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E-visits appear to be on the present horizon, but reimbursements are still being worked out.
Even in an ultra-modern world filled PDAs, wireless broadband Internet connections and built-in Web cams, health plans need to learn how to walk before they can run. While the concept of "visiting" the doctor from the comfort of your computer room seems technologically feasible, even in TV shows like Star Trek, Dr. McCoy couldn't use his futuristic medical devices to care for people that he wasn't in close physical proximity to.
The holdup isn't really about shortcomings on the technology side. Most U.S. industries already are far ahead of healthcare in terms of connectivity and technological adoption. While IT hurdles certainly would need to be addressed, in healthcare, there are more concerns about economics and efficiencies than there are about bits and bytes.
"There aren't too many health plans that currently cover e-visits, but that's finally starting to change," says Jim King, MD, president of the American Academy of Family Physicians (AAFP) and also a private practitioner in Selmer, Tenn. "Right now, there are a number of pilot projects around the country that are designed to determine whether or not they are cost-effective and can maintain a high level of quality of care. That's a good start, and increased access will improve all of those factors over time."
"The biggest issue that looms in provider's minds is the lack of reimbursement for the effort involved," Dr. Eads says. "After they go through the hassle of setting up the platform to do the e-visits, they still have to market it, train staff to sell it, and figure out where to fit it in their workflow. Most physicians know their patients want this capability, but they fear offering it because they see the work involved as a mountain, and the reimbursement as non-existent."
Reimbursement for e-visits needs to be substantial enough for physicians to feel like they are not being taken advantage of. In their eyes, e-visits mainly benefit patients and insurers, she says.
"I would suggest $50 minimum per virtual encounter," she continues. "This would not be for appointment requests and the like, but for true encounters. Most of my virtual visits would be comparable to [CPT codes] 99213s or 99214s in complexity of medical decision making, and I lose money when I take care of them virtually due to poor reimbursement. But that was a personal choice I made years ago to improve access in my practice."