Part two of a two-part series (access part one here): Technology is allowing more doctors and patients to consult via secure electronic communication, and insurance companies are reimbursing for it.
Technology is allowing more doctors and patients to consult via secure electronic communication, and insurance companies are reimbursing for it.
Minnesota might be the epicenter of e-visit reimbursement. At Fairview Health Services, a Minneapolis-based integrated health system, 34,000 peopleor roughly 5% of the Fairview patient populationsigned up since July to use MyChart, its secure portal for e-visits offered by Epic Systems Corp., according to Barry Bershow, Fairview's medical director of quality and informatics.
About 1,000 patients are being added each month, he said. "Just like ATMs were bizarrely rare in the beginning, now, no one can imagine banking at a bank that doesn't use them," Bershow said.
Bershow estimated that state insurance companies have reimbursed Fairview for about 500 e-visits since the July launch at $35 apiece, although hes not sure how that dollar figure came to be. "It mystically appeared in one payer's proposal and it seemed fair and reasonable to us," he recalled. "So we said 'Sure,' and once it was out thereand no one seemed to have an explanation whyeveryone picked the same number on both sides."
Patient response has been overwhelmingly positive, he said, except for two complaints from people who had gotten used to communicating with their physician via e-mail for no charge. Physician response has been mixed.
"We have some docs with over a thousand people signed up, but we also have some with only about 35," Bershow said. "So, obviously those physicians are clearly not into this."
He added that he has used e-visits as both a doctor and as a patient with his own physician through his policy with Preferred One, which picked up 90% of the cost, leaving him with only a $3.50 copayment.
Blue Cross and Blue Shield of Minnesota spokeswoman Jan Hennings said her company recognizes a $35.70 level of reimbursement for an e-visit, but if a member has a $20 copay, her company may only pick up $15.70.
"Obviously, the $35.70 is a lot less than an actual visit to the doctor," she said, adding that the insurer decided to reimburse for e-visits after a pilot study with five providers that found physician reaction better than expected but patient usage to be on the low side.
"But we did see the value in it," Hennings said. "And, as providers get more savvy about it, they'll start informing their patients more about the option."
Medica, the last major holdout in Minnesota, provides reimbursements through its Patient Choice business division, which is a health plan for self-insured employers, and reimbursements will go companywide soon, said spokesman Greg Bury.
Although health plan giant UnitedHealthcare is based in Minnesota, Hennings said state laws mandating that health insurance companies be not-for-profit prohibit UnitedHealthcare from doing business there. Regardless, if it did operate in Minnesota, it probably wouldn't reimburse for e-visits because, according to company spokeswoman Debora Spano, UnitedHealthcare policy calls for only reimbursing for face-to-face visits.
Time and money
Independent family physician and e-visit advocate Michelle Eads of Woodland Park, Colo., 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 fee for an online-consult easier to swallow than the price of an office visit, Eads said.