Medicare Rules, State Regulations Prevent Cost-Saving Innovations

Published June 5, 2015

Have you ever wondered why doctors are reluctant to talk to you on the phone?

It’s been almost a century since all the other professionals discovered the telephone is a handy way of communicating with clients, but not doctors. Why is that?

The short answer is that of the 7,500 tasks Medicare pays doctors to perform, somebody forgot to put “talking on the phone” on the list. Same for e-mail. Most private insurers and most employers pay the same way Medicare pays. That’s why you can’t communicate with your doctor the way you communicate with your lawyer or your accountant.

Help is on the way. A Dallas-based firm called Teladoc is providing telephone consultations to nearly 11 million patients nationwide. Say you are on a business trip and your allergy prescription runs out. You put in call to Teladoc and in 30 minutes or less you get a call back from a doctor who has access to your medical records. After a brief consultation, the doctor prescribes the medication you need.

The service is a godsend. On average, the wait time to see a new doctor is five days in Dallas. Nationwide, the wait is about three weeks, significantly longer than the instaneous consultation offered by Teladoc. Dallas Morning News writer Jim Landers reports the average primary care physician visit for a new patient in Dallas costs $125. The national average is $118. The cost for a Teladoc consultation is $40 or less.

Medical Board Interference

Telemedicine is the wave of the future. It’s convenient and it cost efficient. That’s why a lot of employers are ignoring Medicare payment practices and signing their employees up.

The path forward is not as easy as it ought to be. The Texas Medical Board (TMB), acting as if its a wholly owned subsidiary of the Texas Medical Association, wants to put Teladoc out of business. If it gets its way, you won’t be able to get a prescription from a doctor unless you have seen that doctor face to face, and communicating by Skype doesn’t count.

TMB claims it is only interested in protecting patients, but the same board that thinks you shouldn’t be able to get a prescription from a Teladoc doctor you have never met says it’s permissible for you to get a prescription from an “on-call” doctor you have also never met who is substituting for your regular doctor and probably isn’t looking at your medical records when he orders the prescription.

Protecting Doctors from Competition

Why is one okay and not the other? The only difference I can see is economic. On-call doctors add to total health care spending. They increase revenue for doctors as a whole. Teladoc is challenging orthodoxy and threatens to lower the cost of care and reduce overall physician incomes.

Let’s not ignore patient safety. There are problems that cannot be handled over the phone and require face-to-face encounters. But who are the best people to make those decisions? You and a doctor who has your medical records or an impersonal group of bureaucrats who have never met either of you and who seem to be motivated primarily by protecting doctor incomes from unwelcome competition?

The current conflict is nothing new. The American Medical Association was formed more than a century and a half ago, and its goals were political from day one. Scholarly studies—including my own book Regulation of Medical Care—court documents, and other records have produced overwhelming evidence the long-term goal of organized medicine has been to create the equivalent of a medieval guild.

Texas has surrendered to this raw pursuit of special-interest favoritism. It has some of the most stringent regulations limiting the ability of nurses to deliver the care they are qualified to give and some of the most harmful restrictions on walk-in clinics in the nation.

The United States should embrace these innovations, not outlaw them. The quickest way to lower taxpayer costs, raise quality, and improve access to care for the more than 100 million Medicare and Medicaid patients would be to give them immediate access to phone and e-mail services, walk-in clinics, and the services of nurse practitioners.

John Goodman ([email protected]) is a senior fellow at the Independent Institute. An earlier version of this commentary originally appeared at Forbes. Reprinted with permission.

Internet Info:

Jim Landers, “Is Texas quashing competition among doctors or upholding safety?” Dallas Morning News: