Texas allows rural hospitals to use telemedicine to qualify as level IV trauma centers

The closure of a number of rural hospitals in recent years has raised questions about rural Texans’ access to critical medical services. HB 871 by Price, signed by the governor on May 28 and effective September 1, will allow rural healthcare facilities, after January 1, 2020, to use telemedicine to expand access to trauma care.

Under the new law, a medical facility in a county with fewer than 30,000 people will be able to consult virtually with an on-call trauma physician to meet state administrative rules for designation as a level IV trauma center. Level IV trauma center designation allows healthcare facilities to provide the most basic level of trauma care for patients. The new law also prohibits the executive commissioner of Health and Human Services from adopting rules that would require the physical presence of a trauma physician or that would prohibit the use of telemedicine for designation as a level IV trauma center. According to the 2010 U.S. Census, 160 of Texas’ 254 counties have populations of fewer than 30,000 people.

To qualify as a level IV trauma center, a medical facility currently must have an on-call trauma physician available within 30 minutes of a request. While not providing trauma care as comprehensive as at level I-III facilities, level IV trauma hospitals have written trauma protocols and must employ an emergency medicine physician who is credentialed by the facility’s trauma medical director or a physician who is verified in advanced trauma life support.

On or after January 1, 2020, rural hospitals will be allowed to contract with telemedicine providers to meet the on-call trauma physician requirement. Trauma physicians working through telemedicine may assess, diagnose, consult, or treat patients and transfer medical data to a physician, advanced practice registered nurse, or physician assistant physically located at the rural facility. The HHSC commissioner must adopt rules to implement the bill’s provisions by December 1, 2019.

Supporters of HB 871 said that contracting with a visiting trauma physician to be available within 30 minutes was prohibitively expensive for some rural hospitals, resulting in fewer level IV trauma centers in rural Texas and less access to critical care across much of the state. They said that allowing trauma consultation through telemedicine at these rural hospitals would allow them to provide needed trauma services in locations where residents may not have timely access to a nearby trauma center. In addition, supporters said, the bill would make it possible for rural facilities that already contract with a visiting trauma physician to use telemedicine to maintain their trauma designations and participate in regional trauma systems.

By Andrew McNair

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