Health Tech Austin Presents – Telemedicine: Growing Pains in Texas and Beyond

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hta-nov-pic(From Left to Right: Christie Garbe, Dr. Jacob Childers, Jamie Dudensing and Bill Hammond)

At the beginning of the month, Health Tech Austin drew in a full crowd as three thought leaders in the healthcare community came together to discuss Telemedicine, a controversial trend growing in Texas. Joining the panel was –  Jacob Childers M.D., medical director/eMD Access of Austin Regional Clinic; Jamie Dudensing, CEO of Texas Association of Health Plans; Bill Hammond, CEO of Texas Association of Business; and  Christie Garbe, VP and Chief Strategy Officer at Central Health, serving as moderator.

The following questions were presented by Christie and addressed by the panel:

What is the definition of Telemedicine as it covers a wide range of services and products?

Telemedicine offers the opportunity to save time and money, and we find patients rating this service with very high satisfaction. Texas Medical Board, however, has stated that the first medical visit by a physician must be done face to face, which denies the advantages of telemedicine. Surprisingly, 48 states don’t require this. We are being denied a very beneficial medical service by our state legislators. Currently, 60 percent of care provided in the ER, which cost taxpayers a lot of money, could be done by telemedicine with a huge cost savings, said Bill Hammond.

Jamie Dudensing emphasized that different terms in virtual healthcare must be defined. She has found in Texas, telemedicine is when a medical doctor is providing care, telehealth is when a non-physician practitioner is providing assistance and telemonitoring is when someone is simply following medical information on a patient, like Diabetes. The defining difference is whether someone can provide prescription drugs.

“Doctors have been doing this for years, we make medical decisions based off of a phone call all the time – it’s really nothing new as its just adding in new technologies like FaceTime or messaging to make communication more efficient. It presents challenges in getting this defined because people are worried about unintentional consequences,” said Dr. Jacob Childers.

What are the advantages of telemedicine?

Dr. Childers explained that remote services areas in rural counties have health care needs that go unmet that could use telemedicine, and at Austin Regional Clinic, they are finding a lot of patient satisfaction as this type of service is found to be a huge time saver for those utilizing it.

Dudensing pointed out that employers are requesting telemedicine services for their employees. It’s rare in healthcare to find something that reduces cost of care, improves access and patient satisfaction. It’s no wonder how fast this trend is growing. And importantly, it also increases the availability of specialty care as physician supply issues are a growing concern right now.

The convenience is enormous, especially for those with families chimed in Hammond. The response time is so quick and prevents parents from taking time off work and losing wages as well as prevents employers from losing out on productivity.

Why is there tension around telemedicine?

Dr. Childers explained that you are relying on a physician’s judgement, and in some instances, you may have a urologist, for example, who is trying to answer a pediatric question. There are other instances where an individual may think they have a medical issue that they, in fact, do not. It’s been reported that people who think they have strep, 90% of the time, it has been found to only be a viral infection. This example may put pressure on a provider to issue antibiotics to treat a patient just to keep patient satisfaction high. Quality of care could suffer.

Payment for these services?

Self-funded employers will contract with telemedicine providers, and many health insurance plans offer it this way as well often as something you can use as an extra benefit. Again, defining telemedicine is important because that impacts the legal side of it and how we develop contracts on it. How we pay for this is a big piece of the debate right now, said Dudensing.

TMA wants any and every doctor to offer this service and would like to mandate a payment rate on this, which will hurt the economics of the consumer, negating the low cost this service can provide, explained Hammond.

The fact that Texas regulations require patients to have a face to face visit with their provider first and not allowing physicians to offer services across state lines makes us restricted in how we can use telemedicine right now, said Dr. Childers.

What will happen in the next legislative session?

It’s difficult to predict what will happen, but they need to define telemedicine and offer clarity – no one wants to practice out of state laws and regulations. Now we have more need as well as doctors wanting to offer these services in competition with Teledoc, said Dudensing.

Hammond concluded that 99 percent of Texans will benefit from telemedicine services. “Why do we need a face to face initial visit when 48 states already allow telemedicine services without that? With the next session just around the corner, I encourage everyone to let their legislator know their view on allowing telemedicine in Texas. We are being denied this service by our state.”

What entrepreneurs need to know about Telemedicine

Dr. Childers offered his insight – “It’s a growth industry. There is a lot of opportunity and regulations have kept out competitors, but Texas will eventually converge with national regulations, and from this, will arise opportunities. There are a lot of models to consider and launch.”

“One area that I find is always difficult to innovate in healthcare –  as its consolidated and individual –  is that large groups can figure out how to buy these huge technology platforms, yet small groups or individual physicians have much more trouble doing this on their own. It would be great if those physicians that practice individually could use the same technology products that are available to the larger groups,” concluded Dudensing.