The state of e-Visits in 2008

A recent article called them "mouse calls." Some call them web-visits, or online consultations. The American Academy of Family Physicians (AAFP) defines an e-visit as an evaluation and management service provided by a physician or other qualified health professional to an established patient using a web-based or similar electronic-based communication network for a single patient encounter, that occurs over safe, secure, online communication systems.

e-Visits, introduced at the start of this decade, continue to gain momentum as technologies improve, consumer demand increases, experience from prior pilot studies becomes more widespread and major health plans advance and adopt e-visit initiatives. For common, non urgent ailments, an e-visit can simplify life for a consumer, and for a provider and plan too (because the entire transaction has already been converted to a documented electronic transaction.)
   
Obstacles for increased use of e-visits certainly remain. Numerous purchasers, notably Medicare, do not provide reimbursement. Large segments of physicians have not adopted enabling technologies and or resist participation due to reimbursement issues. There are always issues surrounding security. Some worry about patient over-use, or physician abuse if reimbursement improves. But recent growth in e-visit initiatives are undeniable, and the trend continues to gain ground.

The American Academy of Family Physicians (AAFP) provides the following Guidelines for e-visits, updated in December 2007 and available at: http://www.aafp.org/online/en/home/policy/policies/e/evisits.html :

• e-visits are available only to established patients who have previously received care from the physician’s practice; 

• the patient initiates the process, and agrees to e-visit service terms, privacy policy, and charge for receiving asynchronous care from a physician or other qualified health professional; 

• electronic communication occurs over a HIPAA-compliant online connection; 

• an e-visit includes the total interchange of online inquiries and other communications associated with this single patient encounter; 

• the physician appropriately documents the e-visits, including all pertinent communication related to the encounter, in the patient’s medical/health record; 

• the physician or other qualified health professional has a defined period of time within which responses to an e-visit request are completed; and 

• e-visits should be a payable physician service. 

The following are examples of medical group charges for e-visits. 

• Trinity Clinic in Whitehouse, Texas charges $25 per e-visit, and lowered their current charge from an initial $35 per e-visit.
• The Akron General Center for Family Medicine charges $30 per web visit
• Baylor College of Medicine charges $25 per e-visit
• Family Practice Partners in Murfreesboro, TN charges $25 per e-visit, and lowered their current charge from an initial $30 per e-visit.
• Cranford Family Practice, NJ charges $30 per e-visit
• Jayhawk Primary Care (Kansas City) charges $30 per e-visit
• Park Nicollet Institute (MN) charges $35 per e-visit
• HealthPartners Clinics (MN) charges $35 per e-visit for patients not covered under their health plan
• Presbyterian Medical Group (NM) charges $30 per e-visit

A significant number of health plans now reimburse physicians for e-visits, and some have established separate levels of copays for the visits.

The following provides various applicable e-visit data from the available literature:

• Trinity Clinic in Whitehouse, Texas, reports e-visits average five minutes, compared with 15 to 20 minutes for comparable office encounters, and averages one to two billable e-visits per month per doctor (1)
• Medfusion, an e-visit vendor, has process half a million e-visits for about 2,500 physicians during the last three years (1)
• McKesson's Relay Health, an e-visit vendor, charges physicians $25 per month per doctor for use of the web visit tools (2). RelayHealth, has 15,000 subscribing physicians (3)
• Manhattan Research survey results found 31% of physicians reported using some type of online communication with their patients in the first quarter of 2007, up from 24% in 2005, and 19% in 2003 (3)
• "National surveys suggest that the majority of online consumers now desire e-mail access to their physician and are willing to pay about $25 for an online consultation. A recent Wall Street Journal Online/Harris Interactive Poll found that 62 percent of patients said the ability to talk to a physician electronically would affect their choice of doctors and a Harris Interactive poll conducted in 2006 found that 74 percent of patients would like to use e-mail to communicate directly with their physicians." (3)
• "A recent Kaiser Permanente study of patients who used the medical group’s secure e-mail system between 2002 and 2005 to access their physicians found that they phoned their physicians nearly 14 percent less than did patients not using the system, while each doctor averaged about two e-mail messages per day." (3)
• "A two-year study of a pediatric rheumatologist’s e-mail and telephone interactions with 121 patient families, published in last October’s Pediatrics, found that the physician received an average of 1.2 e-mails per day, while answering patient questions by e-mail was 57 percent faster than using the telephone." (3)
• "75% of patients polled in the 2007 WSJ/Harris poll reported that their doctor does not currently offer e-Visits or other e-services" (4)
• "Blue Shield of California has estimated that the use of online patient-provider communications tools by its members will save the organization $4 million a year in office visit claims." (4) 

(1) Demand for e-visits grows but uptake still sluggish
Managed Healthcare Executive, November 1, 2007
http://managedhealthcareexecutive.modernmedicine.com/

(2) Physicians diagnose their patients via mouse calls
Akron Beacon Journal, March 10, 2008
http://www.statesman.com/life/content/life/stories/health/03/10/0310housecalls.html

(3) Online physician communication 
Physicians News Digest, March 2008
http://www.physiciansnews.com/cover/308.html 

(4) e-Visits:The Tipping Point - Are We There Yet?
Rhondda Francis, TransforMed, 2008
http://www.transformed.com/e-Visits/e-Visits_Are_We_There_Yet.cfm