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FOR IMEDIATE RELEASE
of California to Pay for Physician Online Consultations
After participating in a 13-month pilot program
that demonstrated cost savings for online physician-to-patient consultations,
Blue Shield of California (BSC) says it will expand the program
to physicians and patients across the company's HMO and PPO product
BSC has not yet set reimbursement rates for online consults, but
the rates will be "targeting a level that reflects the intensity
of the office visit that a clinical Internet interaction would appropriately
substitute for," says Jeffrey Rideout, M.D., president of the
BSC Foundation. That's the lowest "evaluation and management
visit code," which Medicare typically reimburses at $20 to
$30, depending on geography. During the pilot program, BSC paid
physicians $20 per online consult. "Patients and employers
want this, and we are ready to pay for it," says Rideout.
The pilot program was conducted by researchers at the University
of California, Berkeley and Stanford University, and sponsored by
RelayHealth Corp. BSC, Farmington, Conn.-based ConnectiCare and
10 large self-insured employers in California participated in the
pilot, which used RelayHealth's webVisit technology, a secure algorithm-driven
clinical interview process used for the physician/patient interaction.
The researchers compared physician claims and total health care
claims for patients using online consults with those for a control
group of patients that did not participate in the program. Patients
using online consults generated $1.87 per member per month less
in health expenses than did the control group.
"This is actually a huge savings relative to total outpatient
expense, and was not anticipated," Rideout says. "We hoped
the system would break even." Blue Shield of California's original
goal was to increase patient/physician access, and the study results
show it achieved that.
"We set the level ourselves, since there is no Medicare RBRVS
code and fee yet," he says. But he notes that RelayHealth is
participating in a process led by the American Medical Assn. to
consider an official CPT code for Web-based office visits. "If
and when one is developed, we will convert to that level, as nearly
all of our physician payments are consistent with Medicare RBRVS
To many physicians, $20 may seem fairly low. In one recent survey,
physicians said they expected to be reimbursed an average of $59
for a 15-minute online consult, says Mark Bard, president of Manhattan
Research. "That's worlds apart from what health plans will
pay." Rideout adds that "each payer will have to make
its own decision regarding reimbursement."
Some physicians are reluctant to participate in online consults,
Bard says. They cite various concerns: being inundated with online
questions; increased liability, since patients and their attorneys
will be able to access an electronic record of the physician/patient
interaction rather than fuzzy recollections from the plaintiff and
defendant; and confidentiality.
"Adoption," Rideout says, "is really a physician
issue. For those who want to use this communication method, the
system is designed to support them."