1. 2013 Telehealth
Alabama
W.E. Goetter, MD, FACP, FCCP

2. DISCLOSURES:
NONE

3. TELEMEDICINE
TELEHEALTH
IS:

4. ...the remote diagnosis and
treatment of patients by
means of Telecommunication
technology. (WHO 2007)

5. BARRIERS TO TELEHEALTH
•
•
•
•
LICENSURE
REIMBURSEMENTS
INFRASTRUCTURE DEVELOPMENT
PRIVACY, SECURITY

6. Two Patterns of Telehealth
Store and Forward
• Teleradiology
• Teledermatology
• Telepathology
Real Time: Face to Face
• Montgomery AIDS Outreach
• U of A Telepsychiatry

7. FACE TO FACE
Distant Site Provider
Originating Site
1. Provider
Patient with
Provider
Patient with
Patient presenter
Patient
2. Provider
3. Provider

8. ISSUES
• Authentication
• Informed consent with known limitations with
telehealth encounter
• Technology appropriate for service rendered
• HIPAA
• Getting paid for services
• Rules and regulations

10. 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

11. 2009
Connecting Alabama:
Broadband & Telehealth Summit

12. 2011

13. 2012

14. 2013
Alabama Board of Medical Examiners
Rule Set on
Telehealth

15. Alabama Board of Medical
Examiners
Telehealth Rule Set
is
―Totally Reasonable‖

16. 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.

17. The multi-specialty camera with built-in
freeze-frame & polarization

18. ENT Scope
Dermascope
Model 3200 Stethoscope
The electronic stethoscope with Bluetooth™
technology lets you hear, visualize, transmit and record body sounds.

19. GE Healthcare
Vscan Pocket
Ultrasound
Pocket-sized
ultrasound that
may transform
the way
physicians see
their patients.

20. Integrated Telemedicine
Cart

21. • Came out of Stanford University PhD Project
• Low cost solution to HIPAA-compliant Telehealth

23. 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

24. MEDICARE ORIGINATING SITE
• Doctor’s Office
• Hospital
• Rural Health Clinic
• Federally-qualified Health Clinic
• Hospital-based Dialysis Center
• Community Mental Health Clinic

25. 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

26. 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

27. HOME-BASED TELEHEALTH
• ZIPNOSIS
• TELADOC

28. Sign Up and
Start
Your
Zipnosis

29. 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

30. 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

31. TELEDOC
1.
2.
3.
4.
Call service
Doctor calls back
Discuss problem: no time limit
Pay for service

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

33. TELEDOC DOCS
•
•
•
•
Board Certified IM, FP, Peds.
Active practice with full state license
You can apply on their website
Docs use phone protocol algorithms

34. UNRESOLVED ISSUE
―The home as an originating site.‖

35. 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