By Greg Guggenmos
As the population of Texas booms, the shortage of trained medical professionals in the state is an ongoing challenge. Without adequate access to care, inexpensive and effective health care services are increasingly inaccessible, making it almost impossible for Texans to get the care they need.
Expanding the use of telemedicine is one way to alleviate these provider shortages. By allowing Texans across the state, whether in remote rural areas or in dense urban cores, to access health care via telemedicine, the Lone State State could enable more people to get the care they need.
Indeed, telemedicine is a rising trend in the health care market nationwide. Late last year, PricewaterhouseCooper’s Health Research Institute wrote, “Entrepreneurs have devised technologies aimed at increasing access, improving quality, and lowering cost… Today the health sector faces a daunting new digital challenge: unleashing the power of technology to fundamentally reinvent how care is delivered.”
Despite the potential for telemedicine to increase access to care in Texas, state regulatory agencies and lawmakers have failed to pave the way for innovation, and in fact have worked to thwart the innovative use of emerging health care technologies like telemedicine.
And yet Texas desperately needs to expand the use of telemedicine, not curb it. The Lone Star State was recently ranked the 5th worst state for doctor-to-resident ratio. With only 176 medical professionals for every 100,000 residents, Texas lags far behind most states, particularly those with strong economic stability. Rural Texans are the most at-risk, due to the low number of doctors in those areas. The rate of medical students who graduate and practice in Texas has failed to rise with the population, creating a shortage of professionals in 36 of the 40 medical specialties.
Some members of the Texas Legislature recognize these problems, and several members sought to expand access to telemedicine and remove barriers to innovation in Texas. Although a few modest telemedicine bills did pass, one bill would have established guidelines for expanding the use of telemedicine in Texas by allowing doctors to treat some illnesses and injuries without having a previous in-person encounter with a patient.
During session, however, the Texas Medical Board (TMB) implemented suffocating regulations that effectively shut down some telemedicine companies and pushed Texas into a position of being one of the least accommodating environments for telemedicine in the country. Early in April, the TMB promulgated a rule banning doctors from practicing medicine over the phone or by video conference before physically meeting with the patient. The rule directly conflicted with regulatory provisions in several telemedicine bills that had already been filed.
Although the TMB cited patient safety as the reason for the rule, the regulations come as other state medical boards and legislatures are changing rules to accommodate greater use of telemedicine. The practical effect of the TMB rule would be to shut down companies like Teledoc, a Dallas-based telemedicine services company that serves more than 10 million Texans and represents competition to Texas-based physicians. Teladoc has been operating for more than a decade in Texas and other states.
Teledoc is fighting back. In late May, the company filed a lawsuit claiming the TMB was engaging in anti-competitive behavior. The company’s argument rests in part on the application of anti-trust laws to state regulatory boards like the TMB. Federal Judge Robert Pitman has granted an injunction, allowing Teledoc to continuing operating while in the lawsuit works its way through the system.
The injunction itself suggests that TMB confused the interest of the public with the self-interest of instate doctors. As Judge Pitman wrote: “Plaintiffs have presented specific evidence detailing the financial harm they will suffer… As to the threat to public safety and health, the TMB has presented only anecdotal evidence of possible public harm.”
In contrast to Texas, other states are moving to expand the use of telemedicine. In the past year, Colorado, California, New Mexico, and Maryland all allowed telemedicine providers to be compensated by insurance plans. Each of these state legislatures clearly articulated the desire to see an increase in telemedicine. According to a May report from the American Telemedicine Association, Texas is one of just two states that receive a failing grade for telemedicine services.
If Texas wants to become a national leader in health care the way it’s a leader in job creation and economic growth, it must embrace new telemedicine technologies that offer residents the ability to connect to a medical expert at anytime, anywhere. To do that, lawmakers will have to recognize that the TMB is trying to stifle telemedicine in Texas, and be prepared to step in and restrain overzealous regulators who seek to stifle telemedicine in Texas.
Greg Guggenmos is an intern in the Center for Health Care Policy at the Texas Public Policy Foundation.