New CPT code for online consultation: patients willing to pay for online medical interactions

OB/GYN News, August 1, 2004 by Mary Ellen Schneider

FORT LAUDERDALE, FLA. -- There are stumbling blocks to increasing online interactions with patients, but payment is not one of them, Dr. Allen Wenner said at a meeting sponsored by the Medical Records Institute.

Payment "is really not the issue," said Dr. Wenner, a family physician in Columbia, S.C., and vice president of clinical applications design for Prime Time Medical Software. "People will pay the money."

The Web site for Dr. Wenner's practice (www.drwenner.com) allows patients to set up their appointments online, request prescription refills, fill out a previsit questionnaire, view test results online, and participate in an online visit. He charges about $50 for a virtual visit, which takes the place of an in-office visit.

Although the cost of online services or virtual visits is rarely reimbursed by insurance companies, Dr. Wenner said patients are more than willing to pay for the chance to skip a lengthy and inconvenient trip to the doctor's office.

Several pilot projects are evaluating this approach, said Dr. John W. Bachman, a consultant in family medicine and professor of primary care at the Mayo Medical School in Rochester, Minn.

So far, most of the projects have found that reimbursement of about $20-$25 per virtual visit is appropriate, he said. It's estimated that the average primary care physician can handle about 12 online consultations an hour, Dr. Bachman said.

And now, there's a CPT code for e-mail and online consultations with patients--0074T--that was issued by the American Medical Association in January and became available for use in July.

Medicare currently does not provide separate payment for e-mail or online consultations and there are no plans to launch any demonstration projects to evaluate reimbursement, according to a CMS spokesperson.

In the future, Dr. Wenner predicts, patients will spend less time face-to-face with their physicians and more time interacting online, with patients possibly sitting in their own offices rather than in the doctor's office during visits.

In fact, Dr. Wenner said he estimates that 20%-50% of visits will eventually be virtual and that about 30%-70% of actual office visits will be for limited exams or confirmation of findings.

And 10%-30% of encounters will be extended, complex visits with multiple illnesses being treated by several providers.

Dr. Wenner said he already uses e-mail to facilitate communicate between his patients and other physicians.

Electronic medical records (EMRs) are important to making such systems work. Without an EMR, a physician will have difficulty both setting up a way to conduct secure messaging with patients and allowing them easy access to test results and past prescriptions, Dr. Wenner said. Dr. Bachman recommends that physicians ask questions about patient portals when shopping for an EMR.

BY MARY ELLEN SCHNEIDER

Senior Writer