February 2021 • DALLAS MEDICAL JOURNAL 31
maintain revenue streams for physicians,
particularly rural and small-practice offices,
that have taken financial hits during the
pandemic. Even pre-pandemic, many physicians
and local mental health authorities
offered telehealth services that resulted
in them breaking even or taking a financial
loss for providing the service.
To put this financial stress into context,
in September of 2020, a TMA survey
revealed that 66% of physicians reported
patient volume reductions of more than
half and 62% of Texas physicians experienced
salary reductions.8 Additionally, 43%
of physicians drew from personal funds,
45% accepted Health and Human Services
stimulus funds, and 64% applied for a
Small Business Administration loan.
Utilization of Telehealth during
COVID-19
COVID-19 has acted as a catalyst
to adoption and practice of telehealth
in Texas. With reimbursement barriers
being lifted during this time, patient and
physician utilization has increased and
is anticipated to be sustained postpandemic.
A Texas Medical Association
survey in April 2020 captured physicians’
plans to offer telemedicine and revealed
that 80% of respondents said they offer
or plan to offer telemedicine.9 When
parsed out further on whether this
acceptance was contingent on appropriate
compensation, 57% said they would do
so regardless of compensation and 23%
who said they would if compensated
appropriately. A more recent survey,
administered in September of 2020,
reported that 32% of Texas physicians
said telemedicine and payment parity were
most important to the viability of their
practice.10 This highlighted importance
of payment parity is in contrast with the
fact that Texas physicians were receiving
payment parity “all or some of the time”
from Texas Department of Insuranceregulated
commercial payers and Medicare
at 39% and 31%, respectively.
From the patient perspective, 77% of
respondents stated their willingness to utilize
virtual care for wellness check-ins. This
perceived willingness to utilize telehealth
was actualized when a recent report from
Accenture highlighted that approximately
4.5 million Texans began using virtual
health services since the start of the
pandemic.11 In particular, Ascension Connect
saw a daily average of virtual visits
increase from 61 to 1,496 from February
to April.12 Additionally, 45% said they trust
virtual health as much or more than an
in-person visit, which is 15% higher than
before the pandemic, and 75% reported
their wait time was shorter or the same.
This increase in utilization, convenience,
and trust in telehealth is highlighted in the
fact that approximately 9 in 10 Texans said
that virtual care options should be available
to everyone.
Increased access to telehealth for
Texans also provides concomitant effects
on economic productivity. Limited options
for telehealth often require individuals
to take significant time off work, which
results in lost wages to the employee and
a reduction in economic productivity for the
business. This is of particular importance
for the state of Texas, where, as of 2020,
there were 2.8 million small businesses,
classified as firms with fewer than 500 employees,
which represents 99.8% of Texas
businesses and 45.1% of the Texas workforce.
13 This increased access and flexibility
of healthcare will have a pivotal impact
on creating on road to recovery from the
pandemic and support essential workers,
such as teachers, healthcare workers, law
enforcement, and grocery store employees,
during this transition who do not have the
option to work from home.
Thus, with patient, provider, and payer
utilization and at an all-time high, long-term
payment parity would be a crucial step
to serving the diverse needs of Texans
statewide. HB 522 seeks to create the
stability needed to provide physicians and
patients with the framework to become
familiar with telehealth and ramp up utilization
over time to treat both physical and
mental health ailments. This bill will have
innumerable benefits for Texans who are
low income or reside in areas where there
is a shortage of health professionals and
provide the flexibility for physicians and
patients to increase access to healthcare
and ultimately empower the patient to take
a preventative approach to their health.
Going into session, it is anticipated
that fewer bills will be filed and committee
meetings will be spread out. However,
community voices are vital now more than
ever to participate in the crucial discussions
coming down the pipeline. I urge
all Texans to engage and make sure your
elected officials know what issues impact
you. To keep up with events in the district
and legislative efforts here in Austin, follow
me on Facebook: @juliejohnsonforTX and
Twitter: @juliejohnsonTX.
Representative Julie Johnson was elected
to the Texas House of Representatives
in November of 2018. She represents
House District 115 in Dallas County, which
includes the cities of Coppell, Farmers
Branch, Irving, Carrollton, Dallas, and Addison.
During the 86th Legislative Session,
Rep. Johnson was appointed to the House
Committee on Insurance and Judiciary &
Civil Jurisprudence.
Rep. Johnson serves as the vice chair of
the Women’s Health Caucus and treasurer
of the LGBTQ Caucus. She is a member of
the House Democratic Caucus, the Legislative
Study group, and the Sportsmen’s
Caucus. In her first legislative session, Rep.
Johnson pushed for legislation that focused
on consumer protection and access within
our healthcare system. For her hardworking
efforts during the 86th Legislative session,
Rep. Johnson was named “Freshman of the
Year” by Texas Monthly.
When Rep. Johnson is back home in the
district, she is an attorney who specializes
in personal injury cases, family law, and
mediation. She has represented thousands
of clients in the DFW area and has been in
practice since 1991. Rep. Johnson grew up
between Houston, Texas, and Auburn, Alabama,
but she settled in Texas as soon as
she could. She attended the University of
Texas at Austin and the University of Houston
Law School and is a board member of
the Dallas Symphony Orchestra. She is a
mother to two teenage boys, and her wife,
Dr. Susan Moster, is a gastroenterologist
practicing in Ft. Worth, Texas. DMJ
1. https://demographics.texas.gov/Resources/publications/
2019/20190925_PopProjectionsBrief.pdf
2. https://www.texmed.org/Template.aspx?id=46540
3. http://dfwhcfoundation.org/wp-content/uploads/
2015/04/mhaNTREC2015studyfinal.pdf
4. https://dshs.texas.gov/legislative/2018-Reports/SB-
18-Physicians-Workforce-Report-Final.pdf
5. https://txeha.org/wp-content/uploads/2020/11/Digital-
Health-Agenda-2021.pdf
6. https://2020scorecard.commonwealthfund.org/state/
texas/
7. https://www.foley.com/-/media/files/insights/
health-care-law-today/19mc21486-50state-survey-of-telehealth
commercial.pdf
8. https://www.texmed.org/uploadedFiles/Current/2016_
About_TMA/TMA_Publications/Texas_Medicine/Aug_20_
TM_Cover_1_Infographic.pdf
9. https://www.texmed.org/TexasMedicineDetail.
aspx?id=53946
10. https://www.texmed.org/TexasMedicineDetail.
aspx?Pageid=46106&id=55482
11. https://www.dmagazine.com/healthcare-business/
2020/07/study-millions-of-texans-are-turning-tovirtual
care-and-loving-it/
12. https://comptroller.texas.gov/economy/fiscalnotes/
2020/may/future.php#article
13. https://cdn.advocacy.sba.gov/wp-content/
uploads/2020/06/04144220/2020-Small-Business-
Economic-Profile-TX.pdf
Increase in utilization,
convenience, and trust in
telehealth is highlighted
by the fact that
approximately 9 in 10
Texans said that virtual
care options should be
available to everyone.