South Carolina gov. signs bill expanding how doctors can use telehealth techniques

South Carolina Gov. Nikki Haley just signed a bill aimed at letting more physicians in the state use telehealth techniques when treating patients and setting standards for the practice.

Haley signed S.B. 1035 into law last week, and the legislation clears the way for many doctors to establish relationships with patients solely through telemedicine technology, like video conferencing. The “South Carolina Telemedicine Act” also stipulates that physicians treating people virtually “adhere to the same standard of care” as they would if they were seeing patients in person, in addition to laying out other requirements through the state’s medical board for doctors hoping to use telehealth.

State Sen. Brad Hutto, one of the bill’s sponsors, told StateScoop he expects the new law will massively expand the use of the technology in South Carolina, calling the legislative effort a result of his “realization that the delivery of health care in rural areas is changing.”

“I represent six rural counties down along the Georgia border, and the governor has chosen not to accept the Medicaid expansion under [the Affordable Care Act], so we, as a result, have lost two of our county hospitals,” Hutto said. “We don’t have great public transportation here, and that’s a big issue, since the local hospitals have closed … so it appears that telemedicine is going to be something that’s particularly important to getting folks in rural areas adequate health care.”

In particular, Hutto sees the bill’s provision allowing physicians to examine patients using something like video live stream could vastly expand rural residents’ access to specialists. Indeed, the Kaiser Family Foundation reports that the state has 5,793 specialists active through April, a number that places South Carolina 26th in the nation.

“It’s going to cut down on travel time, time away from work or school, and also cut down on doctor time if everybody can do a consult together,” Hutto said.

Schipp Ames, executive director for communications and marketing with the South Carolina Hospital Association, believes the law will let large hospital systems like the Medical University of South Carolina help fill that specialist void.

“If your hospital had a relationship with one of the larger hospitals, then you can go right in and have access to specialists that you wouldn’t normally have access to,” Ames said. “It’s really breaking down the geographic barriers for patients.”

[Read more: New Indiana law clears way for telemedicine efforts]

But Mario Gutierrez, executive director for the telehealth advocacy-focused Center for Connected Health Policy, feels the new law is a bit more of a “mixed bag.”

He said it’s an “important step forward” for the state that physicians can now establish relationships with patients virtually but feels some of the law’s language is a bit imprecise.

Specifically, he points to the provision stipulating that any physician working with patients remotely “must be trained in the use of the telemedicine equipment” as something that he’s “never seen before” in any state-level telehealth bill and a stricture that could prove unclear for doctors.

“Who’s going to do the training?” Gutierrez said. “It doesn’t go far enough, it could say that the training be done through a telehealth resource center, since every state in the country has one for their benefit. And that, I think, would provide greater assurance that the training is done appropriately and not done by a vendor trying to sell a particular piece of equipment.”

But Hutto brushed off that concern, noting that he expects the medical board will set specific telehealth training standards for doctors, and lawmakers merely “wanted to set up a framework” for that process, not “micromanage” it. He also feels that technology companies will necessarily play a role in the training process, and doesn’t see their influence as a pernicious one.

“It’s like when you buy a new computer or a new copier or anything else,” Hutto said. “Whoever the supplier of the machine is will have either a sales person or IT person come along and show the staff how to use it.”

Claudia Tucker, vice president of government affairs for the telehealth provider Teladoc, said her company embraces that provision, since they already require “vigorous training” for the physicians they work with.

“There’s an ongoing peer review we do with our physicians, and we do a review for about 90 days as part of our onboarding process,” Tucker said. Lawmakers are “trying to make sure that the quality of care is high and it’s safe, and of course we’re right there with them on that.”

Those training worries aside, Gutierrez is also disappointed that the bill restricts physicians from virtually prescribing abortion-inducing drugs or erectile dysfunction medicine, pointing to the Iowa Supreme Court’s ruling to strike down a similar provision as proof that “there shouldn’t be a distinction for what may be more of a moral question.”

Hutto lamented that he never intended the bill to contain that language, but he felt forced to include it to ensure its passage at a pair of key legislative junctions to placate “pro-life proponents.”

“We had to put provisions in, but those were the only hiccups along the way,” Hutto said.

With those hurdles cleared, Hutto’s main concern now is charting a way to put the law into action.

“It’s not like we have the best connectivity out in the rural areas, so that’s going to be a little bit of a challenge to try and get it in the right locations for it to work in rural areas, and some of those might have to be schools or churches,” Hutto said. “And maybe as we roll this out, we find out we didn’t get it quite right and go back and tweak it later, but we wanted to get the framework in place.”

Contact the reporter at alex.koma@statescoop.com, and follow him on Twitter @AlexKomaSNG.

This story has been updated.