We can only practice Telemedicine in TX under a MD/DO’s delegation

[deleted1071022]

To my knowledge, this is the first that I’ve seen where DPMs are required to function under an MD/DO (similar to a PA or NP) to deliver care to our patients. Texas recently added this to the Podiatry practice regulations:

What is telemedicine?

"Telemedicine medical service" means a health care service delivered by a physician licensed in this state, or a health professional acting under the delegation and supervision of a physician licensed in this state, and acting within the scope of the physician's or health professional's license to a patient at a different physical location than the physician or health professional using telecommunications or information technology.

Can a podiatrist practice telemedicine?

A podiatrist can only practice telemedicine under the delegation of a MD or DO.

A podiatrist in this scenario must:

• Apply the same standard of care that would apply to the provision of the same health care service or procedures in an in person setting;
• establish a practitioner-patient relationship; and
• must maintain complete and accurate medical records as set out in §165.1 of this title (relating to Medical Records).

Podiatry Practice Standards - Texas.gov

www.tdlr.texas.gov

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[king22]

To my knowledge, this is the first that I’ve seen where DPMs are required to function under an MD/DO (similar to a PA or NP) to deliver care to our patients. Texas recently added this to the Podiatry practice regulations:

What is telemedicine?

"Telemedicine medical service" means a health care service delivered by a physician licensed in this state, or a health professional acting under the delegation and supervision of a physician licensed in this state, and acting within the scope of the physician's or health professional's license to a patient at a different physical location than the physician or health professional using telecommunications or information technology.

Can a podiatrist practice telemedicine?

A podiatrist can only practice telemedicine under the delegation of a MD or DO.

A podiatrist in this scenario must:

• Apply the same standard of care that would apply to the provision of the same health care service or procedures in an in person setting;
• establish a practitioner-patient relationship; and
• must maintain complete and accurate medical records as set out in §165.1 of this title (relating to Medical Records).

Podiatry Practice Standards - Texas.gov

www.tdlr.texas.gov

I read over information provided in the link. It appears that they distinguish between two telephone services- "Telemedicine" and "Telehealth" It appears that Telemedicine can only be provided by an MD/DO (or someone working under the supervision of an MD/DO) but Telehealth can be provided by any clinician working within the scope of their license.

IMO, this is just a technicality that results from the fact that the law considers the practice of podiatry separate from the practice of medicine (even though we might be delivering the same exact care).

 

[heybrother]

I'm not really touching the matter at hand - but I did probably 100+ telehealth encounters last year during Covid and I have no desire to ever do them again. I was hoping for plantar fasciitis, onychomycosis, and ingrowns, but I got every sort of weird thing under the sun. My 2nd encounter was critical limb ischemia where the patient didn't believe me. Old people cannot use a camera to save their lives and unfortunately a lot of people have bad internet, bad cameras etc. Here's an out of focus shot of something on my foot - what is it. The patients are even more neurotic because you aren't actually there to examine them. The old documentation rules were in place so I was trying to document based just on what I could see. And the visits paid less than they should have though it may have been because there were issues with how the visits were supposed to be billed initially ie. place of service. Additionally, because the patients weren't "roomed" by a MAs I was doing a lot of stupid documentation that normally my MA would have done ie. adding pharmacies. The only way I'd ever agree to do telehealth again would be a set $/time amount outside of insurance. I did what I had to do to try and help my practice/revenue during Covid, but I didn't particularly enjoy it. Your mileage may vary.

 

[619]

What makes Podiatry profitable just like Ortho, Derm, etc is we are able to do office procedures, lots of it.

You cannot make money from office visits alone. That is why Telehealth or telemedicine or whatever alphabet name they give is not something I am interested in. You can't do procedures, dispense DME, sell OTC stuffs via Telehealth visits.

A practice will go broke only billing 99213s all day which is basically all you do with Telehealth.

 

[Feli]

...You cannot make money from office visits alone. That is why Telehealth or telemedicine or whatever alphabet name they give is not something I am interested in. You can't do procedures, dispense DME, sell OTC stuffs via Telehealth visits...

Yes, tele-visits were just a way for some offices to keep trickle income coming in in 2020 in places where governors ordered shutdowns and it wasn't known how long offices would be closed. We never bothered with them where I work (thankfully).

There is basically noting besides a very straightforward refill on gapapent or naproxen or triamcinolone that a tele-visit can actually help in podaitry, though. Those could also be a 2min email or phone voicemail to the office, but some practices tried to capitalize on it. Anything else podiatry... PF, ingrown, deformity, wound, metatarsalgia, verruca, etc etc etc all need a real exam, procedure, insoles, xray, etc. Skin tinea or venous stasis would be about the only new F&A complaint things that a video visit would be even remotely useful for.

The MDs had the same problem even in PCP specialties that use little or no procedures: aside from just Rx refills, the tele-visits are basically hot garbage they just had to do in order to keep their office/hospital from plunging deep into the red. There just isn't much that can be diagnosed and solved without at least a basic physical exam... and decent vitals and labs for most of the medicine specialties. It was crappy band-aid medicine, and they all knew it.

...for Texas telemedicine by DPMs, I think this is more of just a parity issue for APMA types to work on. It is not an actually impactful issue in and of itself. It is like DPMs administering COVID vacc, admitting patients and doing H&P, holding hospital admin spots at VAs, etc. It is not stuff the vast majority of DPMs care to do, but the point is just that we are as well trained as other specialists and should not be excluded.

 

[king22]

On a personal note- After more than a year of doing telehealth encounters I'm not much of a fan. There's really just no substitute for an in person history and physical. I don't know how many times I did a telehealth for tinea pedis or a wart only to be hamstrung by crappy video quality.

To expand a bit further, IMO, this telehealth craze in medicine is going to lead to a decreased quality of care. Telehealth only lets you see what the patient wants you to see; only hear what the patient wants you to hear (or only what they hear). It's complete tunnel vision. A lot of stuff will be missed.

 

[DYK343]

I liked it for follow ups and med refills with a couple questions attached. Patients asking to take a 15 minute break to talk to their doctor vs taking 1/3 a day off work makes a huge difference to peoples lives, income, and quality of life.

They dont need to come into the office for terbinafine when they already had a CMP from their PCP last month. A 6 month follow up "how you doing" bunion surgery is easy telehealth. Stress fracture can be telehealth. Some MRI follow ups can be telehealth. Etc, etc.

I did get stuck with quite a few "youre just going to have to come into the office" telehealth visits.

It has its place in podiatry but not everyone can be a telehealth. Especially new patients. I personally think it should stay. But in reality only about 10% of the people I see could be telehealth.