August 22, 2017

The Texas Telemedicine Breakthrough

Robert Graboyes

Senior Research Fellow

The Texas Legislature just enacted landmark health care reforms by opening the state to telemedicine. This success shows that states have great power to improve health care without waiting on Washington. This is especially important as the Affordable Care Act (ACA, or “Obamacare”) grows more unstable and neither party in Congress seems capable of responding.

Telemedicine can improve health and lives—especially in a sprawling state with vast, thinly populated areas. As high-quality video conferencing and remote telemetry become more sophisticated and less expensive, telemedicine offers high-quality care without the need for face-to-face contact in many (not all) situations.

Since an episode of cardiac arrhythmia, I’ve carried a $99 device (AliveCor.com) that conducts clinical-quality electrocardiograms, analyzes them, and gives one-touch, low-cost access to professional help. My then-92-year-old mother’s life was probably saved by an iPad FaceTime conversation with her grandson (an M.D.), who sensed the onset of sepsis. Low-cost digital stethoscopes, blood pressure cuffs, and other devices can plug into smartphones or tablets, transmitting information directly to teledoctors.

Telemedicine can mean instantaneous medical care for distressed patients on remote ranches in the dead of night. A mother of four can get immediate care for one child without transporting her whole brood to an emergency room or doctor’s office for hours of waiting. An ill employee can get care without leaving the office.

Texas delegates much control over medical care to the Texas Medical Board. Previously, a Texan could engage with her personal physician electronically or with practitioners referred by that physician. But until the recent spate of legislation, the medical board strongly resisted direct-to-consumer (DTC) telemedicine, precluding the use of national vendors like DoctorOnDemand.comsherpaa.com, and Teladoc. The Medical Board became embroiled in legal action vs. Teladoc over various restrictions.

Spring 2017 saw a remarkable breakthrough. After protracted discussions involving telemedicine companies, advocacy groups, legislators and TMB, four bills passed the Legislature with unanimous approval by both parties’ legislators and were signed into law by Gov. Greg Abbott. Nora Belcher, executive director of the Texas e-Health Alliance, called this a “whole new ballgame” and said, “The Texas telemedicine market is now completely open for business.”

Senate Bill 1107 allows patients to receive prescriptions from doctors whom they meet for the first time via electronic means.

HB 1697 established grants enabling rural hospitals to purchase teleNICU (neonatal intensive care) equipment—allowing greater leeway for parents to care for some struggling infants at home. SB 922 broadened Medicaid reimbursements for telemedicine via physicians or other providers providing services in schools. SB 1633 allowed pharmacies to establish remote dispensing sites using telepharmacy in areas where brick-and-mortar pharmacies are unavailable.

Among other things, this legislative breakthrough ended the litigation between TMB and Teladoc. The success of this effort suggests ways states can spearhead reforms, especially given Washington’s partisan trench warfare on health care.

The Texas story also suggests how it’s productive to shift the focus away from health insurance structure and toward the delivery of care. Telemedicine is only one aspect. Dr. Darcy Nikol Bryan, Jared Rhoads, and I co-authored a Mercatus Center study titled “The Health Openness and Access Project,” (HOAP), which explores several dozen ways in which states can expand the supply of health care, often lowering costs in the bargain.

These include more telemedicine, broader scope of practice for nurse practitioners and other non-physicians, greater flexibility in structuring medical businesses, greater use of direct primary care practice models, medical liability reform, and hospital competitiveness.

And if we focus on care, rather than insurance, progress is even possible in Washington. The Senate just approved (unanimously) a bill creating a “right to try” allowing those with life-threatening illnesses to get experimental medications earlier.