“Mouse Calls”–rodent or the real deal?
Physicians Practice, (March, 2009 pp 51-55) had a great article on “mouse calls,” or online consults. The mouse call is used for sub-acute, non emergent consults, and according to the article, may be the wave of the future. Of course, as it always is, money appears to be the issue: only two insurers routinely pay for such visits–Aetna and Cigna. Aetna reimburses for such consults only in California and Florida, and only if the physician goes through a ‘physician connectivity company.’ Such companies allow patient-physician communication through a secure Internet connection, either through the practice’s web site or through a website the company provides. Aetna requires physicians to use Relay Health, at a cost of $100 per month, per physician. Insurance companies will typically reimburse between $25-35 per visit for these qualified online encounters.
Of course, given that only physicians in California and Florida can participate in the Aetna plan, (I sniffed around the Cigna website and couldn’t find much information), it leaves the rest of the country out. However, some physicians ask patients to deposit a set fee ($35 is mentioned) in a PayPal account, describe their symptoms on a template, and send it via regular email to their physician. It would seem reasonable that this fee could be applied to a copay if the patient ended up requiring an office visit. In addition, some private insurers are paying for these visits, which are coded as a 99444.
Issues that must be worked out before a practice springs head long into this:
- Security. Some physicians have patients sign an agreement that patients recognize that email is inherently insecure, and encourage them NOT to use workplace email addresses. Otherwise, practices should consider one of the secure websites such as: Medem, Medfusion, RelayHealth.
- Safety: patients must realize that email consults are not for emergencies. It just takes one subject headline to the effect of “Doc, I’m having crushing substernal chest pain” to bag the whole system.
- Timeliness: physicians must set clear guidelines about how quickly they will respond to an email consult.
- Charting: every email and response must make it’s way into the permanent record.
- Patients: the patient should be well known to the physician to participate in these exchanges.
- Reality check: according to Physicians Practice, “only 36% of patients are actually willing to pay for online consults.”
I am intrigued, as this may be a way for primary care physicians to keep pace with the speed of change, as long as these consults are reimbursed. If we are not reimbursed for online consults, we will only hasten the demise of primary care.
Tags: EMR, on line house calls, physician, primary care
