Rep. Dan Sullivan

The Arkansas House of Representatives has voted down a bill that would allow telemedicine companies to offer services within the state. The bill was defeated 41-21 with two people voting present.

The bill was sponsored by Rep. Dan Sullivan (R-Jonesboro) who explained in the hearing that the bill specifically addressed "the opportunity to do certain primary care activities, primary care diagnoses over the phone and over video".  The bill did not include exchanges that were audio-only, email, text messages, or online questionnaire-based.

If the bill had passed, telemedicine companies would still have to ensure they employed licensed Arkansas doctors to conduct the online visits with Arkansas patients. 

During the hearing, Sullivan pointed to several large companies including DirectTV, Kohl's, Red Lobster, Pfizer, and Home Depot that use telemedicine services in every state except for Arkansas. He also referred to a map, created by telemedicine company Teladoc, which shows that Teladoc offers its services in 48 states, excluding Idaho and Arkansas, though he added that Idaho just passed a bill that would allow Teladoc to operate there.

Rep Stephen Magie (R-Conway), who voted against the bill, said providers who do not have an established relationship with a patient, for example via a telemedicine service, should not treat patients because they may be unfamiliar with the patient's medical history. He added that decisions on what telemedicine services these companies can provide given the lack of patient-physician relationship should be under the purview of the Arkansas State Medical Board -- not "for-profit" companies, like Teladoc.

"I have a real issue with whether or not a person has an established relationship with their physician," Magie said. "I think that's the issue the medical board has. I can't speak for the medical board, I think they may have dragged their feet on some of these issues a bit, but their position as outlined in our rules and regulations is you have an established -- to practice what we call telemedicine, we've done that as long as the telephone's been around -- you have to have an established patient-physician relationship."

The Arkansas senate is set to review a similar bill, but their version requires an in-person visit between patient and physician before online visits can take place.

While states make their own rules, some organizations are already offering programs to ensure online visits providers are abiding by certain quality measures.

In December 2014, The American Telemedicine Association rolled out a new, nationwide service for accrediting live, direct-to-consumer telemedicine services. The accreditation program focuses specifically on direct-to-consumer services that involve live doctor-patient interaction, ATA CEO Jonathan Linkous told MobiHealthNews at the time, whether that be phone or video-based. It doesn't cover email consultations or pure store-and-forward plays, like some dermatology apps. The purpose will be to assure consumers and payers that the services are meeting some basic requirements for safe and responsible practice.

“We know that there are payers who will be using this,” Linkous said at the time. “We know that there are some regulators in the [state] medical boards who have had an interest in making sure everyone who practices in their state has to go through this process. So we think they’re going to have widespread appeal. We talked to a lot of providers about this, and there’s pretty much universal support.”

Last year, Teladoc hired a Little Rock, Arkansas-based lobbyist after they were forced to shutdown their office in the state, Politico reported at the time. Last month, Politico also reported that Arkansas passed a bill that banned providers from administering medication abortions via telemedicine. Instead, patients will have to be in-person with the provider when taking the medication.