Why reimbursing doctors for e-visits makes sense for patients and providers

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As the Obama administration and Congress continue to debate the details of healthcare reform, there is one clear opportunity for reduced costs and improved outcomes that should be included:  universal government reimbursements for e-visits.

Currently, Medicare and Medicaid do not reimburse for asynchronous e-visits, yet both Internet access and email use continue to gain traction among all Americans.  According to the ‘National Technology Scan‘ report, 82% of American households had Internet access in their homes in 2007.   A recent Pew Research study found that 55% of adult Americans have high-speed connections.  According to the Pew Research Center’s Internet & American Life Project surveys, the largest increase in Internet use since 2005 can be seen in the 70-75 year-old age group.  In 2005, 26% of 70-75 year olds were online compared to 45% now.

% of Americans online by age

Currently, CMS allows for reimbursements for real-time video consults with patients under certain circumstances.  There are several vendors that offer secure real-time video consult software, such as American Well.  While useful, this real-time technology requires that both patients and doctors have web camera technology at their computers.  Additionally, a patient may not have access to a private area with a computer with video camera in the workplace, making these video consults impossible during normal business hours.

American Well

American Well

We believe that Medicare and Medicaid, and any new Public Plan created by the Obama administration, should include reimbursements for asynchronous online patient visits with established patients, meaning after an initial in-person consultation. Providing patients with the convenience of email consults could provide many benefits:

doctor at computer

  • Reduced costs
  • Better access to care in rural areas
  • Reduced number of missed work days
  • Reduced time and travel costs associated with in-person visits
  • More frequent preventative care visits
  • Improved medication adherence
  • Improved health outcomes through routine monitoring, particularly for those with chronic diseases
  • Increased patient and office efficiencies through online scheduling, lab results and bill pay
  •  

For those without access to the Internet or email, there would be no change in their current method of care.  However, if given the choice, studies have shown that most patients with email access prefer an e-visit over an in-person visit, especially for routine care and quick questions.  According to a 2009 Kaiser study published in Health Affairs, the use of secure e-mail, which began in late 2005, had increased nearly sixfold by 2007 and office visits per member have decreased 26.2 % in the three years since the health plan introduced their EMR.

According to a RelayHealth sponsored study conducted by investigators at the University of California at Berkeley and Stanford University, an analysis of healthcare claims revealed savings of more than $1 per health plan member per month within the RelayHealth treatment group as compared to the control group.  A 2007 study conducted by the Palo Alto Medical Foundation found that for every $1 employers invested in e-visit programs, they received a $4.50 return through a reduction in lost work productivity.

During this time of heated national debate over healthcare, we must come together over proven opportunities to save costs, improve efficiencies and provide better health outcomes for patients.  Creating federal reimbursements for e-visits is something we can all agree upon.

 

Related links:

http://pewresearch.org/pubs/1093/generations-online

http://www.transformed.com/e-Visits/e-Visits_There_Yet.cfm

http://www.cms.hhs.gov/Telemedicine/

http://mikethompson.house.gov/PRArticle.aspx?NewsID=381

https://www.ichp.ufl.edu/documents/Telemedicine%20in%20Medicaid%20and%20Title%20V%20Report.pdf

http://www.medscape.com/viewarticle/432585

http://www.americantelemed.org/files/public/policy/Private_Payer_Report.pdf

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5 Responses to “Why reimbursing doctors for e-visits makes sense for patients and providers”

  1. alyssaalyssaalyssa Says:

    This is a fascinating post and really well done. Love the poll! I had no idea the software capability was so sophisticated. I’m really happy to see a movement to promote technology as a cost and time saving measure. There is so much room for technology to improve health care and having Medicare/Medicaid support it would be powerful. Much like online learning has streamlined education, online medicine has a real future.

    It would require little effort to construct guidelines for what constitutes a web consult. There may be some issues of fairness, where not all people have access to the hardware, but even that seems like it could be overcome. Even if every business and public libraries had a dedicated private room with a computer and camera, the cost savings could be remarkable. Thank you for advocating on this topic. I am going to look into it more!

  2. htappis Says:

    This is a very interesting post. In the current healthcare reform debate and (hopefully) period of change, more attention should be paid to developments in e-health and m-health (mobile health! http://mobihealthnews.com/) to ensure that these emerging approaches to health care provision are taken into account. I do think that this is the next wave in many sectors and will be following closely to see how debate emerges.

  3. rockerdocmom Says:

    This is very interesting and excellently written. But with the high risk of medical malpractice suits, i am not sure how liability will be address. I have seen many cases in which one receives patient medical history, history of present illness from the ED and then when I actually show up and touch the patient to conduct a complete physical exam, my exam reveals something that was completely missed! And usually this changes the diagnosis. I think it is a good idea in theory but I think the practical risk of misdiagnosis increases exponentially. Doctors are trained for 4 years in physical diagnosis and observation. It would be a shame if this was done away with just to save costs… Some things are priceless.

  4. schmidtidp Says:

    Certainly face to face appointments continue to be important but if a patient of mine called for a rash after I start an antibiotic, I could save her an a lot of time by seeing her via a televisit. My own specilaty society, Infectious Disease Society of America, supports the idea. Many of my friends utilize the technology. http://www.medscape.com/viewarticle/514462.
    It would be extremely important, however, to get paid on a similar CPT coding scale as a face to face visit. It will take the same amount of time to see the patient and the same diagnostic skills. Herein lies the problem and where the big battles begin. I expect the current RVU (relative value) committee will need to hash this out, with supportive materials, of course.

    My personal gripe is not getting paid for a 15 minute phone call to discuss someone’s cough, fever, etc…Wouldn’t it be nice to keep the flu out of the office. I can make this diagnosis in a flash, decide when they need medical attention, or keep them at home so as to not spread it thoughout my waiting room. Big disconnect out there in policy land…

  5. phobrodine Says:

    As stated by others writing comments, this is a very well-written posting. I agree with many of the arguments made by the author in terms of the value of distance consultations. I would insert a caveat into the recommendation, however. I feel strongly that a concept like this must be connected to related reforms…specifically, I think the concept of e-visits has an appropriat place in the health information technology (HIT) regulatory debate. If there is to be an attempt to develop a national infrastructure and standard for HIT (which includes diagnostics, accessibilty issues, electronic health records, etc.), a novel method of connecting patients with providers should be subjected to the scrutiny of regulation to ensure quality of care. Including these types of visits in the scope of study and oversight by the National Coordinator of HIT would facilitate a uniform and comprehensive approach to integrating electronic-based/distance interventions with conventional medicine.

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