Big business backs virtual doctor visits as Texas loses fight for limits

Video or telephone visits with doctors — the practice known as telemedicine — have survived one of their biggest legal challenges yet in Texas, but hurdles remain in Arkansas and some other states.

The challenges come as telemedicine is gaining widespread support among major employers and many consumers.

A federal judge ruled late last week that a Texas Medical Board rule that prohibited doctors from diagnosing patients over the phone was likely anti-competitive and blocked the board from enforcing it.

The rule was set to take effect Wednesday.

The ERISA Industry Committee (ERIC), which represents the country's largest employers including General Motors and Walmart on employee benefits issues, is directing a new state telemedicine lobbying effort that also includes patient groups and consumer advocates. The goal is to convince state legislatures that telemedicine is needed to keep health care costs down and that state laws need to be more consistent in what they allow.

"The risk will fester in Texas, as long as the threat from the board's court case continues and other states also impose hurdles to the use of telemedicine." says Annette Guarisco, CEO of the industry committee. "Uniformly, employees really like it as a benefit and that is why employers don't want any curtailment at this point,"

Texas would have become one of the only states that still require an in-person visit before a telephone consultation. A new Idaho law that takes effect July 1 loosened its requirement that doctors know their patients. Arkansas still has such a requirement in place.

"The rest of the country is really moving forward fairly aggressively to promote telehealth legislation and regulation," said Jason Gorevic, CEO of Teladoc, which filed an antitrust lawsuit against the Texas Medical Board in late April for restricting its ability to to do telephone consultations in the state.

Major employers are concerned, however, about a patchwork of state laws that restrict telemedicine in different ways.

Among the concerns are the restrictions on doctors operating across state lines and state laws that mandate private employers to provide telemedicine at the same cost as in-office visits.

"This doesn't make a lot of sense since using the technology is more efficient and should cost less," said Andrew Mekelburg, Verizon's vice president of federal government relations.

The Texas Medical Association says it pushed the state medical board to require in-person visits with only limited exceptions to protect the safety of patients. After the judge's decision, the medical board said that is its primary concern as well.

"The telephonic providers don't have to know the guy on the other end, there's no follow up procedure and no underlying relationship," says Russell Thomas, a family physician who is a spokesman for TMA.

Teladoc, which calls itself the oldest telemedicine company and is one of the largest, does about 90% of Teladoc's consultations by phone and nearly always without another doctor present with a patient.

Judge Robert Pitman said the medical board's rule can't be enforced until after Teladoc's antitrust suit is decided. In his decision, Pitman signaled that, given Texas' physician shortage, Teladoc likely could show consumers could be harmed if the telemedicine company wasn't allowed to do phone consultations.

Telemedicine aligns with federal efforts to reduce health care costs and can dramatically improve access to care for those in rural areas, which have been hard hit by hospital closings.In its decision.

But some say less restrictive state laws run counter to the Affordable Care Act's emphasis on preventive care by reducing patients' dependence on primary care doctors. Insurers have to cover physicals and routine tests such as mammograms at no cost to consumers under the law.

The goal is to increase the likelihood that people will use the services and prevent serious health issues or catch problems before they require costly and often invasive treatment.

The American Telemedicine Association encourages its members to urge consumers to seek out a primary care doctor, CEO Jonathan Linkous says.

Besides, most people only use telemedicine a few times, typically when illnesses or injuries occur outside of most doctors' business hours or when they can't leave jobs or school to get to a doctor, says physician Reed Tuckson, president of the telemedicine association. That's among the reasons employers want insurance plans and state laws to permit these virtual visits, Guarisco says.

Telemedicine can save money in other ways, including by limiting the use of emergency rooms, which are one of the costliest types of medical care.

"Our society, our families and people that pay the health care bills can't afford for people to use emergency rooms for things they don't need them for," says Tuckson, former chief of medical affairs for UnitedHealth Group.

Critics including Thomas says telemedicine can help rural areas without compromising treatment.

"The issue is the patient needs to be seen," he says.

But Andrew Barbash, a neurologist who practices telemedicine for Specialists On Call from his home in Rockville, Md., says he can do an even better job remotely as he can look at a patient, her medical records and test images at the same time on the three screens on his desk.

"It's a win-win all around," Barbash says. "If it wasn't safe and good medicine, I wouldn't do it."

Contributing: Alanah Quinn