Well, duh.
Many patient encounters, like those involving medication refills for instance, can be done without an office visit. An e-mail or telephone conversation would suffice in most cases. However, with Medicare and other private insurers refusing to reimburse for such claims, it is no wonder that many doctors insist on a face to face visit that gets reimbursed.
HMO Kaiser Permanente recently published a study showing that, for its members in Hawaii, office visits dropped by about 25 percent between 2004 and 2007, after secure e-mail and “telephone visits” were instituted.
Such an effect can only take place in a salaried physician structure, which is uncommon in the United States. Many doctors belong to small practices, where they are paid fee-for-service. If the number of office visits decline, so will their revenue.
So, without a financial incentive to keep patients out of the office, I don’t expect the Kaiser findings to be replicated nationwide.
Related posts:
- A doctor without an office
- Do longer office visits matter?
- How increasing payments for office visits can help specialists
- How much would you pay to e-mail your doctor?
- After a doctor is convicted, is telemedicine dead?
- John Edwards and forced visits to the doctor
- HIPAA forbidding patient/physician e-mails?
{ 10 comments }
It can be replicated on a large scale in the US. All primary care physicians have to do is switch to a retainer model payment. No need to be an HMO employee.
No reason why these e-visits cannot be fee for service. If patients cannot see the value of these directly for themselves (e.g., no travel, eliminated hassels), or gripe about any co pay not covering the fee, then they have only themselves to blame. Alternatively, this could be an additional ‘micro concierge’ service that could be done under a retainer. If that’s not allowed then perhaps another line of work may be in order.
Chuck Brooks
FutureWare SCG
Chuck… not necessarily.
It depends on the insurance contract. In some it is not a covered service, thus you could charge separately. In others (Medicare comes to mind) it IS a covered service, it is just not paid anything. In those cases you cannot charge.
Sgent-
I may be mistaken, but I believe that medicare does NOT bundle after-hours access & telephone/email-based care (including med refills) into the payment for an office visit.
This means that you CAN both be participating with medicare (ie. bill for the office visit) AND bill the patient an additional fee for after-hours access eg. med refill by phone/email.
This, of course, may all change with the medical home model being pushed by the ACP, where I foresee continuing to be underpaid, but now EVERYTHING is bundled into the hands of the primary care doctor. THen patients will feel even more entitled to ridiculous after hours care (e.g. just saw you a week ago doc, but i forgot that i'm almost out of my xanax, proscar, vasotec, & six other meds. Oh, and can you fill out these forms & mail them back to me ASAP?)
Please correct me if I am wrong, with evidence to the contrary,
thanks.
Happyman,
Take a look at the 2009 Fee Schedule for Medicare (available at http://www.cms.hhs.gov/PhysicianFeeSched/PFSRVF/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=1&sortOrder=ascending&itemID=CMS1216693&intNumPerPage=10)If you look at the CPT codes in PPRRVU09.xls after downloading the schedule, you can look at the status codes for various services. The status code for after hours visits indicate the service is included; however, you are correct that (and this is relatively new) the status code for phone E&M consultation by a physician is a non-covered (thus separately billable) service.
I have patients ask for my hospital email all of the time. I tell them it’s 911.
This excellent discussion of when and how physicians can be reimbursed for e-mail/phone calls just goes to show how much our health care system is still embedded in an episodic acute care model when the vast majority of care provided relates to chronic disease that is best managed by providing continuity in care.
Email is not a confidential medium. If the email address/computer system is owned by the patient’s employer, they have every right to read the patient’s medically related emails.
If a breast augmentation patient who told her employer she was having “chest surgery” and would be out for six weeks, emails a question and I answer it online, who’s liable if her employer reads that email, which he legally owns, and fires her?
Out of the office care is a logistical problem, as the services vary, and physicians may or may not want to charge for it, depending on the service or type of practice. Billing is also problematic as the cost of billing is sometimes more than the payment. For that reason, we developed a flexible on line service, housedoc.us, that lets the physician list the on line services offered, decide whether to charge or how much, and be able to forgive the payment. Patients then pay be credit card. Its also free for physicians, and includes any regulatory mandated agreements. The service enables doctors to offer their service on line, regardless of the type of practice. Should solve a lot of problems.
This article exemplifies why people outside of health care need to step in. In what other industry could you improve efficiency by 25% and have people argue against it?
If we had an excess of family practice providers perhaps this would be a problem but the last time I checked only 4% of medical school grads are going into family practice.
By freing up the providers time to focus on people with chronic conditions or those that are more complex (AKA you can bill more) this is a great solution.
Kevin you are defending a dinosaur and as of this post I no longer need to read you as you clearly don’t grasp what is happened in the field. Everyone will have email access to their providers, care will be provided by NP’s and PA’s, family practice doc’s will become project managers. Get on board.
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