Legislature(2015 - 2016)BUTROVICH 205
04/13/2015 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB98 | |
| HCR9 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 98 | TELECONFERENCED | |
| *+ | SB 65 | TELECONFERENCED | |
| + | HCR 9 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 98-PRESCRIPTION WITHOUT PHYS. EXAM.
1:37:38 PM
CHAIR STEDMAN announced the consideration of SB 98.
SENATOR PETER MICCICHE, Alaska State Legislature, sponsor of SB
98, explained that the bill will drive down the cost of health
care in Alaska, improve health care access for rural residents,
and prohibit unprofessional conduct claims against a physician
who is licensed in Alaska, but out of state at the time of
prescribing a prescription drug.
He related that in 2014 the legislature passed HB 281 by a near-
unanimous vote to allow physicians to prescribe a prescription
drug to a person without conducting a physical examination,
within certain parameters. A prescription drug could not be a
controlled substance, unless the health care provider was
present with the patient to assist the physician with
examination, diagnosis, and treatment.
He said HB 281 required the physician to be located in the
state. For example, a physician in Ketchikan could conduct a
remote diagnosis and prescribe a drug in any community in
Alaska. Alaska is the only state that does not allow stateside
physicians to practice telemedicine across state lines, so the
pool of physicians that can provide this service is greatly
diminished.
SENATOR MICCICHE stated that SB 98 addresses the lack of
physicians available to do remote consults by removing the
"physical, in-state presence" requirement. The physicians would
still require an Alaska medical license. He pointed out that
telemedicine services average less than one-third of the cost of
an in-person office visit and less than one-tenth the cost of an
ER visit.
He said what some physicians are concerned about is already
allowed in Alaska. There is remote prescription of medication
occurring now with no in-person visits required as per HB 281
from last year. The only difference is that a physician may now
be out of Alaska to do so. From the patient's perspective, there
is zero difference. The Alaska State Medical Board has been
issuing Alaska Medical Licenses to stateside physicians for
decades. The Department of Health and Social Services (DHSS) has
been using stateside physicians for years to deliver health care
via telemedicine to Alaskans at a far more reasonable rate and
it has worked out very well.
He noted a report by the Federation of State Medical Boards of
the United States, a national non-profit organization that
represents 70 state medical and osteopathic boards on model
policy for the appropriate use of telemedicine technologies and
the practice of medicine. The report concludes that the
physician/patient relationship is clearly established when a
physician agrees to undertake diagnosis and treatment of the
patient, and the patient agrees to be treated, whether or not
there has been a personal encounter between the physician and
the patient.
SENATOR MICCICHE summarized that SB 98 does five things: it
clarifies that the legislature's intent is to support
telemedicine in Alaska, prevents the Alaska Medical Board from
blocking telemedicine to private sector insurance programs,
ensures the patient controls their medical records, including
their psychiatric records, removes the requirement that the
physician must be physically located in Alaska, maintains the
requirement that the physician is licensed in Alaska, and it
provides substantive cost savings to individuals in public
programs.
He said both AETNA and Premera Blue Cross Blue Shield of America
support the bill. State employees currently have this benefit.
He shared a personal story of how the benefit might help his
family.
1:42:52 PM
CHUCK KOPP, Staff, Senator Peter Micciche, Alaska State
Legislature, presented information related to SB 98. He related
that Section 1 prohibits the State Medical Board from imposing
discipline on a physician licensed in the state for rendering a
diagnosis or providing a treatment without a physical
examination, if the physician or another physician or licensed
health care provider's practice is available for follow-up care,
and the physician requests that the patient consents to release
copies of records of the encounter to the primary care
physician, and, if the patient does consent, the physician sends
for the records.
He said Section 2 is a conforming amendment - on page 1, lines
9-14 are deleted and on page 2, line 1 is deleted. It is a
stylistic drafting change recommended by Legislative Legal.
1:44:01 PM
CHAIR STEDMAN noted the arrival of Senator Ellis.
SENATOR GIESSEL asked about removing the physical presence of
the prescribing clinician in Section 2. She maintained that
something significant happens; it removes the provision that the
subscriber must be in Alaska. She also asked, in Section 2,
lines 14 and 15, who the "appropriate licensed health care
provider" is.
MR. KOPP answered the first question noting that the "physician
is located in the state" is deleted in Section 1. To the second
question, he explained that the "licensed health care provider"
is taken from current law that deals with prescription of drugs
without physical examination. The law is currently worded that
an appropriated licensed health care provider is to be present
with the physician to assist with the exam, diagnosis, and
treatment if a controlled substance is involved. He said he
would have to look up the definition of "licensed health care
provider."
1:46:22 PM
CHAIR STEDMAN said it is the first hearing on SB 98 and he would
be setting the bill aside, providing ample time for the sponsor
to get back to committee questions and concerns.
SENATOR GIESSEL said she needs to confirm that pharmacies in
Alaska fill prescriptions from out-of-state prescribers. She
asked who the sponsor would call late at night using
telemedicine.
SENATOR MICCICHE said it would be a Teledoc person within the
state.
SENATOR GIESSEL said Arizona uses a statewide nurse call line,
not necessarily a physician employed by Teledoc.
1:48:19 PM
SENATOR STOLTZE asked for clarification of Teledoc.
SENATOR MICCICHE recalled that in the new Teledoc plan the idea
was that there would be an M.D. on the end of the line. He
opined that in many cases, calls could be handled by a nurse,
nurse practitioner, or other health care provider.
SENATOR STOLTZE asked if it creates a new billing opportunity
for doctors.
SENATOR MICCICHE thought the effort nationally was to reduce the
cost of office visits by allowing calls, and a Teledoc physician
can manage phone calls for less cost.
SENATOR STOLTZE repeated the question.
SENATOR MICCICHE said insurance companies look at it as savings.
1:51:40 PM
CHAIR STEDMAN opened public testimony.
DR. MIKE HAUGEN, Executive Director, Alaska State Medical
Association (ASMA), testified in opposition to SB 98. He
maintained that ASMA had concerns last year about HB 281
expanding the use of telemedicine by allowing a physician to
prescribe medication via telemedicine without conducting a
physical exam and without establishing a physician/patient
relationship. He said that ASMA took a neutral position on HB
281, providing there were safeguards put in place. He maintained
that SB 98 removes one of the primary safeguards - that the
physician be located in Alaska. He said the Alaska State Medical
Board is currently working on guidelines for telemedicine. He
requested that the bill be held until those regulations are in
place.
1:54:37 PM
SENATOR GIESSEL asked whether there is a provision for billing
for phone consultations.
DR. HAUGEN said he did not know.
DR. HENRY DEPHILLIPS, Teladoc, testified in support of SB 98. He
said the legislative intent in Alaska, considering the passage
of HB 281, is to allow telemedicine in the state. This bill has
a major provision, removing the requirement that the physician
or licensed practitioner practicing telemedicine be physically
present in the state. He said Alaska is the only state that
requires the physician to be present in the state.
He noted the mismatch between the need for services in Alaska
and the number of physicians available. He thought it was
interesting that the Alaska State Medical Board seems to want to
allow physicians in the state to practice telemedicine, but not
those licensed in Alaska, but living elsewhere. The compensation
for physicians in Alaska is three times that in other states. He
suggested that telemedicine costs in Alaska would have to be
tripled to be effective. He concluded that it makes more sense
to allow out-of-state practitioners to practice telemedicine.
1:58:22 PM
SENATOR GIESSEL asked Dr. DePhillips if he agrees with the
controlled substance provision in the bill.
DR. DEPHILLIPS said the Teledoc program is in 48 states and does
not allow the prescribing of DEA controlled substances under any
scenario. He noted prisons in Alaska as an exception.
2:00:11 PM
DR. JOHN PAPPENHEIM, representing himself, testified in
opposition to SB 98. He said he is a psychiatrist and opined
that while telemedicine and tele-psychiatry, when done
appropriately, can provide safe and effective treatment while
improving access to health care providers, SB 98 in its current
form does not do that. He requested waiting for the State
Medical Board to write telemedication regulations.
2:01:30 PM
SHEELA TALLMAN, Senior Manager of Legislative Policy, Premera
Blue Cross Blue Shield of Alaska, testified in support of SB 98.
She stated that telemedicine can reduce health care costs. She
said this year Premera launched a virtual care benefit that
enabled all members to access health-related services and
information via a variety of telecommunication channels. She
noted growing interest for those services. SB 98 will promote
the use of telemedicine in Alaska.
SENATOR STOLTZE asked if other states have expanded telemedicine
to outside the borders of the U.S.
MS. TALLMAN said they have been successful in other states, but
she did not know about other countries.
SENATOR GIESSEL said Medicaid currently does not pay for
providers outside Alaska. She asked if it does in other states.
MS. TALLMAN said yes.
2:04:27 PM
CRIAG KESTRAN, Senior Account Executive Benefits Manager, Alaska
USA Insurance Brokers, testified in support of SB 98. He related
that due to the doctor shortage, telemedicine is in name only.
Telemedicine removes the barriers to entering the Alaska market
and makes quality health care available. It will provide for
low-cost, high-quality health care.
2:06:04 PM
REBECCA LING, Director of Recovery Services, Cook Inlet Tribal
Council, testified in support of SB 98. She spoke of the success
of tele-psychiatry service for behavioral health issues provided
by physicians outside the state, but licensed in Alaska. She
said the services have been provided by the University of
Colorado for seven years. She described how the process works.
She spoke of the reluctance of patients to sign releases to
share records with primary care physicians, which is required by
law. She said Recovery Services does not prescribe medications
other than basic medications. She said SB 98 would benefit their
participants.
2:08:23 PM
CAM CARLSON, Public Member, Alaska State Medical Board,
testified in opposition to SB 98. She said the previous bill, SB
281, did not assure that there would be a health care provider
involved, nor did it provide an adequate standard of patient
care. She maintained that the doctors calling from out of state
are in it for the money.
2:10:25 PM
KATE BURKHARDT, Executive Director, Alaska Mental Health Board
and Advisory Board on Alcoholism and Drug Abuse, testified in
support of SB 98. She said she had concerns about out-of-state
physicians and the sharing of patient records as contained in SB
281. She spoke about the use of telemedicine in the community
behavior health system. She gave examples of who provides
psychiatric services and the way the system is designed. She
said a physician's relationship is created at the outset. She
testified in favor of removing the provision that the physician
must be inside the state. She also liked the consent request
section in SB 98 because Section 2 alleviates their concerns.
2:13:50 PM
CHAIR STEDMAN closed public testimony.
MR. KOPP thanked the committee for hearing the bill.
CHAIR STEDMAN commented that they will work on the bill to
rectify concerns.
CHAIR STEDMAN held SB 98 in committee.
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