A major telemedicine provider is objecting to a proposed rule governing telemedicine in the state that would leave some patients out of reach.

The provider, Teladoc, opposes a portion of a rule drafted by the North Dakota Board of Medicine that would require the equivalent of an in-person visit for a patient’s first telemedicine appointment.

Bonnie Storbakken, executive secretary of the North Dakota Board of Medicine, said it is important to allow patients to verify for themselves that they are being treated by a licensed doctor. It also allows the doctor to establish a relationship and verify who the patient is with greater accuracy.

“The intent of the board is to ensure that the standard of care is no different in an in-person meeting with your provider than it would be through a telemedicine meeting,” Storbakken wrote in testimony to the members of the North Dakota Legislature Administrative Rules Committee.

Some suggestions for accomplishing this include video conferencing or an in-person visit with a nurse practitioner or physician assistant consulting with a telemedicine medical doctor. Storbakken said a conversation over the phone would not be enough.

After that initial relationship is established, the physician or others associated with that same practice may use discretion in deciding how to visit with and diagnose patients.

But Teladoc disagrees that video is always necessary and questions the need for it on the first visit.

“There’s no data to show video is best,” said Dr. Donna Campbell, a member of the Texas State Senate and an emergency care physician who works with Teladoc.

Campbell questioned the difference between using video for a first visit versus any other visit, calling the rule arbitrary.

Campbell said the rule creates a barrier to access, disenfranchising those without access to broadband or technology. She said the access to medical records and high-definition photos provided to doctors through Teladoc is enough in treating many illnesses, with video access available to those with the capability.

“While the company is technology neutral, we offer both video and interactive audio. Of all the consultations done, 95 percent were done using interactive audio,” said 

New Benefits, a client of Teladoc’s, offered written testimony in opposition to the portion of the rule in question.

“For more than a decade, we have offered telemedicine services through Teladoc to our members. Though New Benefits is headquartered in Texas, our presence in North Dakota is substantial. We work with clients such as MBI Energy Services, Cracker Barrel and Red Lobster, as well as a number of small businesses and school systems,” wrote New Benefits CEO Joel Ray.

In that time, Ray said his company, an aggregator of employee benefit services, has had “virtually no complaints.”

Others objecting to the in-person equivalent portion of the rule include the Allergy and Asthma Network and United Spinal Association. Sanford Health expressed support for the in-person equivalency.

The Administrative Rules Committee tabled action on the proposed rule to allow time for more consultation between the Board of Medicine and Teladoc.

Reach Jessica Holdman at 701-250-8261 or jessica.holdman@bismarcktribune.com

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