Legislature(2013 - 2014)BARNES 124
03/26/2014 03:15 PM House LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| HB316 | |
| HB370 | |
| HB281 | |
| HB336 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 370 | TELECONFERENCED | |
| += | HB 281 | TELECONFERENCED | |
| *+ | HB 336 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 316 | TELECONFERENCED | |
HB 281-PRESCRIPTION WITHOUT PHYSICAL EXAMINATION
4:02:29 PM
CHAIR OLSON announced that the next order of business would be
HOUSE BILL NO. 281, "An Act relating to prescription of drugs by
a physician without a physical examination." [Before the
committee was CSHB 281(HSS)].
4:02:39 PM
REPRESENTATIVE LYNN GATTIS, Alaska State Legislature, stated
that HB 281 clarifies in statute that physicians cannot be
sanctioned for dispensing or administering prescription
medications without conducting a physical exam of the patient if
some basic stipulations are met in a practice called
telemedicine. Under HB 281, care would be delivered by primary
care physicians licensed in Alaska, and patients would be able
to obtain over the phone or on-line consultations in which
physicians can diagnose an ailment and if necessary, prescribe
prescription medicine; however, physicians could not prescribe
controlled substances. At the last hearing, a concern was
raised about overprescribing. She reported that her information
shows that the national average prescribing rate for common
uncomplicated diagnoses is 82 percent in the "brick and mortar"
setting, and 77 percent in the telehealth setting, per Teladoc's
156,000 consultations. The efficient quality of the system
comes down to cost and access for the average citizen. These
practices can have favorable impacts because of access to care
for individuals living in rural and urban settings.
4:04:32 PM
CHAIR OLSON reported that his office received concerns from the
Department of Corrections (DOC). He anticipated a forthcoming
amendment that will be considered at a later hearing.
LAURA BROOKS, Health Care Administrator, Office of the
Commissioner, Department of Corrections, introduced herself.
4:05:39 PM
The committee took an at-ease from 4:05 to 4:21 p.m. due to
audio issues.
4:21:17 PM
ROBERT LAWRENCE, Doctor; Chief Medical Officer; Inmate Health,
Department of Corrections, with respect to DOC, discussed
different forms of telemedicine. One type of telemedicine that
has been practiced in the state involves provider-to-provider
communications, in which a nurse contacts a physician and orders
are given over the phone or via Internet. A second type of
telemedicine involves direct patient to medical provider
communication, specifically when a patient has a preexisting
relationship with the provider; however, this bill introduces a
new form of telemedicine to the state, in which a patient is
allowed to contact a medical provider without having a
preexisting doctor-to-patient relationship.
DR. LAWRENCE said DOC's concern is that the HB 281 inadvertently
hampers the department's ability to provide services in rural
Alaska using telemedicine in ways that are already approved by
the medical board, specifically in terms of controlled
substances. For example, a physician in the DOC often will be
called for a prescription involving a controlled substance for a
patient in a remote DOC facility. The department needs to
retain the ability to give the prescriptions at a distance
instead of sending the inmates to an emergency room or to ask
other providers to be available. Secondly, the department is
affected by the requirement on page 2 that the physician must be
physically located in the state in order to render care over the
phone or by other means. Those are the two primary concerns, he
said, and he understood the sponsor is working to accommodate
those. He appreciated working with the sponsor on these issues.
CHAIR OLSON acknowledged that the committee is working with the
sponsor and DOC on the aforementioned changes to the bill.
4:24:55 PM
KATE BURKHART, Executive Director, Alaska Mental Health Board,
Department of Health and Social Services (DHSS), stated the
Alaska Mental Health Board (AMHB) is the state planning council
for issues related to mental health. She said the board has
reviewed the bill and appreciates the sponsor's support for
telemedicine. She recalled earlier testimony about the types
and forms of telemedicine in the state. The AMHB acknowledged
that while the bill doesn't speak directly to tele-psychiatry,
it was important to place on the record how tele-psychiatry
works and its importance to patients.
MS. BURKHART explained that tele-psychiatry in the publically-
funded behavioral health system is integral to mental health
services. In many communities, the ability to recruit and
retain psychiatrists is hampered by geography and compensation.
She reported the current vacancy rate for psychiatrists is
almost 25 percent and many communities wait years to find a
psychiatrist. Community behavioral health centers and federally
qualified health centers that offer mental health services often
contract with psychiatrists who are licensed psychiatrists in
Washington but often practice in the Pacific Northwest. In
addition, psychiatrists from the University of Washington and
Children's Hospital are frequently contracted with to provide
tele-psychiatry services. These psychiatrists often prescribe
medications in the course of mental health treatment and some
are controlled substances; however, these drugs are not what
this bill intends to prevent being diverted into inappropriate
uses; rather, they are anti-anxiety medications and similar
medications that are part of an ongoing course of treatment.
MS. BURKHART stated that psychiatrists practicing through
telemedicine work in conjunction with community behavioral
health centers, where clients present and are impaneled at a
community behavioral health center for mental health services
such as therapy, case management, life skills, and
rehabilitative services. She further stated that psychiatrists
provide medications necessary to stabilize and manage chronic
health conditions, which is part of an ongoing relationship. In
fact, tele-psychiatry is not used in acute psychiatric
situations, but is part of ongoing care, although tele-
psychiatry is sometimes used in those situations in Bush Alaska
when a psychiatric emergency arises. In community behavioral
health centers, the importance of tele-psychiatry is to provide
ongoing mental health treatment. Although the bill does not
speak directly to psychiatry, the AMHB felt it was important to
provide an overall context of how tele-psychiatry works and the
importance of providing this access to rural Alaskans.
4:29:07 PM
CHAIR OLSON recalled a number of people in the medical community
in the late 1970s came to Alaska through the Bureau of Indian
Affairs or the military. He said these doctors received tuition
repayment for each year they stayed in Alaska, with about 75
percent remaining in the state. He asked whether that type of
program is currently happening.
MS. BURKHART replied that issues related to recruitment of
psychiatrists that he addresses includes practitioners who are
now retiring. She explained that recruiting doctors in the
early or middle part of their career is more difficult if the
doctors have not had experience in Alaska. Some attempts have
been made to establish a psychiatric residency in Alaska, since
doctors tend to practice in a close proximity of their
residency; however, the board has not been able to establish
that residency. The state has a relationship with the Western
Washington WWAMI program to help with recruitment, but part of
the issue is the cost of living and conditions. For example,
Fairbanks has struggled for years to recruit and retain
psychiatrists, in part because the military is a competitive
employer and pays a higher salary, thus the hospital and
community behavioral health center and tribal providers have had
trouble competing. In Ketchikan, Community Connections provides
services to people with developmental disabilities and early
childhood mental health, but also contracts with a psychiatrists
at Children's Hospital. Although the Ketchikan community has
recently had two psychiatrists, neither is a child psychiatrist.
She reported that all of the psychiatrists providing services in
the publically-funded system are licensed in the state, which is
the quality assurance mechanism.
4:32:09 PM
REPRESENTATIVE JOSEPHSON referred to the description of tele-
psychiatry, and he recalled that people in Alaska used providers
in Washington State. He asked whether the provider would have
licensure in Juneau.
MS. BURKHART stated that the integrated behavioral health
regulations require that the client be present at the behavioral
health center and a clinician is with them during the
appointment, in part, to navigate equipment and ensure
continuity of care. The state will not reimburse the
appointment without this method. Therefore, a client is not
being served at home with the tele-psychiatrist appointment.
4:33:39 PM
REPRESENTATIVE HERRON said that in his region communities have
contracted for services from someone in Minnesota. He asked for
the average vacancy rate in the Lower 48 and how it compares to
the 25-percent vacancy rate for psychiatrists in Alaska.
MS. BURKHART recalled the board had a presentation on the
vacancy rate, and an expected vacancy in the community health
system is 10 percent and anything over that requires planning
efforts. In the health care industry in Alaska, they are
looking at those fields with 11 percent or over, but psychiatry
has the highest rate.
REPRESENTATIVE HERRON asked whether this is a national trend.
MS. BURKHART said it depends on the community and the
subspecialty. For example, geriatric psychiatry has often been
in demand and is provided through tele-psychiatry in Alaska, but
the practice is robust in Florida. She offered to provide the
national average on vacancy rates for psychiatrists.
4:35:35 PM
CHAIR OLSON, after first determining no one else wished to
testify, closed public testimony on HB 281.
[HB 281 was held over.]