In just about every study of telemedicine that has been published, three key elements seem to be ever present: it cuts costs, it's effective and patients like it. So, as Congress plans to expand the VA's telehealth program, New York passes legislation mandating that telehealth visits be reimbursed the same as in-person visits and the American Telemedicine Association readies accreditation standards for the industry, the Texas Medical Board voted to hinder the practice dramatically by robbing telehealth docs of the right to prescribe medically-necessary controlled substances for their patients.
Yes, you heard that right. The Lone Star state has crafted a rule that is contrary to every trend in healthcare, inexplicably banning a practice that last August they essentially endorsed by backing a move that would create a national licensing board for telemedicine practitioners. Moreover, the state already offers a special license specifically for out-of-state doctors who practice telemedicine with patients living in Texas.
So, are they just confused? Living in the past? Probably neither: They are concerned about the prescribing of controlled substances by doctors who have never met their patients. At least, that's the justification offered by one doctor interviewed by Government Technology. Russell Thomas, an osteopathic doctor in Eagle Creek and former medical board member, allows his small-town patients to confer with faraway specialists. That's okay by him as an addition to face-to-face visits, but not as a stand-alone practice.
"What can the quality of service be," he said, "when it's sight unseen and you have no relationship to the patient?"
Good question, but probably not a good one for the Texas Medical Board, which apparently has a problem prosecuting doctors nabbed in illegal prescription of controlled substance cases, according to the Austin American Statesman. According to the report, also published by the Associated Press, criminal charges were filed against fewer than a third of the 83 doctors punished by the Texas Medical Board in the past three years for drug law violations involving two or more patients, despite the passage of a 2010 law cracking down on the abuse of controlled substances. If the Board found just 83 doctors that might have violated the law, and criminal charges were filed against less than a third of those, how widespread could the problem be?
Moreover, Medicare has debunked the idea that e-prescriptions of controlled substances (EPCS) are dangerous, because it actually helps curb illegal prescriptions. Healthcare Dive reported last month that the ONC posted a blog on its website detailing how the HHS is hoping e-prescriptions will eliminate waste, like the $25 million Medicare reimbursed providers in 2012 for false controlled substance prescriptions.
"As we move toward better health and healthcare at lower costs, the growth of EPCS highlights one opportunity to support safer use and management of prescription medications, including controlled substances," wrote Tricia Lee Wilkins, PharmD, PhD, and economist Meghan Gabriel, PhD, Office of Planning, Evaluation, and Analysis, in the post. "As the growth of EPCS continues to increase, we are committed to continue to work with public health officials to address opioid related use and overdose through a variety of programs and coordination efforts."
Which brings us back to the question of just what the heck they are doing down there. While the sensitivity to drug abuse is noble, ignoring facts and copious amounts of highly credible research while doing so is harmful, misguided and a threat to the patients of Texas.