telemedicine and how to get paid using it - dr. goetter

2013 Telehealth Alabama

W.E. Goetter, MD, FACP, FCCP

DISCLOSURES:

NONE

TELEMEDICINETELEHEALTH

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 TelehealthStore and Forward• Teleradiology• Teledermatology• Telepathology

Real Time: Face to Face• Montgomery AIDS Outreach• U of A Telepsychiatry

FACE TO FACE

1.Provider Patient with Provider

2.Provider Patient with Patient presenter

3.Provider Patient

Distant Site Provider Originating Site

ISSUES•Authentication

• Informed consent with known limitations with

telehealth encounter

• Technology appropriate for service rendered

•HIPAA

•Getting paid for services

•Rules and regulations

1997 RULES OF THE ALABAMA BOARD OF

MEDICAL EXAMINERS

CHAPTER 540-x-16THE PRACTICE OF MEDICINE OR OSTEOPATHY ACROSS STATE LINES

540-X-16-.01 Authority540-X-16-.02 Definitions540-X-16-.03 License Requirement540-X-16-.04 Qualifications For A Certificate of Qualification For A

Special Purpose License540-X-16-.05 Issuance of Certificate of Qualification, Transmittal To

Medical Licensure Commission540-X-16-.06 Appeal From Denial of Application For Certificate Of

Qualification For Special Purpose License540-X-16-.07 Effect Of Special Purpose License

2009

Connecting Alabama:Broadband & Telehealth Summit

2011

2012

2013 Alabama Board of Medical Examiners

Rule Set onTelehealth

Alabama Board of Medical Examiners

Telehealth Rule Setis

“Totally Reasonable”

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.

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

Model 3200 StethoscopeThe electronic stethoscope with Bluetooth™technology lets you hear, visualize, transmit and record body sounds.

Dermascope

ENT Scope

Ophthalmoscope

GE Healthcare

Vscan PocketUltrasound

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 site facility

•But in Alabama there is no commercial Medigap payment

MEDICARE ORIGINATING SITE

•Doctor’s Office•Hospital•Rural Health Clinic•Federally-qualified Health Clinic•Hospital-based Dialysis Center•Community Mental Health Clinic

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

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

HOME-BASED TELEHEALTH

•ZIPNOSIS

•TELADOC

Sign Up and StartYour

Zipnosis

Get Started!

Prescriptions sent

Instantly

Response back in

1 Hour

Diagnosis by a

Local Clinician

Online Interview for

$25

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

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

TELEDOC

1. Call service2. Doctor calls back3. Discuss problem: no time limit4. 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• Docs use phone protocol algorithms

UNRESOLVED ISSUE

“The home as an originating site.”

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 2013October 16-18

Marriott Legends at Capitol Hill Prattville, AL