Friday, April 17, 2015

Texas Hangs Up on Teladoc

Our country has a very expensive healthcare system whose results are not as good as we would hope. Now companies are trying new approaches to chip away at the cost without sacrificing quality.  But change is hard for people, and often there is pushback.  

Here is one story.


This company, founded in 2002, offers telephone consultations with doctors, sometimes using Skype or Facetime, for people with minor illnesses like the flu, skin rashes and sinus infections.  

Many health insurance companies like the idea. One, Blue Shield, makes Teladoc available to 350,000 state employees in California.  

The very short video below gives a brief overview of how Teladoc operates. I'm not advertising it, but I believe it is interesting.  I can think of several occasions when Teladoc would have been helpful to me. 

Teladoc has many things going for it: speed, convenience, 24/7/365 access and low cost.

But Teladoc is based in Dallas, Texas, which is unfortunate.  Last week the Texas Medical Board came down on the service like a chicken on a junebug, as the saying goes in the Lone Star State.

Based purely on concern for patient care, the doctors' organization has banned Teladoc and similar operations in Texas.


The Texas Medical Board licenses and regulates doctors and medical practices.  It has ruled that no physician can prescribe medicine over the phone without a “face-to-face visit” with a patient, which the board has said is necessary to protect public health.

There are exceptions, of course.

     -- One is for psychiatric prescriptions, which puzzles me.

     -- Another is for colleagues of regular doctors who are on-call -- like say, on the weekends -- so the regular doctors won't be bothered by pesky patients at inconvenient hours.

      -- A third is for remote areas like rural hamlets, prisons and offshore oil rigs -- or as one newpaper report described them, "underserved areas that also pose little risk of competing with physicians' practices."

Firms like Teladoc will not solve all of America's healthcare problems.  Its physicians cannot put splints on broken arms.  They cannot diagnose and treat cancer or diabetes or heart disease.  But these firms may reduce the crush of patients in emergency rooms and provide limited care for people with minor illnesses and not much money.

Just not in Texas.

Teeth Whitening

A similar set-to occurred in New Jersey several years ago when the state association of dentists drove a company called Beach Bum Tanning out of the teeth-whitening business.  Beach Bum had been offering $99 whitening services with very low hydrogen peroxide concentrations.  Jersey dentists charged $500 for teeth whitening with higher hydrogen peroxide concentrations.

The dental association won.  Only dentists (a lot of dentists) now advertise teeth whitening services in New Jersey.

At least 25 states' dental associations have taken similar actions.

A New Precedent?

The U.S. Supreme Court ruled against North Carolina dentists in a little-reported decision this February.

The FTC had sued the North Carolina Board of Dental Examiners in an anti-trust case involving teeth whitening practices.  The board, which is independent of the North Carolina government, regulates dental practices in the state and had banned teeth whitening procedures by anyone who wasn't a dentist.

Six of the nine justices (Alito, Scalia and Thomas disagreed) saw a conflict of interest.  Here's the finding:

      When a controlling number of decision makers on a state licensing board are active
       participants in the occupation the board regulates, the board can invoke state-action
       only if it is subject to active supervision by the state.

This may break open some of the barriers I have mentioned in this article.  Or it may mean that professional asociations will accede to state regulation and then lobby states' regulators and legislators to achieve the same ends.

I could see things going either way.

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