State Support for Telemedicine will Keep Rural Texans Healthier

Telemedicine has helped keep Texas healthy through the pandemic — and Texas is not going back.

Especially in rural areas, telemedicine has become a cornerstone of good health. More than one in five health care visits are expected to remain virtual even after the COVID pandemic passes, as Texans continue to meet doctors, nurses, or therapists through their computer and phone screens instead of face-to-face. This will include office visits, follow-ups, mental health services, and a host of other appointments.

The change is driven by innovation, technology, necessity and convenience. It has been proven out through positive telemedicine experiences over the past 14 months — and is being preserved by a bipartisan legislative push to support the services on which Texans have come to rely. The House of Representatives has unanimously passed House Bill 4, and the Senate will soon vote on it. That measure provides more access to virtual care in underserved communities, and it keeps in place some of the short-term rules introduced last year.

Sponsored by lawmakers who understand the health needs of rural Texas (Rep. Four Price of Amarillo and Sen. Dawn Buckingham of Lakeway, who is also a physician), HB 4 removes the uncertainty around future-focused services that are working well for both providers and patients. It increases telemedicine for children with special health care needs, as well as needed services like physical therapy, occupational therapy, speech therapy and nutritional counseling.

This helps rural residents whose providers are sometimes miles away. These Texans can’t afford to miss work for half-a-day to travel to routine, but vitally important, checkups.  It also provides continuity of care for patients who have established relationships with their virtual providers over the past year.

Technology-driven improvements also help patients recovering from surgery who may not be completely healed or able to drive to in-person follow-up appointments. And they help parents of children with compromised immune systems who would be vulnerable, even after the pandemic has passed, sitting in a waiting room when a virtual visit is just as effective.

The state’s Health and Human Services Commission reported last year that children who receive teleservices need fewer trips to the emergency room, which can both be expensive and reflect more severe health problems. Additionally, individuals who are blind or have a disability and participate in telehealth require fewer inpatient, outpatient, or emergency services on average.

Telemedicine is not new: it started taking root in Texas more than 20 years ago. The state propelled this innovation in 2019 with Senate Bill 670, also by Sen. Buckingham and Rep. Price, which made it easier for providers to offer and be reimbursed for telemedicine and telehealth services through Medicaid.

So, when the pandemic came, Texas was well-positioned to meet the moment.

Last March, the state provided even more flexibility for doctors to provide virtual services through Medicaid and the Children’s Health Insurance Program. House Bill 4 this year makes that flexibility permanent — while also upholding high standards of care. And it closes gaps related to the use of technology that providers and patients have identified over the past year.

It will work hand-in-hand with other new legislation, such as HB 5, which will expand broadband access, particularly in rural communities.

All of this will make medicine more customer-friendly than ever before. Before the pandemic, between 15% to 28% of physicians nationally were using telemedicine. Since then, 80% of Texas physicians have offered — and plan to continue offering — telemedicine services.

These doctors can build more loyalty and deeper relationships with their patients.

Some services, of course, will always need to be in-person; that won’t change. But for so many other health care services, we now see there is another way — one driven by the kinds of innovators and big thinkers who have helped Texas transform the world.


Nora Belcher is Executive Director of Texas e-Health Alliance. Charles Miller is Texas 2036’s Senior Policy Advisor focused on health.

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