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Blue Shield 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 lines.

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 rates."

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."
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