In Arkansas, Rules Restrict e-Services By Physicians

In Arkansas, Rules Restrict e-Services By Physicians

Teladoc Inc. of Dallas is the latest telemedicine provider to be shut out of Arkansas because of Arkansas State Medical Board rules involving physician-patient relationships.

“The board has traditionally defined the establishment of a doctor-patient relationship as: an in-person history and a physical,” board attorney Kevin O’Dwyer told Arkansas Business recently.

And without that, the telemedicine doctors — unless they’ve seen a patient in person — can’t treat Arkansans, making Arkansas one of the handful of states that don’t allow telemedicine companies in their state.

O’Dwyer said the only reason the board has the requirement is to protect the patient.

Still, O’Dwyer said the board discusses the issue “regularly. … We haven’t seen a model from any of these companies that would satisfy, in the board’s opinion, the regulation.”

Teladoc had been offering the service in Arkansas since 2008, its CEO, Jason Gorevic, said. But recently, the board “made it clear that they would take action against physicians who were practicing telemedicine,” Gorevic said.

Teladoc suspended its service in November, pending approval from the board. It has 70,000 members in Arkansas.

Gorevic said Teladoc has been trying to get a meeting before the board to explain its practice and telemedicine.

“They have, unfortunately, declined our offer to come in and present,” Gorevic said. “In the meantime, there are many other parties in the state who are interested in telemedicine and see its promise for reducing costs, improving quality of care and improving access to care.”

Teladoc offers services across the country except in Arkansas and Idaho, where it also recently suspended its service because of its medical board rules. But Gorevic said he hopes that Teladoc will be allowed to practice in Idaho soon, thanks to pending legislation.

Teladoc sells its services primarily to employers and health plans to use as part of their benefits packages. The members then have full-time access to a national network of board-certified, state-licensed physicians who can be connected to a patient within about eight minutes, Gorevic said.

The patient can decide to interact with the doctor by a video or phone consultation. Or a patient can send a photo of the ailment to the doctor.

The consultation fee can be $40 or less, depending on the plan.

The American Telemedicine Association in Washington estimated that more than 800,000 online patient consultations occurred in 2014. “This is expected to grow rapidly as more consumers, providers and payers look to the convenience of online services,” the ATA said in a December news release.

The ATA said most states allow patients to use telemedicine without the in-person requirement.

“Alabama, Arkansas, Missouri, Nebraska and Texas are the only states that don’t allow telemedicine in lieu of an initial in-person exam to establish a physician-patient relationships in most cases,” according to a September 2014 study by the ATA.

Latoya Thomas, the director of the ATA’s state policy center who worked on the study, told Arkansas Business that the medical boards should leave it up to doctors to decide “what appropriate tool and methodologies should be used in the care of their patients.”

The Federation of State Medical Boards of Denver supports telemedicine and released its updated guidelines in April. It said the same standards of care that have protected patients during in-person medical visits must be applied to medical care delivered electronically.

“Telemedicine offers wonderful tools to help expand treatment options for patients – particularly in helping provide care in remote areas, lowering costs and helping support preventive care efforts,” FSMB President and CEO Humayun J. Chaudhry said in the April news release. “But as telemedicine has grown so, too, has the need for clear, common sense guidelines that help health care providers transition to this exciting new environment in a safe way.”

O’Dwyer said the board is always open to listening to different telemedicine scenarios and models.

“We certainly don’t want to be left behind everybody else in this,” he said. “But it still has to conform with our rule.”