A rule change proposed in August to the Texas Medical Board, the official agency that oversees medical practice in the state, redefines so-called patient site presenters--the caregivers physically with patients who receive care via telemedicine from distant physicians--as being restricted to advanced-practice nurses, physician assistants or physicians. Currently, presenters can include a broader range of health professionals.

"This would be a very unfortunate setback for telemedicine in Texas, and result in a huge increase in cost for healthcare," Ben Raimer, MD, senior vice president of health policy and legislative affairs for the University of Texas Medical Branch, said in a statement decrying the move.

According to the Texas Tribune, rural hospitals and prison doctors also oppose the change, and telemedicine advocates warn that in far-flung parts of the state, EMTs and licensed vocational nurses are often the only personnel available. "In towns like Turkey, Texas, if you limit an EMT's ability to provide telemedicine, people there will have to drive 80 miles for any kind of healthcare," Don McBeath, director of advocacy for the Texas Organization of Rural and Community Hospitals, told the Tribune. "It's creating a huge barrier to the growth of telemedicine in rural areas."

Advocates suspect the Board, building on recommendations from the state Health and Human Services Commission that followed policy changes in 2007 designed to improve telemedicine care under Medicaid, excluded the nurses and EMTs without fully realizing the ramifications.

There's still time to sound off against the change. The proposed rule will be among those considered by the Board at a meeting on Nov. 6 in Austin where the public will be able to comment. Until then, written comments can be sent to the Texas Medical Board, Rules Development, P.O. Box 2018, Austin, TX 78768-2018, or e-mailed to Rules.Development@tmb.state.tx.us.

"We are receiving a large number of comments," TMB spokesperson Jill Wiggins told the Tribune, "so it's uncertain exactly what will be adopted."

For more: www.tmb.state.tx.us/rules/proprules_mb.php.