Mississippi is on the wrong track with telemedicine
Generally speaking, most efforts to manage health-care costs are focused on chronic-care management, preventative care and keeping people out of emergency rooms. Telemedicine instead offers an alternative for the kinds of care most people most typically receive – visits to doctors. By linking patients with doctors either via telephone or video chat, barriers of distance can be eliminated, which is particularly crucial for rural areas. But the technology also offers promise for many types of routine consultations.
A study of the national firm Teladoc by Harvard University’s Niteesh Choudhry and colleagues, which appeared in the May 2014 edition of Health Affairs, found that, over a 30-day period, use of Teladoc’s telemedicine service saved an average of $191 compared with physician office visits and $2,661 compared with emergency room visits. For employers, the savings were $727 per telemedicine consultation, with annual savings for one employer of more than $5.4 million.
A December 2014 Harris Poll conducted on behalf of telemedicine firm American Well found that 64 percent of Americans said they were interested in remote visits with their doctors. A separate American Well survey of doctors, released in May 2015, found more than 57 percent would be willing to meet with patients via video.
Founded in 2002, Teladoc, whose clients include PepsiCo and Bank of America, claims 298,000 consultations and recently closed its initial public offering. American Well’s Amwell app now has 1.6 million users, up 400 percent from 2013 to 2014. Apple also recently got into the market, which also features such names as Myca Health (makers of the HelloHealth service) and RelayHealth, by launching its own Apple Health app earlier this.
But this emerging market doesn’t sit well with some state regulators. In May, Teladoc won a federal injunction against the Texas Medical Board, which is attempting to enforce a rule that requires physicians must meet face-to-face with patients before they may prescribe them medications. In Mississippi, which in 2013 became the 16th state to pass a law explicitly permitting telemedicine, the State Board of Medical Licensure promulgated new rules in March that likely would make life more difficult for telemedicine firms, requiring they establish formal relationships with in-state providers and disallowing prescribing medications over the phone. The rules state:
A physician may not prescribe medications based on a phone call or a questionnaire for the purpose of telemedicine. Videoconferencing is required as part of the teleconsult if a medication is to be prescribed.
Thankfully, the rules have been delayed, albeit only temporarily, in response to a challenge that noted the board did not conduct an economic impact study before implementing them, as required by the Mississippi Administrative Procedures Act.
These sorts of rules clearly are bad for health-care consumers. Who among us can say we haven’t wished we could just get our own doctor on the phone for a minute or two to get a prescription processed for a common medical condition? What difference should a video picture make for prescribing treatment for an acute respiratory episode or a urinary tract infection? Those were, in fact, the two leading reasons for telemedicine visits by children and adults, according to a 2014 RAND Corp. study of California Public Employees’ Retirement System’s telemedicine program.
The Mississippi rules are simply harassment, and the Mississippi Legislature should rise up and swat the licensing folks down if they decide to try again. The RAND study and others have found that telemedicine consultations produce outcomes sufficiently comparable with office visits. The research also suggests that telemedicine is effective in meeting the standard of care and the error rate of diagnosis is no worse than office visits. Teladoc reports a 95 percent patient satisfaction rate.
One big factor in the future of expansion of telemedicine could be the Interstate Medical Licensure Compact, sponsored by the Federation of State Medical Boards. Last month, Illinois became the 11th state to join the compact, which allows doctors licensed in one state to enjoy certain practicing privileges in other compacting states.
In April 2014, the federation also promulgated a model policy for the appropriate use of telemedicine. While a perfectly reasonable document, it’s faced some pushback from groups like the American Medical Association and the American Academy of Pediatrics, who argue that telemedicine should only be provided to patients a physician has already met in-person and also that physicians should be compensated the same for telemedicine visits that they would be for in-person visits. Sadly, one suspects fear of competition and lower profits may be playing a bigger role in those groups’ stances than concern for patients.
Mississippi is poised to let a very small group of doctors running an anticompetitive licensure racket dictate that the medical establishment turn its back on tens of thousands of patients who could take advantage of today’s technology to get quality care cheaply and efficiently. Given the environment we already face with the implementation of the Obamacare regime, this is a colossally bad idea.