What is US Telemedicine Policy?


The US Telemedicne Policy Latest

US telemedicine industry has undergone a sea change through the history and evolution of the Texas Telemedicine Act and the implications of the passage of the Act for Texas, the telehealth industry, and the United States as a whole. Thus you will clearly understand the latest US telemedicine policy.

Texas Governor Greg Abbott on Tele medicine

On May 27, 2017, Governor of Texas (hereinafter referred to as Texas) Greg Abbott passed the state's telemedicine legislation bill (the Senate Bill SB1107 and House Bill HB2697), abolishing doctors only in face-to-face contact with patients After that, it is possible to provide telehealth services.

As the last of the 50 states in the United States to repeal this rule, the Texas Telemedicine Act allowed a number of telemedicine companies, such as Teladoc, American Well, Doctor on Demand, and MD Live, to extend their remote video business to National market.
The US Telemedicine Policy Illustration
Telemedicine Laws

But in a strict sense, telemedicine operations in Arkansas and Idaho still have limitations because the two states still have restrictions on telemedicine telephony services.

Texas is the second largest state in the United States and the largest state in the southern United States. The passage of the bill is not only about opening up a new market for telemedicine, but more importantly, enabling the people of Texas to enjoy more diverse medical services. In addition, the bill marks the end of a two-year lawsuit between Teladoc and the Texas Medical Board, making it a landmark antitrust case in the US medical industry.

At this historic moment, the Internet medical information website MobiHealthNews sorted out the history of the Texas Telemedicine Act. This article takes you through the history and evolution of the bill and the implications of the passage of the bill for Texas, the telemedicine industry, and the United States as a whole.

Teladoc and Medical Board lawsuits, litigation costs up to $7 million a quarter

Texas has a large number of rural poor, and telehealth can bring scarce medical services to these people. From this perspective, it should not be the last state to approve telemedicine business.

Jason Gorevic, CEO of Teladoc, said: “There are 35 families in Texas who do not have any family doctors. The state has the highest population growth rate in the United States, but its number of primary care physicians per capita is only the fifth lowest. Access to services is a big problem in Texas."

Dallas-based Teladoc has been operating in Texas since 2005. However, in 2010, the Texas Medical Board passed a revision of the prescription rules for telemedicine, requiring doctors to conduct face-to-face consultations with patients before providing telemedicine services.

Medical committees vs Telemedicine companies

Medical committees and telemedicine companies have different interpretations of this revision. Companies such as Teladoc and MDLive believe that this regulation is only for video-based businesses, and it only limits video services and continues to provide telephony services in Texas. However, the Medical Council believes that these companies have exploited linguistic vulnerabilities and that their intentions are clear: to ban all telemedicine services that are not face-to-face.

Therefore, when Teladoc continued to provide telemedicine services to the Texas public by telephone, the Texas Medical Board sent an open letter to them asking them to stop providing any services immediately. A contingency rule was issued that clarified any ambiguity between the telephone and video services in the previous version. Teladoc then countered that the rule was not followed by proper procedures and prosecuted.

Lawsuit in 2015

The lawsuit has intensified in April 2015 and may have been directly reported to the Supreme Court. Teladoc sued the Medical Board under the Anti-Monopoly Law, calling it a licensed physician organization that would limit the development of telemedicine to bring economic benefits, and the Medical Board could not pass such a regulation aimed at curbing other competitors.

The lawsuit took two years and Teledoc paid a huge economic price for it. According to the company's 2016 public financial report, spending on litigation is as high as $7 million in just one quarter. But Teledoc CEO Gorevic believes that all this is worthwhile because they are fighting for their right to run their business and the right of customers to get better medical services. On the other hand, they dare to stand up and challenge the authority, and the side also shows their leadership in the telemedicine industry.

From the perspective of the lawsuit, everything seems to be more favorable to Teledoc. The US Federal Trade Commission (FTC), an important antitrust agency of the US government, even submitted to the court a "Friends of the Court" complaint that favored Teledoc's position. But in the end, both sides realized that the long-lost lawsuit would only hurt both sides. Instead of appealing to a higher court, it would be better to sit down and negotiate. Last fall, the two sides demanded that the case be suspended and began to show signs of reconciliation.

Gorevic concluded that the signing of the bill would completely end the lawsuit because it was "no need for litigation."
Telemedicine Laws and Practice
Telemedicine Practice

Good Telemedicine policy can solve problems in the medical system and promote the legislative process

 Since 2015, Teledoc has been in court with the Texas Medical Board. For two years, people have been trying to use legislation to end the lawsuit and reach a compromise.

According to LaToya Thomas, director of the National Center for Policy Resources at the American Association of Telemedicine (ATA), legal guidance is not only the only way to resolve the conflict between Teledoc and the Texas Medical Board, but also a necessary way to prevent similar conflicts in the future.

Thomas believes that the case in Texas is very special because it involves not only the medical committee but also other committees. The state’s advisory committee had wanted to pass similar rules, but fortunately it was blocked. Therefore, it is necessary to have the participation of state legislators.

Bills on Teledoc case

Nora Belcher, director of the Texas Electronic Medical Alliance, said that the early legislative attempts were too confusing to be passed in the legislature. Therefore, although a series of bills have been proposed to solve the Teledoc case, it is difficult to really play a role because they are all different from different angles.

In this case, Belcher, Teladoc, the Medical Council, and a number of other stakeholders, including hospitals and care practitioners, began to sit down and discuss together. They tried to meet a full year before the start of the Legislative Council and drafted a bill that would satisfy everyone.

It turns out that there are not too many requirements for suppliers (referring to medical service providers): they want to ensure a sound standard of care, do not change the licensing arrangements, clarify matters related to reimbursement, especially the medical insurance plan will not be a phone call. Ask a doctor or fax a bill. But the legislature does not want to pass a “supplier bill” but will protect all telemedicine providers. The bill passed this time solves all these problems.

Gorevic believes that the root cause of the partnership between Texas and remote companies is the shift in perceptions of telehealth from 2010 to the present.

Government Regulator on Telemedicine Policy

“Government’s regulators tend to protect the status quo in change,” he said. “Texas is the case. If new things show their value and take steps to ensure equality, the more they can break the status quo and start adapting to innovation. As a leader in the telemedicine market, Teledoc is able to drive this process. Over time, people are beginning to understand that telemedicine is not a new gadget, but a real solution in the medical system. Problems and industries that can bring great value to the people of Texas."

In the end, the bill was unanimously passed in both the parliament and the Senate. The bill passed this time even includes some novel forward-looking regulations, such as redefining storage and forwarding technologies, including cloud infrastructure. However, the bill also makes Texas a 20th state that prohibits the use of telemedicine for abortion, showing that there are still many challenges in the future development of telemedicine.

3 Acts of Texas Telemedicine on Telehealth reveal US TelemedicinePolicy

At the 185th Legislative Council in Texas, SB1107 was the most important bill on telemedicine. In addition, the following three telemedicine bills were passed in the Legislative Council.

The SB1633 will allow more remote pharmacy technology to be used in areas where there are no pharmacies in Texas. Another bill, HB1697, will provide a donation program for remote neonatal intensive care unit (NICU) services for premature babies. Then there is the SB922, which will ensure that the school's telehealth services are reimbursed for Medicaid.

In addition to SB1633, two other bills have been submitted to the governor. The remote pharmacy bill is currently being settled with the House of Representatives and the Senate.

In this regard, Belcher said: "This year is a surprising year for us. Last year we submitted 17 bills, only 2 of which were passed. If three of the four bills passed this year, not only It will be a structural victory and very symbolic."
US Laws on Tele medicine
Conduction of Telemedicine

Telehealth expands its business in Texas, and four telemedicine companies in the US are optimistic

 Although the current regulatory status is still not friendly, the four top telehealth companies in the United States have already established some businesses in Texas. Teladoc and MDLive have been operating telephone services based on their understanding of existing regulations. American Well has partnered with Texas hospitals to use the company's telemedicine services during hospital visits without any legal problems; mental illness It has not been within the prescribed limits, so Doctor on Demand has been providing telephone mental health services throughout the state.
However, with the passage of the bill, all four companies will be able to implement remote video services in Texas and across the country.

According to Belcher, Texas is the last state to allow telemedicine companies to conduct video services in the state. This is very important for these companies because it means they can finally strategically deploy in all states across the United States.

American Well's attitude was the most cautious before the bill passed. Although the company is providing telephony services in Texas as described above, company CEO Roy Schoenberg still emphasizes that unless the medical committee explicitly supports other business methods for telemedicine, they will not expand their business in Texas. He said with no irony: "We don't think that operators who are trying to slap words are thinking that doing this or letting doctors do this will not be sued."

However, after the passage of the bill, American Well believes that this will not only benefit the company's direct sales business, but also help strengthen corporate partnerships. Schoenberg said that due to the medical committee's regulations, American Well did not directly operate in Texas, and many of the large national insurance companies that cooperated with it, such as Anthem and United, were also affected and could not enter the Texas market.
Laws on Teledoctor or ehealth

The New Law on Tele-medicine

The new law just passed opened the way for American Well and its customers to use its platform to provide a variety of services in Texas. Previously, these customers were only able to follow up patients, and now they can finally open the system and take advantage of all their functions.

Hill Ferguson, CEO of Doctor on Demand, emailed MobiHealthNews that in Texas, they have been providing mental health services through the video platform for a long time and have been successful in this regard. With the passage of the new bill, his company will gradually expand to other areas of care based on mental health business.

And MDLive's CEO, Scott Decker, is not worried about the passage of the bill, which will make the competition more intense. He believes that MDLive has established a stable patient population in the Texas telephone service market, and these patients will not easily switch to other video services. The passage of the bill allows it to have a wider display in Texas, and the solid user base is the company's largest net income guarantee.

The biggest obstacle to the development of telehealth will be reimbursement

 The passage of the Texas Telemedicine Bill was a huge victory, but it was far from the end of the legislative road. ATA's Latoya Thomas pointed out that some states' telemedicine situation is not optimistic, such as Connecticut and Rhode Island still have telehealth restrictive bills for ophthalmology; Arkansas still has a telephone ban; Iowa Physical Therapy Committee A new regulation is in place that only licensed physiotherapists can provide telehealth services for physical therapy.

Thomas also said that Texas's legislative victory is a good first step and a good example for other states. If Texas can do this, other states are likely to follow suit. “I think other states should learn from the Texas experience and give a green light to local telemedicine.”

Teladoc CEO Gorevic believes that all parties are very concerned about the telemedicine legislation in Texas. The support of the Texas legislature is an important recognition of the value of telehealth. In addition, it complements the positive actions of Washington.

For example, the 21st Century Therapy Act signed by Obama in December 2016, the High-Quality Results and Outcomes Necessary to Improve Chronic, which was just passed in the Senate Finance Committee in May 2017. High quality outcomes and prognosis, etc., support the use of telemedicine to improve the health care system.

Obstacle in Development of Tele-medicine

On the other hand, most people agree that the biggest obstacle to the development of telemedicine will be reimbursement. As MDLive's CEO Decker said, the next legislative focus will be on medical insurance reimbursement for telehealth outpatient clinics across the US. At present, even in a state like Texas that achieves telemedicine equality, its reimbursement is actually very difficult.

Schoenberg, CEO of American Well, believes that “equality” looks good in the legal provisions, but if doctors ask questions about providing telehealth services to patients and receiving money, the answer is an embarrassing uncertainty. According to Schoenberg, the root cause of the problem is the attitude of the federal health insurance. Maybe it will change in the future, but so far, people can only wait and see, not sure how to do it.


Of course, Texas's telemedicine legislation is a great victory. Both parties involved and legislators can celebrate this rare legislative win-win situation. Especially for Texas, the second largest state in the United States, it can win more space for telehealth development here, and it is a great encouragement to all companies in the industry.

Tags: #USA, #United States Telemedicine,  #American Telemedicine, American Telemedicine Policy, #Telemedicine in America, #Telemedicine Laws, #Telemedicine State laws, #Telemedicine Legal

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