2013 Telehealth
Alabama
W.E. Goetter, MD, FACP, FCCP
DISCLOSURES:
NONE
TELEMEDICINE
TELEHEALTH
IS:
...the remote diagnosis and
treatment of patients by
means of Telecommunication
technology. (WHO 2007)
BARRIERS TO TELEHEALTH
•
•
•
•

LICENSURE
REIMBURSEMENTS
INFRASTRUCTURE DEVELOPMENT
PRIVACY, SECURITY
Two Patterns of Telehealth
Store and Forward
• Teleradiology
• Teledermatology
• Telepathology

Real Time: Face to Face
• ...
FACE TO FACE
Distant Site Provider

Originating Site

1. Provider

Patient with
Provider
Patient with
Patient presenter
Pa...
ISSUES
• Authentication
• Informed consent with known limitations with
telehealth encounter

• Technology appropriate for ...
1997
RULES OF THE ALABAMA BOARD OF
MEDICAL EXAMINERS
CHAPTER 540-x-16
THE PRACTICE OF MEDICINE OR OSTEOPATHY ACROSS STATE ...
2009

Connecting Alabama:
Broadband & Telehealth Summit
2011
2012
2013
Alabama Board of Medical Examiners
Rule Set on
Telehealth
Alabama Board of Medical
Examiners
Telehealth Rule Set
is
―Totally Reasonable‖
HIPAA and TELEHEALTH
• Telemed clinic has same duty to
safeguard, store and maintain privacy of
records.
• All transmitted...
The multi-specialty camera with built-in
freeze-frame & polarization
ENT Scope

Dermascope

Model 3200 Stethoscope
The electronic stethoscope with Bluetooth™
technology lets you hear, visuali...
GE Healthcare

Vscan Pocket
Ultrasound
Pocket-sized
ultrasound that
may transform
the way
physicians see
their patients.
Integrated Telemedicine
Cart
• Came out of Stanford University PhD Project

• Low cost solution to HIPAA-compliant Telehealth
MEDICARE TELEHEALTH PAYMENTS
• Specific codes with GT modifier
• Payments to both distant site provider, and
originating s...
MEDICARE ORIGINATING SITE
• Doctor’s Office
• Hospital
• Rural Health Clinic
• Federally-qualified Health Clinic
• Hospita...
TELEHEALTH INSURANCE PAYMENTS
STATE

MEDICAID

COMMERCIAL

ALABAMA

YES

NO

GEORGIA

YES

YES

FLORIDA

YES

NO

MISSISSI...
ALABAMA MEDICAID TELEHEALTH PAYMENTS
INITIATED: JANUARY 16, 2012
ENROLL:

931, SPECIALITY OF TELEMEDICINE

SIGN:

TELEMEDI...
HOME-BASED TELEHEALTH
• ZIPNOSIS

• TELADOC
Sign Up and
Start
Your
Zipnosis
Get Started!

Start a visit 24/7 — get your Zipnosis 8AM - 8PM, 7 days a week.

Prescriptions sent

Diagnosis by a

Instan...
TELADOC
• Founded in 2002
• First and largest Telehealth provider with 5
million members
• U.S. board certified doctors 24...
TELEDOC
1.
2.
3.
4.

Call service
Doctor calls back
Discuss problem: no time limit
Pay for service
TELEDOC
•
•
•
•
•
•

Cold, flu, bronchitis
Allergies, poison Ivy
Pink Eye
UTI
Sinus problem
Ear infection
TELEDOC DOCS
•
•
•
•

Board Certified IM, FP, Peds.
Active practice with full state license
You can apply on their website...
UNRESOLVED ISSUE
―The home as an originating site.‖
2nd Annual Alabama Rural Health
& TeleHealth Summit 2013
Alabama Partnership for Telehealth is partnering
with Alabama Rur...
 Telemedicine and how to get paid using it - Dr. Goetter
 Telemedicine and how to get paid using it - Dr. Goetter
 Telemedicine and how to get paid using it - Dr. Goetter
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Telemedicine and how to get paid using it - Dr. Goetter

  1. 1. 2013 Telehealth Alabama W.E. Goetter, MD, FACP, FCCP
  2. 2. DISCLOSURES: NONE
  3. 3. TELEMEDICINE TELEHEALTH IS:
  4. 4. ...the remote diagnosis and treatment of patients by means of Telecommunication technology. (WHO 2007)
  5. 5. BARRIERS TO TELEHEALTH • • • • LICENSURE REIMBURSEMENTS INFRASTRUCTURE DEVELOPMENT PRIVACY, SECURITY
  6. 6. Two Patterns of Telehealth Store and Forward • Teleradiology • Teledermatology • Telepathology Real Time: Face to Face • Montgomery AIDS Outreach • U of A Telepsychiatry
  7. 7. FACE TO FACE Distant Site Provider Originating Site 1. Provider Patient with Provider Patient with Patient presenter Patient 2. Provider 3. Provider
  8. 8. ISSUES • Authentication • Informed consent with known limitations with telehealth encounter • Technology appropriate for service rendered • HIPAA • Getting paid for services • Rules and regulations
  9. 9. 1997 RULES OF THE ALABAMA BOARD OF MEDICAL EXAMINERS CHAPTER 540-x-16 THE PRACTICE OF MEDICINE OR OSTEOPATHY ACROSS STATE LINES 540-X-16-.01 540-X-16-.02 540-X-16-.03 540-X-16-.04 540-X-16-.05 540-X-16-.06 540-X-16-.07 Authority Definitions License Requirement Qualifications For A Certificate of Qualification For A Special Purpose License Issuance of Certificate of Qualification, Transmittal To Medical Licensure Commission Appeal From Denial of Application For Certificate Of Qualification For Special Purpose License Effect Of Special Purpose License
  10. 10. 2009 Connecting Alabama: Broadband & Telehealth Summit
  11. 11. 2011
  12. 12. 2012
  13. 13. 2013 Alabama Board of Medical Examiners Rule Set on Telehealth
  14. 14. Alabama Board of Medical Examiners Telehealth Rule Set is ―Totally Reasonable‖
  15. 15. HIPAA and TELEHEALTH • Telemed clinic has same duty to safeguard, store and maintain privacy of records. • All transmitted data has to be via ―secure‖ means –this excludes Face Time and Skype applications as commonly used today.
  16. 16. The multi-specialty camera with built-in freeze-frame & polarization
  17. 17. ENT Scope Dermascope Model 3200 Stethoscope The electronic stethoscope with Bluetooth™ technology lets you hear, visualize, transmit and record body sounds.
  18. 18. GE Healthcare Vscan Pocket Ultrasound Pocket-sized ultrasound that may transform the way physicians see their patients.
  19. 19. Integrated Telemedicine Cart
  20. 20. • Came out of Stanford University PhD Project • Low cost solution to HIPAA-compliant Telehealth
  21. 21. MEDICARE TELEHEALTH PAYMENTS • Specific codes with GT modifier • Payments to both distant site provider, and originating site facility • But in Alabama there is no commercial Medigap payment
  22. 22. MEDICARE ORIGINATING SITE • Doctor’s Office • Hospital • Rural Health Clinic • Federally-qualified Health Clinic • Hospital-based Dialysis Center • Community Mental Health Clinic
  23. 23. TELEHEALTH INSURANCE PAYMENTS STATE MEDICAID COMMERCIAL ALABAMA YES NO GEORGIA YES YES FLORIDA YES NO MISSISSIPPI YES YES LOUISIANA YES YES NATIONAL 42 OF 50 19 OF 50
  24. 24. ALABAMA MEDICAID TELEHEALTH PAYMENTS INITIATED: JANUARY 16, 2012 ENROLL: 931, SPECIALITY OF TELEMEDICINE SIGN: TELEMEDICINE SERVICE AGREEMENT BILL BY: SPECIFIC CODES PAYMENT: ABSENT FOR PRESENTING SITE
  25. 25. HOME-BASED TELEHEALTH • ZIPNOSIS • TELADOC
  26. 26. Sign Up and Start Your Zipnosis
  27. 27. Get Started! Start a visit 24/7 — get your Zipnosis 8AM - 8PM, 7 days a week. Prescriptions sent Diagnosis by a Instantly Local Clinician Response back in Online Interview for 1 Hour $25
  28. 28. TELADOC • Founded in 2002 • First and largest Telehealth provider with 5 million members • U.S. board certified doctors 24/7/365 • Average doctor call back time: 24 Minutes • 95% member satisfaction
  29. 29. TELEDOC 1. 2. 3. 4. Call service Doctor calls back Discuss problem: no time limit Pay for service
  30. 30. TELEDOC • • • • • • Cold, flu, bronchitis Allergies, poison Ivy Pink Eye UTI Sinus problem Ear infection
  31. 31. TELEDOC DOCS • • • • Board Certified IM, FP, Peds. Active practice with full state license You can apply on their website Docs use phone protocol algorithms
  32. 32. UNRESOLVED ISSUE ―The home as an originating site.‖
  33. 33. 2nd Annual Alabama Rural Health & TeleHealth Summit 2013 Alabama Partnership for Telehealth is partnering with Alabama Rural Health Association and The Alabama Office of Primary Care and Rural Health for the 2nd Annual Rural Health & TeleHealth Summit 2013 October 16-18 Marriott Legends at Capitol Hill Prattville, AL
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