State’s Restrictions On Remote Doctors Subject Of Debate

Should patients be able to receive medical care over the internet from a doctor with whom they’ve never had a face-to-face meeting? Under current Arkansas law, they can’t. A national telemedicine company says it does business in 49 other states where they can.

At issue is a law passed this year that requires patients to have that face-to-face meeting before they can be treated by that physician. The law also defines telemedicine services as those occurring through two-way audiovisual means and says telemedicine services can only occur from a designated originating office.

The law’s Senate sponsor, Sen. Cecile Bledsoe, R-Rogers, said she’s not opposed to telemedicine. In fact, she calls it “the wave of the future.”

The law requires insurance companies to reimburse providers of telemedicine on the same basis as those providing services in person, and to reimburse both the originating provider – typically a primary care physician – as well as the distance provider, likely a specialist from elsewhere. Previously, only the specialist was paid.

Bledsoe, the wife of a physician and mother of two physician sons, none of whom are in private practice in Arkansas, said the reimbursement will encourage the development of more telemedicine providers. She included the provision with the support of Blue Cross Blue Shield.

The law gives the State Medical Board broad latitude to interpret the rules and grant exceptions – which was by design, Bledsoe said. She wanted to give the Board the ability to move at a slow pace while maintaining its authority, rather than leave Arkansas patients vulnerable to charlatans. She said it’s easier to gradually open the door to such a change than it would be to throw open the market and then be forced to close it.

The State Medical Board is studying the issue through a Telemedicine Advisory Committee, which meets Wednesday, Sept. 23. On the agenda is a review of proposed rule language and an announcement of a public comments period.

One of the nation’s largest telemedicine providers, Teladoc, along with ERIC, an industry group supporting large employers, say Arkansas’ law is too onerous. Claudia Tucker, vice president of government affairs for Teladoc, said her company does business in 49 other states that don’t require a prior face-to-face visit. She called the new law “probably the most restrictive bill in the United States.”

Teladoc contracts with a network of doctors to provide an employee health benefit for employers. For a $40 consultation fee, patients can access primary care physicians remotely, often with little wait time, the company says. The company claims to have completed nearly one million virtual visits without a single malpractice claim.

Annette Guarisco Fildes, president and CEO of ERIC, the ERISA (Employee Retirement Income Security Act) Industry Committee, which advocates for large companies’ employee benefit and compensation interests, said the model helps lower health care costs and enables rural residents, working families and the elderly to quickly receive medical care for routine ailments. She said telemedicine complements employers’ wellness programs and can augment their on-site clinics.

“We’d like to see a rule that says, if you wake up and your child has a rash, that you can dial up a medical professional via telehealth, and show the medical professional the rash over video, or send a picture, forward it, or otherwise get advice without having to leave your home,” she said.

Fildes did not disclose the names of her member companies but said they typically have at least 10,000 employees, and many have employees or retirees in every state. She said her group and her member companies will be lobbying policymakers to change the rules.

The State Medical Board has received input from Teladoc, ERIC and from some large employers, including the Mercy Clinics in Fort Smith and Northwest Arkansas, and Hank Henderson, president and CEO of Bentonville-based America’s Car Mart. In a letter dated Aug. 3, Walmart’s Sally Welborn, senior vice president-benefits, and Labeed Diab, senior vice president of health and wellness, argued that Arkansans should be able to access telemedicine without the required in-patient visit. “After the Arkansas legislature enacted new telemedicine legislation earlier this year, our state became one of the most restrictive jurisdictions for telemedicine in the country,” they wrote.

Teladoc’s exit from Arkansas – in November 2014 – actually occurred before the law was passed. Tucker said the State Medical Board revised its interpretation of existing rules and began threatening the company’s doctors with disciplinary actions. Rather than subject those doctors to potentially career-ending actions, the company pulled out of the state.

Bledsoe’s son, Dr. Greg Bledsoe, the state’s surgeon general, said that the practice of telemedicine continues to grow. An emergency room physician with extensive experience in difficult international situations, he’s comfortable with dispensing medical care remotely, but he said many in the state’s medical community may not be. He expects the State Medical Board to make decisions within a year or so about the issue. Meanwhile, the medical community’s acceptance will increase.

“I think that as … people become more comfortable with it, I think you’re going to see a further expansion and a broadening of this definition. … I think telemedicine is the way we’re going, and an expansion of the role of telemedicine is the way we’re going to go in the future,” he said.