Consulting a doctor by phone, text or video is becoming popular. And in Texas, the debate over safety and access to health care is heating up.
Over the weekend, Patti Broyles felt like she was in a fishbowl.
“This weather was really cold and rainy and I had a lot of pressure in my sinus area," Broyles says.
Since she was visiting family near Chicago, nowhere near her primary care doctor in Dallas, she called Teladoc for advice -- and a prescription.
Teladoc, which is based in Dallas, is the largest telemedicine provider in the country. Here’s how it works: Patients whose employers or insurers have deals with the company can call up any time, and be connected with a physician on duty within minutes.
Jason Gorevic is chief executive officer of Teladoc.
"The Telehealth encounter uses the tech we all have access to every day,” Gorevic says. "Whether it’s your cellphone, laptop that has a webcam built in to it, or simply the phone.”
'You can't go shop anywhere else'
In Texas, hundreds of employers offer Teledoc's services to more than 2 million employees, Gorevic says.
But new rules from the Texas Medical Board could make it a lot harder for people like Broyles to get antibiotics in a pinch. That's why Teladoc filed a lawsuit accusing the Medical Board of artificially limiting supply and increasing prices.
"The rules as they’re written today only allow a physician who has seen a patient in person to interact with them remotely," Gorevic says. "That’s basically saying you can’t go shop anywhere else.”
The rules do allow for certain exceptions where a physician can diagnose or prescribe medications via phone or video, for example, if the patient is at a medical clinic or another health care worker is with the patient and can do a sort of surrogate exam. There's also an exemption for remote mental health visits.
Ensuring patient safety
Mari Robinson, executive director of the Texas Medical Board, says the rules aren’t meant to stifle competition. They’re meant to ensure patient safety.
"How can a physician make an accurate diagnose when they have no objective diagnostic data?" Robinson says. "All they have is what the patient has told them."
Dallas healthcare attorney Brenda Tso says if you peak behind the curtain, the strict rules aren't just about patient safety.
“In this situation, doctors are trying to protect their practice from telemedicine," she says.
Still, Tso thinks Teladoc's motivations are purely financial.
The bigger picture
While the Texas Medical Board doesn’t think its safe to rely on patients sending photos, videos and text messages to unfamiliar doctors, lawyer Rene Quashie points out other states do.
“If you look at states like Virginia, Maryland and New Mexico, they have laws and regulations that facilitate the greater use of medicine," Quashie says. "Texas is not one of those states.”
Quashie is senior counsel at the law firm Epstein Becker and Green in Washington, D.C. He says in a state like Texas, where 200 counties are considered medically underserved – more than a dozen have just one primary care doctor – there's a larger role for telemedicine.
“There’s a huge underinsured population in Texas," Quashie says. "Even people who have insurance sometimes have problems accessing care. So we’re balancing access to care, along with patient safety issues with misdiagnosis and over-prescription, but we also want to allow companies to innovate in this space.”
In Texas, the Medical Board received more than 200 comments on the rule change. It says key players such as the Texas Medical Association support the stringent rules. Teladoc points out the vast majority of the comments opposed the new rules set to go into effect in June.
