Virtual house calls rise as doctors embrace new Texas telemedicine law

Austin American-Statesman (TX)

Oct. 21--Doctors in Austin and statewide are gearing up to make house calls again -- at least digitally.

The field known as telemedicine -- in which patients can use their computers or smartphones to see doctors via videoconferencing without leaving their homes -- is poised to take off in Texas, fueled by recent changes to state law that lifted a major restriction on telemedicine and clarified insurance coverage.

Coordination of the growing service is expected to be a big part of the activity at Ascension Texas' new 30,000-square-foot digital hub, called the GoodHealth Solutions Center, that will officially open next month on Metropolis Drive in Austin.

Other local medical groups, including the Austin Regional Clinic and its eMD Access unit, have been investing in and rolling out the technology as well, while national telemedicine providers -- such as Teladoc, based outside Dallas, and Doctor on Demand, based in San Francisco -- are boosting recruitment of Texas physicians to offer their third-party capabilities.

Telemedicine had been been permitted in the state in a limited fashion, but Texas is "now set up to have telemedicine and virtual health flourish" because of the new legal framework, said Kristi Henderson, vice president of innovation and virtual care at Ascension, which owns the Seton Healthcare Family.

The technology isn't intended to be a replacement for all traditional medical care. Instead, proponents view it as an optional tool to provide patients quicker and cheaper treatment for many routine ailments, including respiratory infections, skin rashes and joint sprains, as well as for more acute problems such as vomiting and diarrhea.

According to Doctor on Demand, 18 of the top 20 maladies that result in visits to urgent care clinics or emergency rooms are suitable for less expensive treatment via telemedicine.

In May, Gov. Greg Abbott signed into law a bill allowing doctors to use videoconferencing to treat patients whom they haven't met in person. Previously, doctor-patient relationships in Texas had to be established face-to-face first or patients were required to have another medical professional with them during video consultations.

Beginning Jan. 1, the new law also prohibits insurance companies from excluding from coverage medical treatment solely because it isn't provided in person, and requires insurers to publicize their coverage policies regarding telemedicine.

But physicians who treat Texas patients via videoconferencing still must be licensed in the state, and they aren't able to prescribe controlled substances, such as codeine or other opiates.

Taken together, the changes put Texas -- which had been considered one of the most restrictive states in terms of the technology -- on equal footing with other states that already embraced it. Meanwhile, Texas is viewed as particularly ripe for the service because of its its size, population and prevalence of rural regions that lack convenient access to medical care.

"I think you are going to see telemedicine take off here in a way that we haven't seen" previously, said Jason Tibbels, senior medical director for quality programs at Teladoc, which is publicly traded.

Prior to the new Texas law, Teladoc, a top telemedicine provider, fought a multi-year legal battle in an attempt to overturn the state's restrictions.

Tibbels declined to forecast Teladoc's Texas future growth rate, but he said the industry is increasing "exponentially" overall. The company reaped about 12 percent of its revenue, or $15.1 million, in Texas last year, according its filings with the U.S. Securities and Exchange Commission.

"There is no doubt (telemedicine) will grow rapidly" in Texas, Tibbels said.

Nationwide, Teladoc logged nearly 1 million consultations with patients in 2016, he said, and it's on track to log between 1.4 million and 1.5 million this year. The figures include multiple consultations with individual patients.

Convenience, expediency and cost are viewed as the main selling points of telemedicine services. Patients generally are able to see a doctor within minutes after logging onto an app or website and entering basic personal information, proponents say, compared with days or weeks when seeking a traditional appointment at a bricks-and-mortar office.

Doctor on Demand -- which offers its service directly to consumers in addition to contracting with employers and health plans -- charges $75 for a 15-minute medical consultation for patients paying out of pocket. If a prescription for antibiotics or other medications is deemed necessary, the information is routed to the patent's pharmacy.

"It's a fraction of the cost of an urgent care or ER or in-office visit," said Ian Tong, the company's chief medical officer.

The potential for cost-savings and convenience has many local doctors groups and medical centers beefing up telemedicine offerings.

Austin Regional Clinic has been experimenting with telemedicine for a number of years and has contracted with a technology firm to build its own internal platform, said Jake A. Childers, medical director of the clinic's eMD Access unit. The service currently is being tested with a small percentage of patients.

"They love it," Childers said. "Once a patient has used the service, they are extremely likely to use it again. All signs point to the fact that this is going to be an increasingly important way for people to access the health care system."

He said the Austin Regional Clinic hopes to make the service available to all of its patients "well within a year." The service will be staffed on a rotating basis by local doctors who work for the clinic and want to participate, he said.

At Ascension Texas, plans already were in the works to create a central command center in which to house functions such as 24-hour digital monitoring of patients, transfers and call center operations for bricks-and-motor and telemedicine appointments, Henderson said.

"But we would not have the expansion (of the new GoodHealth Solutions Center) at the speed that we are now without the expansion of telemedicine" in the state, she said.

A grand opening for the new center, at 7701 Metropolis Drive, is set for Nov. 10.

Eventually, Henderson said, all telephone calls to Ascension clinics and hospitals will be routed through the hub, and patients with suitable symptoms will be offered the option of telemedicine appointments. Ascension is providing telemedicine services using doctors already within its provider network, rather than contracting with a third-part telemedicine company.

"We are now giving our health care team across the state one more option for how to care for the patient," she said. "This is really about extending the walls of our clinics and hospitals."

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