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Patients Skip the Waiting Room For Virtual Visits to the Doctor


In a nation where 66% of adults have access to the Internet, it was only a
matter of time before people began using the Web to get medical advice from
their doctors.

But until now, health insurers have held back from covering online
consultations while they studied the potential cost savings, the appeal of
the service to plan members and patient privacy issues.

Last month, Blue Shield of California became the first major U.S. health
insurer to agree to cover online consultations between patients and their
physicians, paying doctors $20 for a "Web call." The decision by
California's third-largest health insurer could spark similar policy changes
at other health plans during the next decade. The option is already under
study at Cigna Corp., Health Net Inc., First Health Group Corp., Pacificare
Health Systems Inc. and ConnectiCare.

"It will grow slowly, but steadily," said Mike Barrett, senior health-care
analyst for Forrester Research in Cambridge, Mass.

Beginning next year, Blue Shield of California's 2.3 million members will be
able to send electronic messages to their physicians using a secure Web
portal designed by RelayHealth Corp. of Emeryville, Calif. Existing patients
can use the portal to schedule an appointment, request a prescription refill
or ask questions about nonurgent medical concerns such as back pain,
seasonal allergies, sore throats and earaches.

"I love it," said Susan Glenn, a 42-year-old financial analyst in Sacramento,
Calif., and one of more than 5,000 patients who participated in a six-month
pilot study. "I don't have to pay to wait for hours in a waiting room and
then only see my doctor for 30 seconds. I get in right away, and I hear back
in a matter of a few hours."

"Web calls" aren't expected to completely replace office visits, nor should
they. The medium is unsuitable for serious or complicated medical problems,
according to experts.

But health-industry analysts agree the Internet can facilitate communication
between doctors and patients, especially regarding sensitive or chronic
medical conditions, in a way that telephones never could. Hectic schedules
leave doctors little time for phone conversations with patients, who can end
up waiting a day or two for a response to a question.

If patients could communicate with doctors over the Internet, more than 20% of
all in-office visits could be eliminated, according to HealthCast 2010, a
1999 survey of health-care executives by PricewaterhouseCoopers. As a
result, physicians would have more time for patients with serious medical
concerns and employees would take less time away from work. Also, health
plans could cut costs-potentially several million dollars a month-by paying
$20 to $25 for a Web call compared with $50 to $70 for a doctor's visit.

There's a crimp in that scenario, however. Industry experts say some doctors
don't share their patients' enthusiasm for online consultations, citing
concerns such as patient privacy, malpractice liability, insurance
reimbursement and, in some cases, the potential for lost revenue. Before
they climb onboard, doctors want assurances they will be paid for the advice
they dish out on the Internet, said Eric Liederman, medical director of
clinical information systems at UC Davis Health System.

People, however, aren't so keen about dipping into their own wallets to pay
for the service, which leaves it to insurers to step up to the plate.

Only 37% of patients in favor of online consultations are willing to pay
out-of-pocket for the service, and 70% of them want to pay less than $5 for
each "Web visit," according to figures from Harris Interactive. "There is no
incentive for doctors to do it unless they get paid for it," Dr. Liederman

Oddly, doctors don't charge patients for telephone consultations, and
insurance companies don't reimburse for them. "If you don't have a way to
recoup your fees, then it is just something else that is costing you money,"
said Michael Good, a physician with ProHealth Physicians in Middletown,
Conn., and a RelayHealth member.

Dr. Good said he receives between one and two Web visits a day. While he
doesn't charge patients who contact him with requests for referrals and
appointments, he does charge between $5 and $30 for consultations.

Write to Johanna Bennett at


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