Texas legislators push to build on state’s telemedicine progress

Sen. Dawn Buckingham is sponsoring SB 412 to expand on the Texas Legislature’s telehealth efforts last year by making current, temporary telehealth flexibility for Medicaid and Children’s Health Insurance Program (CHIP) recipients permanent.


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A practicing ophthalmologist, she said she was doubtful that telemedicine could be effective beyond a certain point. For instance, much of the specialized equipment used by physicians isn’t available through telemedicine. However, Buckingham found telehealth to be more helpful than she initially thought, and said she even found ways to implement it in the specialized practice of ophthalmology. 

She introduced the bill in the Senate Health and Human Services Committee on Tuesday:

“During the COVID pandemic, the use of telemedicine and telehealth was proven to be a vital mechanism for ensuring patients continued to have access to health care services. However, this pandemic also identified areas where current barriers still exist. As a result, the Health and Human Services Commission has allowed for additional flexibilities in the use of telemedicine and telehealth to provide services to Medicaid and Children’s Health Insurance Program (CHIP) recipients since last March.”

In addition to Gov. Greg Abbott’s series of executive actions expanding telehealth capacity beginning in March 2020, the Texas Legislature expanded telehealth services in 2017. In response to COVID-19, lawmakers expanded these services further. Last month, Abbott called for the permanent expansion of telemedicine.

“This bill proposes to make permanent most of the Medicaid and CHIP flexibilities that were put into place as part of the state’s COVID response, while still upholding the standard of care.”

Nora Belcher, executive director of Texas E-Health Alliance, testified in support of the bill:

“Less than 10% of Americans had had a telemedicine visit prior to COVID-19. We now see numbers that look like they’re in the 40 or 50 percents. But it peaked in April of 2020, and it’s fallen off since then. So we don’t expect it to stay at 40%.”

According to Belcher, research has shown that one-fifth of post-pandemic medical visits will be virtual. She said this rate will likely be higher for behavioral health visits and lower for visits with specialty physicians like ophthalmologists or orthodontists.

Although highlighting her support of continued use of telemedicine, she said it’s important to ensure that post-COVID-19 telehealth is approached with prudence. Telemedicine isn’t always the appropriate meeting method, she said.

“Even when we exit the pandemic, we’re going to want some of those things to be in place, but they need to be appropriate. They need to be within the program guidelines, they need to be within the standard of care, they need to respect, say, in Medicaid, the patient-centered medical home — all of those pieces need to stay together.”

Committee Chair Lois Kolkhorst asked if telehealth services are generally cheaper than in-person medical services. Belcher said it depends on the provider.

“If you are a brick-and-mortar practice who’s adding telemedicine to your services, that’s a different cost proposition than setting up a virtual practice group. So that [the cost difference between telehealth and in-person visits] really is individual.”

As an example, she referenced a doctor she knows that added more revenue to their practice by adding telehealth services. By making all of their files virtual, they increased their capacity to hire more physicians and, consequently, increase their revenue.

Primary concerns revolve around the potential for increased telehealth availability to be abused by patients who don’t legitimately need it, as well as an increased demand for physicians to offer telehealth services. Senator Charles Perry said:

“We need to be careful and deliberate in the profession, in how you teach these doctors that now have a resource that their patients didn’t have five years ago.”

Buckingham said the bill contains guardrails to protect against these issues, but welcomes suggestions from her colleagues on how to further prevent telehealth expansion from being misused.

The bill was left pending in the committee on Tuesday.