationship is established when the practitioner:
- Has a pre-existing practitioner-patient relationship established;
- Communicates with the patients pursuant to an established call coverage agreement; or
- Complies with follow-up requirements, and the method allows the practitioner to have access to, and the practitioner uses, the relevant clinical information that would be required in accordance with the standard of care.
It also requires a practitioner who provides telemedicine services to a patient to provide the patient with guidance on appropriate follow-up care; and, if the patient consents, provide to the patient's primary care physician (within 72 hours) a medical record or other report.
Coordination to jointly develop and adopt rules that determine a valid prescription is delegated to the Texas Medical Board, Texas Board of Nursing, Texas Physician Assistant Board and the Texas State Board of Pharmacy.
This case is an example of the importance of effective communication, building relationships, working to resolve conflict and the power of stakeholders coming together to find common ground and collaboratively working to establish a shared vision. Only with the exchange of relevant information are these leaders able to work through their differences and compromise.
"During the last legislative session, there were over a dozen telemedicine bills filed in Texas that didn't pass, because it was clear that there was no consensus among the stakeholders about what approach to take," said one of the stakeholders, Nora Belcher, executive director of the Texas e-Health Alliance. "My organization partnered with the Texas Medical Association and the Texas Academy of Family Physicians during the interim to convene a working group of all the major stakeholders to work through the issues, and this bill is the result."
She is proud of their work and adds, "This bill also guarantees a free, open and competitive market for all kinds of telemedicine in Texas."
If S.B. 1107 is passed this legislative session, it will be an example of how collaboration and compromise helped make patient access to virtual visits a reality in Texas.
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