Texas Had Laws That Were Barriers To Telemedicine. The Coronavirus Changed That.
Telemedicine laws in Texas got revamped this week as the coronavirus spreads through the state.
Gov. Greg Abbott announced Tuesday he was waiving a slew of regulations that made it harder for doctors to treat people remotely, also known as telemedicine or telehealth.
“As the State of Texas responds to COVID-19, we continue to work to maintain regular health care services and operations throughout the state, and telemedicine is one of the most valuable tools we have to ensure Texans continue to receive the health services they need,” Abbott said. “Expanding telemedicine options will help protect the health of patients and health care professionals, while help Texas mitigate the spread of COVID-19.”
Among the changes: Reimbursements doctors receive for providing care through telemedicine are now the same as in-person care; providers can use whatever platform they prefer or have available to them; and doctors no longer have to establish in-person care of a patient before they use telehealth services.
“We need these folks to be able to ramp up quickly to service their patients,” said Stephanie Goodman, a spokesperson for the Texas Department of Insurance. “You can bet that your doctor has a phone. If your doctor suddenly had to have a whole new service to come in and provide other things, that’s going to take longer. We don’t have that kind of time right now.”
The bulk of these changes apply only to people with state-regulated plans – which is about 15% of Texans – however. About 40% of health plans in Texas are federally regulated.
Health officials have opened up telemedicine laws for Medicare patients. However, it’s up to Congress or emergency orders from the White House to change things for federally regulated plans.
Dr. Ogechika Alozie, chief medical officer at Del Sol Medical Center in El Paso, said telemedicine has played a big role in the care his clinic provides, particularly for the HIV-positive community.
He said he’s been talking to other medical providers about finding ways to treat patients remotely for years.
“When I would tell people about telemedicine, I would be like, ‘Hey, this is something that is within your reach, it’s within your workflow, it can make you more efficient,’” Alozie said.
But during those conversations, doctors told him about the many obstacles they faced in actually getting a program like that in place. Alozie said the barriers weren’t obvious things like having the right equipment or software.
“Historically, the technology has not been the difficult part,” Alozie said. “It’s been the payment.”
Health insurance companies have reimbursed providers less for care through telemedicine than for in-person care.
“You would do a visit, but the visit would pay somewhere between 40 and 80% of our in-person visit,” Alozie said. “And so there was no financial benefit to a lot of physicians.”
As the coronavirus started to spread, doctors and public health officials asked people to self-isolate. As a result, telehealth became an important consideration.
Goodman said her agency started hearing from doctor groups concerned about the state’s regulations.
“They were raising concerns with us about making sure doctors would be able to provide services – especially in rural areas,” she said, where doctors and hospitals are harder to come by.
Doctors can also use telemedicine to continue to treat patients, she said, if they come in contact with someone who tests positive for COVID-19 and need to self-quarantine.
Texas is now requiring doctors get paid the same for telehealth care as they do for in-person care.
The state also looked at onboarding laws, Goodman said, which were a barrier.
“There was a state law saying that you must establish the doctor-patient relationship in person before you can use telemedicine,” she said. “The governor waived that.”
In addition, the state opened up what platforms doctors can use, like FaceTime or Skype. Some insurers previously had required doctors to use a certain portal or type of technology.
Federal officials also waived some parts of privacy laws, known as HIPAA, to allow doctors to talk to patients using basically any kind of platform the patient prefers.
“I think that democratizes and opens up and catalyzes this process,” Alozie said. “If your patient has an iPhone and you want to do FaceTime, you do FaceTime and document it and bill the visit.”
"We put up potentially artificial barriers. But this has driven us to focus on what's practical, what's efficient, and what works."
The changes, which were put into place basically overnight, show things can be done quickly to meet health care needs, he said.
“We put up potentially artificial barriers,” Alozie said. “But this has driven us to focus on what’s practical, what’s efficient, and what works. And hopefully on the back end of this pandemic, we can keep the things that work and then put those safety mechanisms around them as well.”
Although the changes are temporary, Goodman also thinks this could give the state an opportunity to look at health care a little differently.
“One of the things we are all going to learn across health care and insurance is how many of these kinds of provisions may have the potential to help us expand care outside of a disaster situation," she said.
Alozie says it’s been eye-opening to see how this pandemic has changed the way health officials approach care.
“It’s funny, I was on a phone call with a couple of colleagues the other day, and they are like, “Wait, so literally in 48 hours, the government has gotten rid of all the barriers that they always said were dogma and they couldn’t get rid of?'” he said. “But all of a sudden, a little virus has changed the things that they said they had to do.”
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