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Mind the Gap: Antitrust, Health Disparities and Telemedicine

Published online by Cambridge University Press:  06 January 2021

Theodosia Stavroulaki
Theodosia Stavroulaki*
Affiliation:
Edmond J. Safra Center for Ethics, Tel Aviv University
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American Journal of Law & Medicine , Volume 45 , Issue 2-3: Symposium - The Crisis of Democracy in Healthcare: Non-Legislative Efforts to Change Health Law , May 2019 , pp. 171 - 187
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Copyright © American Society of Law, Medicine and Ethics and Boston University 2019

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References

1 Jessica Glenza, Rich Americans Live Up to 15 Years Longer than Poor Peers, Guardian (Apr. 6, 2017), https://www.theguardian.com/us-news/2017/apr/06/us-healthcare-wealth-income-inequality-lifespan [https://perma.cc/QYC4-3RDL].

2 Id. Across the Chasm: Six Aims for Changing the Health Care System, Inst. for Healthcare Improvement, http://www.ihi.org/resources/Pages/ImprovementStories/AcrosstheChasmSixAimsforChangingtheHealthCareSystem.aspx (last visited Apr. 7, 2019) [https://perma.cc/ACN5-8H7G]. “Race, ethnicity, gender, and income should not prevent anyone in the world from receiving high-quality care. We need advances in health care delivery to match the advances in medical science so the benefits of that science may reach everyone equally.”

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6 Id.

7 Id.

8 Id.

9 Teladoc, Inc et al. v. Tex. Med. Bd., 112 F. Supp. 3d 529, 534 (W.D. Tex. 2015).

10 Id. at 537.

11 Id. at 539.

12 Id. at 538.

13 Id.

14 Stavroulaki, Theodosia, Connecting the Dots: Quality, Antitrust and Medicine, 31(2) Loy. Consumer L. Rev. 175, 222 (2019)Google Scholar.

15 See About UsTelemedicine FAQs, Am. Telemedicine Ass'n, httpshttp://www.americantelemed.org/main/about-us/./telehealth-faqs- (last visited March 24, 2019) [https://perma.cc/SG49-G6FH].

16 See Chiron Health, What is Telemedicine?, https://chironhealth.com/telemedicine/what-is-telemedicine/ (last visited March 24, 2019) [https://perma.cc/64XR-8D9S].

17 See World health Org.,Organization, Telemedicine: Opportunities and Developments in Member States, Report on the Second Global Survey in eHealth 8 (2010), https://www.who.int/goe/publications/goetelemedicine_2010.pdf.

18 Id.

19 Kvedar, Joseph, Joel Coye, Molly & Everett, Wendy, Connected Health: A Review of Technologies and Strategies to Improve Patient Care With Telemedicine and Telehealth, 33 Health Aff. 194, 194 (2014)CrossRefGoogle ScholarPubMed.

20 Am. Telemedicine Ass'n, supra note 15.

21 Id.

22 Craig, John & Petterson, Victor, Introduction to the Practice of Telemedicine, 11 J. Telemedicine & Telecare 4 (2015)Google Scholar.

23 Id.

24 Id.

25 Id.

26 Id.

27 Uscher-Pines, Lori et al., Access and Quality of Care in Direct-to-Consumer Telemedicine, 22 Telemedicine J. & e-Health 282 (2016)CrossRefGoogle ScholarPubMed.

28 Id.

29 Bashshur, Rashid L., Telemedicine and Health Care, 8 Telemedicine J. & e-Health 7 (2002)CrossRefGoogle ScholarPubMed.

30 Id.

31 Uscher-Pines et al., supra note 27.

32 Rachel Z. Arndt, Turning to Telemedicine for Prisoners' Mental Health Treatment, Mod. Healthcare (Jan. 6, 2018), https://www.modernhealthcare.com/article/20180106/NEWS/180109957 [https://perma.cc/797F-5E8S].

33 Anne Deslich, Stacie, Thistlethwaite, Timothy, Coustasse, Alberto, Telepsychiatry in Correctional Facilities: Using Technology to Improve Access and Decrease Costs of Mental Health Care in Underserved Populations, 17(3) Permanente J., 80, 80–81 (2013)CrossRefGoogle Scholar.

34 Id.

35 Arndt, supra note 32.

36 Id.

37 Id.

38 Uscher-Pines et al., supra note 27, at 282.

39 Id.

40 Ateev Mehrotra, RAND Corp., Expanding the Use of Telehealth: Promise and Potential Pitfalls Addendum 6 (2014), https://www.rand.org/content/dam/rand/pubs/testimonies/CT400/CT409z1/RAND_CT409z1.pdf [https://perma.cc/XN34-HCD9] (testimony before the Committee on Energy and Commerce, Subcommittee on Health, United States House of Representatives).

41 Id.

42 Id.

43 Id.

44 Uscher-Pines et al., supra note 27, at 282.

45 Id.

46 Alan Miller, Edward, The Technical and Interpersonal Aspects of Telemedicine: Effects on Doctor–Patient Communication, 9 J. Telemedicine & Telecare 2 (2003)Google Scholar.

47 Nuffield Council on Bioethics, Medical Profiling And Online Medicine: The Ethics Of Personalized Healthcare In A Consumer Age 131 (2010).

48 Nat'l. Telecomm. Info. Admin., Econ. Statistics Admin., U.S. Dept. of Commerce, Exploring the Digital Nation America's Emerging Online Experience 10 (2013).

49 Id. at 11.

50 Id.

51 Underserved Populations Least Likely to Use Telehealth Options, GW Today (Dec. 3, 2018), https://gwtoday.gwu.edu/underserved-populations-least-likely-use-telehealth-options [https://perma.cc/LAC9-35VJ].

52 Id.

53 Id.

54 Id.

55 Park, Jeongyoung et al., Are State Telehealth Policies Associated With The Use Of Telehealth Services Among Underserved Populations?, 37 Health Aff. 2060, 2066 (2018)CrossRefGoogle ScholarPubMed.

56 Id.

57 Id. at 2067.

58 Id. at 2066.

59 Id.

60 Id.

61 Mehrotra, Ateev et al., Rapid Growth in Mental Health Telemedicine Use Among Rural Medicare Beneficiaries, Wide Variation Across States, 36 Health Aff. 909, 909 (2007)CrossRefGoogle Scholar.

62 Id.

63 Id.

64 Id. at 915.

65 Id.

66 Id. at 915-16.

67 Id. at 916.

68 Id.

69 Mehrotra, supra note 40, at 3.

70 Scott Ashwood, J. et al., Direct-To-Consumer Telehealth May Increase Access toTo Care But Does Not Decrease Spending, 36 Health Aff. 485, 489-90 (2017)Google Scholar.

71 Megan Molteni, Telemedicine Could Be Great, If People Stopped Using It Like Uber, Wired (Mar. 6, 2017, 4:20 PM), https://www.wired.com/2017/03/telemedicine-great-people-stopped-using-like-uber/ [https://perma.cc/Q9D6-888W].

72 J. Scott Ashwood et al., supra note 70, at 490.

73 Id.

74 Jonah Comstock, Experts Debate Telemedicine Merits and Myths, mobi health news (Oct. 12, 2018), https://www.mobihealthnews.com/content/experts-debate-telemedicine-merits-and-myths [https://perma.cc/3V2H-63G4].

75 Uscher-Pines et al., supra note 27, at 285-86.

76 Id.

77 Id.

78 Id.

79 Uscher-Pines, Lori et al., Mulcahy, Andrew, Cowling, David, Hunt, Gerald, Burns, Racher, and Mehrotra, Ateev, Antibiotic Prescribing for Acute Respiratory Infections in Direct-to-Consumer Telemedicine Visits, 175(7) JAMA Internal Med. 1234, 1235. (2017)Google Scholar.

80 Id.

81 Edward Alan Miller, Nuffield Council on Bioethics, Telemedicine and the Provider-Patient Relationship: What We Know So Far, 2010 Nuffield Council's Working Party 16-17 (2010), http://nuffieldbioethics.org/wp-content/uploads/Miller-E-2010-Evidence-review-Telemedicine-and-the-Provider-Patient-Relationship-what-we-know-so-far.pdf [https://perma.cc/V5BY-3ENZ].

82 Id.

83 Id. at 17.

84 Id. at 20.

85 Hiratsuka, Vanessa et al., Patient and Provider Perspectives on Using Telemedicine for Chronic Disease Management Among Native Hawaiian and Alaska Native People, 72 Int'l J. of Circumpolar Health 1, 6 (2013)Google Scholar.

86 Id. at 4.

87 Id. at 3.

88 Id.

89 Id. at 6.

90 Id.

91 Id. at 5.

92 Id. at 3.

93 Id.

94 Id.

95 Id. at 5-6.

96 Miller, supra note 81, at 21.

97 Id.

98 Id. at 22.

99 Alexander von Hafften, Telemedicine and the Role of State Medical Boards, Am. Psychiatric Ass'n: Blog (Jan. 18, 2018), https://www.psychiatry.org/psychiatrists/practice/telepsychiatry/blog/telemedicineand-the-role-of-state-medical-boards [https://perma.cc/Y8U4-5UF9].

100 Stavroulaki, supra note 14.

101 Id.; see also Hammer, Peter J. & Sage, William M., Antitrust, Healthcare Quality and the Courts, 102 Colum. L. Rev. 545, 557 (2002)CrossRefGoogle ScholarPubMed.

102 Teladoc, Inc et al. v. Tex. Med. Bd., 112 F. Supp. 3d 529 (W.D. Tex. 2015).

103 The rule in question was 22 Tex. Admin. Code § 190.8 (2015). See Teladoc, 112 F. Supp. 3d et al. v. Tex. Med. Bd., supra note 9, at 534.

104 Id.

105 Id. at 537.

106 Id. Teladoc et al. v. Tex. Med. Bd., supra note 9.

107 Id. at 538

108 Id. at 540.

109 Id. at 539.

110 Id.

111 Id. at 540.

112 Id. at 538.

113 Id. at 539-40.

114 Id. at 537.

115 Nat'l Soc'y of Prof'l Eng'rs v. United States, 435 U.S. 679 (1978).

116 Teladoc,112 F. Supp. 3det al. v. Tex. Med. Bd., supra note 9, at 540.

117 Id.

118 Julian Rivera & John Ferguson, The Teladoc v. Texas Medical Board Struggle Continues, Digital Health Legal, Cecile Park Media (Jan. 2017, at 17, 17,), The Commission voted to close the investigation after Texas enacted a law that overrides the board's restrictive rules See: https://www.ftc.gov/news-events/press-releases/2017/06/federal-trade-commission-closes-investigation-texas-medical-board. https://hbfiles.blob.core.windows.net/files/a8e4fdba-305f-4484-b3d8-41978c46ccf0.pdf [https://perma.cc/3UDE-XAG6].

119 Brief for the F.T.C. et al. as Amici Curiae Supporting Plaintiff-Appellees, Teladoc, Inc. et al., v. Tex. Med. Bd., 112 F. Supp. 3d 529 (W.D. Tex. 2015).

120 Id. at 35.

121 Brief for Am. Med. Ass'n and Tex. Med. Ass'n as Amici Curiae in support of Defendants-Appellants seeking reversal, Teladoc, Inc et al. v. Tex. Med. Bd., et al., 112 F. Supp. 3d 529 (W.D. Tex. 2015).

122 Id. at 5.

123 Id.

124 Id.

125 Id.

126 Id. at 16.

127 Id. at 22.

128 Id. at 16. The Am. Med. Ass'n and the Tex. Med. Ass'n claimed that several state medical boards have adopted restrictions on the ability to prescribe medications without prior physical examination by the prescribing physician or a patient site presenter.

129 Id. at 27.

130 Id.

131 Id. at 9.

132 Ashwood, et al., supra note 70, 485-91.

133 Miller, supra note 81, at 20.

134 Nat'l Soc'y of Prof'l Eng'rs v. United States, 435 U.S. 679 (1978).

135 Id.

136 Id. at 686.

137 Id. at 685.

138 Id. at 686.

139 Id.

140 Id.

141 Id.

142 Id. at 695.

143 Id.

144 Id.

145 Id. at 696.

146 F.T.C. v. Ind. Fed'n of Dentists, 476 U.S. 447 (1986).

147 Id. at 448-49.

148 Id. at 463.

149 N.C. State Bd. of Dental Exam'rs v. F.T.C., 135 S. Ct. 1101, 1109 (2015).

150 Opinion of Commission, N.C. Bd. of Dental Exam'rs, FTC Docket No. 9343 at, 1 (Dec. 7, 2011).

151 Id. at 24.

152 Id. at 26.

153 N.C. State Bd. of Dental Exam'ers v. F.T.C., 717 F.3d 359, 377 (4th Cir. 2013).

154 Id.

155 Jordan J. Cohen, Professionalism in Medical Education: An American Perspective, 40 Med. Educ., 607, 608 (2006); Stavroulaki, supra note 14 at 219.

156 Brennan, Michael D. & Monson, Verna, Professionalism: Good for Patients and Health Care Organizations, 89 Mayo Clinic Proc. 644, 645 (2014)CrossRefGoogle ScholarPubMed; Stavroulaki, supra note 14.

157 Brief in support of Defendants-Appellants, supra note 121, at 29.

158 Avedis Donabedian, An Introduction to Quality Assurance in Healthcare 4 (Rashid Bashshur ed., 2003).

159 Id.

160 Inst. of Med., Crossing the Quality Chasm: A New Health System for the 21st Century 2 (2001).

161 The OECD Health Care Quality Indicators project, initiated in 2001, aims to measure and compare the quality of health service provision in the different countries. An Expert Group has developed a set of quality indicators at the health systems level, which allows [us] to assess the impact of particular factors on the quality of health services, see OECD Health Care Quality Indicators Project – Background, OECD, http://www.oecd.org/els/health-systems/oecdhealthcarequalityindicatorsproject-background.htm [https://perma.cc/Z7YR-MPPG].

162 Edward Kelley & Jeremy Hurst, Health Care Quality Indicators Project: Conceptual Framework Paper 13 (OECD, Health Working Paper No. 23, 2006).

163 Stavroulaki, supra note 14 at 222-223. I have suggested that the Agencies should also extend the notion of quality when they examine US hospital merger cases. Specifically, I argued that they should take into account research in public health and health services research on how health outcomes in hospital markets are improved. See Stavroulaki, Theodosia, 39 Integrating Healthcare Quality Concerns into the US Hospital Merger Cases, A Mission Impossible?' 593–624 (2016)Google Scholar

164 Id.