Elyse discusses Electronic Consultations on her weblog today, and I agree that electronic communication does hold some merit as a method of providing some contact btween patients and their physicians.
She's right that the CPT has been updated for 2004 to include online consultations. This was well covered in Health Data Management in early January. While the code has been "released" .. it's not yet implemented .. and none of the insurance companies in our area has announced plans to pay for this code any time soon.
Additionally - one needs to read the description of the code carefully. This needs to be an interaction that the patient has initiated that has nothing to do with anything that has already been paid for.
Huh?
Patients often wonder why an office visit costs $65. It's not because I need to pay for my lexus. I don't have a lexus .. I drive a 1996 Saturn. The $65 pays for the visit AND any "pre-service" or "post-service" work. So the prescription refill, lab result follow-up etc. etc. would not be covered by this code. The ironic part is that if we make a patient come in to the office to discuss the lab work or get the prescription, we get to bill the $65 again. Seems like the incentive remains (under fee-for-service models) for us to make patients come to the office rather than provide good electronic or telephone communication. (oh .. we never actually GET $65 for a $65 bill .. as this fee gets discounted by the insurance contracts. New Battery for Saturn - $70 .... career as a family physican - priceless.)
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Online Medical Evaluation An online medical evaluation is a type of Evaluation & Management service provided by a physician or qualified health care professional, to a patient using Internet resources, in response to the patients online inquiry. Reportable services involve the physicians personal timely response to the patients inquiry and must involve permanent storage (electronic or hard copy) of the encounter. This service should not be reported for patient contacts (eg, telephone calls) considered to be pre-service or post-service work for other E&M or non E&M services. A reportable service would encompass the sum of communication (eg, related telephone calls, prescription provision, laboratory orders) pertaining to the online patient encounter or problem(s). |
Released Implemented |
Nonetheless, if we COULD get them to pay for it ... the code would provide us with an incentive to enhance our use of electronic communications with patients. In our practice, we use a web-based communication system that mimics web-based e-mail.
The system works well, but it doesn't take the place of phone calls or office visits.
Using regular e-mail is a bad idea. Not just because it's not secure, but because the e-mail isn't part of the chart, and to MAKE it part of the chart will require extra steps in my workday (or someone I pay) ... and so this is not something that can be sustaind in an efficient manner long-term.
Danny Sands has a useful site on electronic patient-physician communication. I don't agree with everything he says (I decided not to tell him this when we were in an elavator at AMIA last fall) .. but it is a thorough and useful guide to the subject.
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