On May 27, Texas Governor Greg Abbott signed legislation, putting an end to the battle between the Texas Medical Board and companies wishing to expand the availability of telemedicine in Texas. As I predicted in a 2015 Physicians Practice article, “Texas Medical Board Unplugs Telemedicine for Some.” the Medical board wasn’t so much wrong, but more on the wrong side of history and larger financial interests.
Telemedicine clearly offers a less expensive alternative to a traditional doctor’s visit, but also a potentially lower quality of care. Don’t be confused. The Texas Medical Board didn’t lose the debate whether a doctor visit on a cell phone can deliver the same quality of care as a face-to-face encounter. It can’t. The Texas Medical Board lost the battle over physician autonomy.
One concern might be, if a patient can see a doctor via telemedicine then the doctor could be anywhere; Texas, California, or in any country where people can talk to Americans fluently. But that’s not the problem. State medical boards usually are able to limit the practice of medicine to doctors licensed in the patient’s state.
The concern is over the question, “who employs to doctor on the other end of the telemedicine visit?” If the telemedicine doctor does not need to work in a traditional office, a few minutes from the patient’s home, the doctor could be employed by anyone, under any number of nightmarish, but economically efficient corporate conditions. And if that is true, how does the physician on main street stay in business?
That’s what worried the Texas Medical Board. And for good reason, if what happened to pharmacies is any example. There was a time when prescription medications were always dispensed by licensed local pharmacist. But the need for a pharmacist/patient encounter declines, when the patient is receiving the same medication, month after month, without any problems that might require a pharmacist. In fact, the pharmacist could just “mail it in,” literally, if not figuratively. And mail-order pharmacies were born.
But if there is no need for a pharmacy on main street, there is no need for a pharmacy at all. Insurance companies could go into the business of delivering mail-order prescriptions, in direct competition with local pharmacies. This is exactly what happened, but they didn’t stop there. Health insurance plans, major pharmacy chains and PPO pharmacy benefit management companies developed more and more efficient ways of delivering prescriptions, which will eventually relegate local pharmacies to the same fate as main street hardware stores.
So it was with this in mind, the Texas Medical Board passed a rule in 2015, requiring at least one face-to-face encounter, to establish a physician/patient relationship. After that, the encounter could be by telemedicine. As I wrote at the time, the money was on the other side. Legislation signed by Governor Abbott last week, ends a lengthy court battle between telemedicine companies and the Texas Medical Board.