Blue Cross and Blue Shield of Massachusetts said it will increase more than three-fold the number of participating physicians its year-old pilot program to pay for Internet-based "office" visits.
The Blues plan will add primary-care physicians with Caritas Christi Health Care and Beth Israel Deaconess Medical Center in Boston and Baystate Health System in Springfield to the pilot it launched in March 2003.
The additions will increase the number of participating physicians from about 185 today to more than 500 by next year, according to John Fallon, M.D., chief physician executive for the payer.
Blue Cross Blue Shield of Massachusetts pays participating physicians $19, and its members make $5 copayments for an Internet-based consultation under the program.
The Blues have contracted with RelayHealth, the Emeryville, Calif., company formerly known as Healinx, to provide the billing and Internet portal service that connect participating physicians and patients.
Fallon described the Internet billing scheme as a transformation in the practice of medicine.
"It recognizes that healthcare is changing and that face-to-face encounter is not the only way for a physician to see a patient," Fallon said.
Edward "Ned" Legare, M.D., is an internist with Newton-Wellesley Primary Care, an eight-physician group practice in Newton, Mass. Legare said he's been using the e-mail consultation service for almost a year.
All eight physicians in his group use it. Most of the patient contacts are brief, including requests for appointments and prescription refills. "I get on average 10 hits a day, (but) maybe only one or two a day I feel comfortable to charge for a visit," he said.
"Probably the most useful thing is patient reassurance," Legare said. "I'll get 'Hey, Ned. I've been doing this and this for a cough. Is it the right thing? Should I come in?'"
Legare said the Internet-based visit also has been a way to serve patients who travel and snowbirds who winter away from Massachusetts.
Legare said his group uses the system for patients other than Blue Cross Blue Shield members, but those patients pay the entire $24 cost of the online visit out of their own pockets.
Each month, RelayHealth keeps track of the number of charged visits and sends Legare a check, less $50 for the company's service fee. So far, Legare said, the time spent during the online visits and the revenues they generate are in balance. "I think the money is adequate," Legare said. "It's a win."
Legare said his only concern--something he says he is on guard against--is doing too much over the Internet and missing something that would have been detected in a face-to-face encounter. He said he errs on the side of caution and asks patients to come into the office if there is any doubt.
Eric Zimmerman, senior vice president at RelayHealth, said the portal has about 5,000 physicians using the system nationwide and about 2,000 in states where the plans are reimbursing physicians for online visits.
In addition to the Massachusets Blues plan, there are six other payers working with RelayHealth on physician reimbursement programs, Zimmerman said.
They are Blue Shield of California, Blue Cross of California, Blue Cross and Blue Shield of Tennessee, the Anthem Blue Cross and Blue Shield plan in Colorado, Group Health in New York City and a plan under contract that has not yet announced the program, Zimmerman said.