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Telemedicine providers propose legislation on rules

By JACK WEATHERLY

It’s been about six months since the Mississippi Medical Licensure Board said it would provide an economic impact statement linked to its proposed rules changes for telemedicine.

Meantime, Teladoc Inc., the nation’s largest telemedicine provider, has introduced a set of rules of its own in a bill in the Legislature.

The board is seeking to require videoconferencing and a contract between a telemedicine physician and a primary care physician.

Senate Bill 2071, authored by Sen. Terry Burton, R-Newton, would make teleconferencing optional and not require a contract between a telemedicine practitioner and another physician.

Those requirements, as the board proposes, are unnecessary and would drive up the cost of service, Teladoc contends.

Teladoc operates in 49 states, including Mississippi, where it has 68,000 clients.

Dr. H. Vann Craig, executive director of the board, said this week that the work on the impact statement is “still in process.”

The rules have “been withdrawn at this time. So they will have to be refiled with the economic impact statement.” The board had filed them with the secretary of state’s office in March.

Of SB 2071, Craig said, “Everyone in the United States, including the Telemedicine Association, does not recognize the audio-only is the way to go. Audio-visual is the standard of care as far as telemedicine is concerned.”

Craig referred to the association’s “core operational guidelines.”

The document does not specifically require videoconferencing as essential to providing telemedicine.

Teladoc argues that mandatory videoconferencing will drive up costs and limit access to some residents of rural Mississippi. Coverage costs $45 a month.

However, Ronnie Colvin, senior director of external affairs for Comcast Cable in Mississippi, said that whether by cable, or cellphone or satellite, no place is off-limits in the state.

All 82 Mississippi counties are medically underserved in terms of the ratio of physicians to the population, according to Teladoc, which cites the U.S. Department of Health and Human Services as its source.

Teladoc cites studies that show that its services save a weighted average of $673 per episode of care, compared with office and emergency room visits.

The board is not planning to propose legislation of its own, Craig said. “We do not propose legislation.”

Teladoc says in a position paper that “recent actions and statements by the Mississippi Board of Medical Licensure have made it apparent that patient access to healthcare via telemedicine is under attack, and that some want to severely restrict telemedicine as an element of patient homecare in the state.”

Teladoc succeeded in blocking an effort by the Texas Medical Board from requiring that telemedicine practitioners conduct a physical exam of a client before a prescription could be made.

The company argued that the Texas board was violating antitrust laws and the Commerce Clause of the U.S. Constitution. The board appealed the court-imposed injunction and lost, but it is appealing.

Teladoc physicians are board certified and licensed but are not necessarily residents of Mississippi. They do not prescribe controlled substances, in accordance with federal law.

Also, Teladoc physicians have the option of determining if an office or emergency room visit is more appropriate.

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