Priority: Improve access to high-quality, physician-led telemedicine care that is covered at the same rate as in-person visits.
Background: El Paso infectious disease specialist Ogechika Alozie, MD, witnessed more than half of his patients – many of whom were immunocompromised or bed- or wheelchair-bound – turn to telemedicine appointments during the COVID-19 pandemic to receive otherwise inaccessible care.
Likewise, Dr. Alozie says telemedicine provided access to care for patients with behavioral health needs who could not make in-person visits due to the severity of their conditions, or for reasons like distance, lack of appointment availability, or cost.
“The pandemic made us realize that we had solutions to [health care access] issues … for some time,” the past chair of the Texas Medical Association’s Committee on Health Information Technology said. “Now, we’re seeing people returning to in-person visits, yes, but there’s still a population of people utilizing telemedicine due to a lack of access.”
According to TMA’s 2023 health information technology survey, 75% of Texas physicians continue to use telemedicine for approximately 10% of patient visits. December 2022 data from the Texas Health and Human Services Commission shows the number of telehealth services in Texas Medicaid increased more than 500% between 2019 and 2021. Common diagnoses among clients receiving telemedicine and telehealth services included mental, behavioral, and neurodevelopmental disorders.
Telemedicine proved its worth in expanding access to timely, physician-led care in Texas and stands to grow as the state seeks to continue to expand broadband options, particularly in areas where Texas is most challenged: rural regions and mental health care.
During the pandemic, the Centers for Medicare & Medicaid Services issued an emergency waiver that required Medicare to pay for telemedicine visits at the same rate as in-person visits; allowed the use of non-HIPAA-compliant platforms; and removed geographic site restrictions that would normally prohibit a patient from receiving a telemedicine service in their home. At the state level, the Texas Department of Insurance issued an emergency rule regarding telemedicine payment parity.
Many of these flexibilities have since expired, will soon expire, or only apply to certain payers, leaving a patchwork of inconsistent or nonexistent payment policies for virtual care provided in Texas, despite patients receiving the same standard of care.
These policies, as well as the sometimes-expensive cost of integrating telemedicine devices into a practice – especially those with features like electronic health record integration – have created financial uncertainties for physicians providing telemedicine services, says Dr. Alozie.
Moreover, many rural areas in Texas lack reliable high-speed internet, which is essential in providing effective telehealth care.
Solutions: Telemedicine has paved the way for increased access to cost-effective care, but in order to stay viable, physician practices must receive adequate payment to provide it. At the same time, TMA understands telemedicine is not the answer for every health care concern and is vigilant of health plan efforts to use it as a substitute for adequate networks.
This session, the association will work to ensure broadband access keeps expanding so patients can access telemedicine, and physicians are paid fairly for providing it.
“[TMA is] exploring any and all options to move the [payment parity] ball forward, to both increase access and to increase payment,” TMA lobbyist Matt Dowling said.
One of those options may be the reintroduction of legislation similar to House Bill 1726 in 2023, which sought to require Texas health plans to pay for an array of telemedicine services at least at the same rate the plan pays that physician when the service is provided in-person, including mental health.
As for internet connectivity, TMA is monitoring the roll-out of the $1.5 billion Texas Broadband Infrastructure Fund. The TMA-supported measure expanded internet connectivity to Texans across the state in 2024.
Additionally, Proposition 8, a TMA-supported amendment to the Texas Constitution, supplements federal dollars to upgrade and expand broadband networks. The amendment, which took effect on Jan. 1, 2024, created a state fund with almost $5 billion of collective federal and state dollars – financed through money allocated by the state legislature, gifts, grants, and investment earnings and administered by the state comptroller – to expand internet access.
“The funding is there. What remains is the work of getting the infrastructure in place,” said Shannon Vogel, TMA associate vice president of health information technology. Broadband access “is much better and will only continue to improve.”
TMA also continues to support digital literacy among patients to ensure successful use of broadband and telemedicine.
With such improvements, Dr. Alozie is hopeful patients will continue to be seen, especially in Texas’ most rural areas.
“TMA has supported [telemedicine payment] parity before the pandemic, during the pandemic, and after the pandemic,” he said. “Telemedicine enables clinicians to deliver care to their patients. Physicians getting paid for those services at the same rate as in-person visits is imperative.”