Blue Cross and Blue Shield of Massachusetts said late last month that it would increase by more than three times the number of participating physicians in 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, Mass., 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 and 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 connects participating physicians and patients.
Fallon described the Internet billing plan as a transformation in the practice of medicine.
"It recognizes that healthcare is changing and that a face-to-face encounter is not the only way for a physician to see a patient," he said.
Edward 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, he said. Most of the patient contacts are brief, including requests for appointments and prescription refills. "I get an 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.
Legare said the Internet-based visit also has been a way to serve patients who travel and snowbirds who winter away from Massachusetts.
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 revenue they generate are in balance.
Legare said his only concern is doing too much over the Internet and missing something that would have been detected in a face-to-face encounter.