digimed agency: Out of the Office? Try An E-Visit

inspired By Elizabeth Gardner

Your patient discovers a weird rash over the weekend, which prompts the inevitable question. Should they go to the emergency room to get it checked, or wait for the YOU to squeeze them in on Monday? HealthPartners, an integrated health delivery system in Minneapolis, has a better idea: E-visits. Its service, called virtuwell, has interactive diagnostic questionnaires online (depending on initial answers, subsequent questions may change) for about 40 different conditions with clear treatment protocols.

Nurse practitioners stand by 24/7 to review the questionnaires as well as uploaded photos of any skin lesions or other visible symptoms, give advice, and, if necessary, send a prescription to a pharmacy. The questionnaires automatically flag anything potentially serious. For example, if bladder infection symptoms have gone on for more than a week, virtuwell will end the interview and give the patient a list of options for care in person, usually a clinic. The E-visits cost patients $40 or less, compared with $100 and up for a trip to a doctor's office or to the ER; as with regular office visits, insurance may cover some of the cost. Amy Wood, a 29-year-old working mother of one daughter from Cottage Grove, Minn., has used virtuwell several times for treating her chronic sinus infections. "This service has saved me so much time driving all the way to the doctor just for her to confirm what I already know I have," she says.

Both Kaiser Permanente and the University of Pittsburgh Medical Center allow their primary care physicians to offer E-visits, which they note saves time for both sides. UPMC's chief medical information officer, G. Daniel Martich, says one of the center's doctors completed an E-visit while vacationing in Puerto Rico, much to his patient's relief.

No phone tag. Even doctors who don't offer full-fledged E-visits are increasingly communicating with patients by secure E-mail through online patient portals or mobile phone apps that access EHRs. Ferdinand Velasco, chief medical information officer for Texas Health Resources, a 25-hospital system based in Arlington, says some affiliated physicians were initially concerned that they'd be deluged with messages, but now they appreciate being freed from playing phone tag.

Industry observers agree that E-visits will potentially reduce medical costs greatly as insurers determine how best to incorporate and pay for them. Some providers, like Kaiser and HealthPartners, have already achieved savings because they insure many or (in Kaiser's case) all of their patients and employ their physicians, who get paid the same whether they communicate with patients face-to-face, over the phone, or online. Any revenue lost on the provider side with the use of less expensive E-visits is more than made up on the insurer side as patients are kept healthier, reducing the costs of care.

Currently, however, most people still go to independent medical practices that get paid for specific services by many different insurers. Though some large insurers reimburse physicians for E-visits, including Cigna, Aetna, and Humana, the industry has not agreed on how to define them. "First you need all the doctors' offices to have the technology, and then you have to carefully work through the rules to make sure you're doing E-visits in a way that's safe for patients and achieves goals for their care," says Susan Pisano, spokeswoman for America's Health Insurance Plans, an industry group.

Medicare and private insurers are studying ways to pay providers for results rather than for specific services. When they start doing so in sufficient numbers, more providers may look to E-visits as another way to keep their patients healthier, at less cost.

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