Teladoc Inc., a telemedicine provider, has served notice it does not want to be reined in by rules changes proposed by the Mississippi Board of Medical Licensure.
The provider opposes the proposed requirement of a videoconferencing before medication is prescribed and a contract is signed between a telemedicine physician and a primary care physician.
Teladoc Inc. contends those changes are unnecessary and will drive up the cost of medical delivery.
Teladoc operates in 49 states and charges $40 a month for the service. It has been in Mississippi for about eight years, has 68,000 members in the state and saved $2.6 million for employers in the past 14 months, according to the company.
Because the board did not include an economic impact statement with its proposed changes, Teladoc succeeded in getting the board to agree to a stay of implementation after the agency filed the rules changes with the Mississippi secretary of state’s office in March.
In May, Teladoc succeeded in getting a temporary restraining order and preliminary injunction in May, in the U.S. District Court for Western Texas, Austin Division, preventing the Texas Medical Board from amending its rules to require a physical examination before a prescription could be made.
The company argued that the requirements and others violated antitrust law and the Commerce Clause of the U.S. Constitution.
Dr. H. Vann Craig, executive director of the Mississippi licensure board, said that an impact statement is being worked up, but he was not sure that it would be ready in time for the board’s next scheduled meeting on Sept. 17.
Rather than the proposed change that would require a contract with a primary care doctor, Teladoc would insert language to “require the patient to have a primary care physician.”
“This puts the patient in charge of establishing that relationship with a physician of their choice,” Teladoc Chief Medical Officer Henry DePhillips wrote in letter to Rhonda Freeman, bureau director of the board.
The board is composed of members of the Mississippi Medical Association, which represents about 70 percent of the state’s practicing physicians.
Dr. Claude Brunson, president of the association, said Tuesday that telemedicine physicians “ought to have audiovisual conferencing to have as much of an in-person interview session that can be done.”
The association sees telemedicine an “innovative approach to providing health care that will be helpful to a state like Mississippi, being a rural state . . . as long as it integrates into the full medical practice that we offer to Mississippians.”
Also, a contract between a telemedicine practitioner and a primary care physician would ensure the availability of a doctor for an in-person visit, Brunson said.
DePhillips said in the letter that it should be up to the telephysician whether videoconferencing is used when a medication is to be prescribed.
Teladoc said that mandating videoconferencing is not necessary to maintain the quality of care, and would limit patient access and increase patient cost and preempt the physician’s judgment.
However, Craig said that the company offers an smartphone app that would enable such communication.
A Rand Corp. study commissioned by Teladoc and published in the February 2014 edition of Health Affairs, a peer-reviewed journal, concluded:
» “Further research is needed to to understand whether Teladoc might be improving access for patients with lower incomes and those in rural areas”;
» “It is highly likely that Teladoc visits . . . which had very low follow-up rates, are less expensive for payers, compared to visits to physicians’ offices and (emergency rooms)”;
» “If we consider follow-ups to be a rough proxy for clinical resolution, there is very little evidence of misdiagnosis or treatment failure in Teladoc visits.”