Virtual Office Visits
Friday, July 4th, 2008 The doctor doesn’t have to see you now. Thanks to new technology, patients may not always need a face-to-face visit with their doctor to get the care they need.
And thanks to a growing awareness of this fact on the part of health plans, structured, Internet-facilitated and reimbursable “virtual visits” are on the verge of entering mainstream medicine. Virtual visits also are seen as a tool that will save money, provide convenient care and maybe do something to solve the problem of patients not having access to their doctors.
This is especially true in Minnesota, where five of the six largest private health plans reimburse physicians about $35 per virtual office visit, and the last holdout announced that it will soon join the club. Unresolved, however, are issues over standards for billing and legal jurisdiction matters concerning doctors conducting e-visits during travel to states they are not licensed to practice in.
Health information technology vendors are helping to bring the parties together, and a message is being spread that virtual visits benefit patients by offering affordable and convenient access to their doctors; help providers more efficiently process routine cases; aid employers by reducing absenteeism created when workers take time off to see their physician; and—perhaps most significant—assist insurance companies in saving money.
“I would hope that 100% of the companies will be doing this in the next few years,” said independent family physician and e-visit advocate Michelle Eads of Woodland Park, Colo. “Once the insurance companies get it through their thick skulls that it saves money, they’ll be more than willing to do it.”
Eads is also the sole practitioner in a pilot study Kaiser Permanente of Colorado Springs is conducting exploring the use of virtual visits by in-network independent physicians. She receives $50 for an online consultation and said preliminary figures from 2006 show that Kaiser is saving between $70 and $120 on each virtual visit.
Internist Paul Tang, the vice president and chief medical information officer of the Palo Alto (Calif.) Medical Foundation, believes employers should pay more attention. He said, in a study, his organization found that for every $1 employers invested in virtual-visit programs, they received a $4.50 return—mostly in the form of savings generated from having less lost productivity.
Eads, speaking at the AAFP’s annual scientific assembly in Chicago earlier this month, said it takes about 16 minutes to complete the typical virtual visit, and that they have been particularly useful in monitoring patients with hypertension and depression. Besides chronic conditions, Eads said these visits are also helpful for patients who work nights or who are just under the weather.
“I live in the mountains,” she explained. “Some people don’t want to drive into the mountains just for me to say ‘Yes, you’re sick.’ ”
E-visits also work out for patients without insurance who find the $50 online-consult fee easier to swallow than the price of an office visit, Eads said.
Miami-based family physician Bernd Wollschlaeger has nothing but self-pay patients in his cash-only, paper-free practice, and he said his patients don’t mind paying for electronic communication. Fees start at $15 to $20 for a prescription refill, $25 for chronic condition management, and then go higher the more complex the task. “Most people in my practice understand that my time is money,” Wollschlaeger said. “I’ve never heard a complaint.”
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