Internist Peter Basch said he was in Costa Rica recently when he checked his e-mail -- yes, while on vacation -- and learned that one of his patients was seeking more blood pressure pills. In less than a minute, Basch said, he sent a refill order to a pharmacy on Capitol Hill.
"For things that people actually leave their home or leave their office to come and see me for . . . many of these could be managed with a type of e-mail interaction," Basch said.
In fact, he said, "perhaps as many as 50 percent of the people I see each day could be dealt with appropriately using virtual techniques," including at-home devices to track blood pressure, weight and blood glucose.
So why don't more doctors use this approach, and why does Basch swap e-mails with only about 5 percent of his patients while charging nothing for the service? Money is part of the answer.
"If I used virtual communication techniques as often as I felt was appropriate, my practice would close its doors because it would go broke within a week," Basch said. That's because he participates in managed care networks, and the insurers who run them pay doctors only for face-to-face contacts with patients.
And that does not look likely to change soon.
"We're very interested in pursuing options that make it easier for doctors to treat patients," said Walter Cherniak, a spokesman for Aetna, "but we have no immediate plans to implement an e-medicine reimbursement structure."
CareFirst BlueCross BlueShield issued a similarly cautious statement: "We are aware of a number of pilot programs around the country that involve e-mail consultations between physicians and patients. . . . We have discussed the concept, and expect to explore opportunities to become involved in the future."
Edward Fotsch, CEO of Medem, which offers secure messaging systems to practitioners, says insurance coverage is not the only obstacle: Doctors who want to deliver care via e-mail also need to train their patients.
Without prompting from their doctor, patients "just default back to" using the telephone and arranging in-person visits, said Fotsch. RelayHealth, the service that Basch uses, allows patients with "non-urgent" ailments to describe their symptoms. Their doctor's reply could be a prescription or advice to make an office visit.
"It's basically like an online house call," said Briana Pompei, a RelayHealth spokeswoman. "Physicians who are not being reimbursed by health plans can choose whether to charge an out-of-pocket fee or . . . whether to waive it altogether."
"If you talk to doctors one on one," said Eric Zimmerman, a RelayHealth spokesman, "what they're going to say is, 'This is a way to have . . . more satisfied patients.' "
-- Tom Graham
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