November 20, 2006

Health care hits the Web

Clinics, insurers warm to a new choice: e-care. But will patients?

BY JEREMY OLSON

Pioneer Press

E-mails and phone calls paid at least in part by insurers are a fast-growing solution to a common ailment in health care: the unnecessary visit to the doctor's office.

Doctors have used phone calls for years to cut down on these visits — to tell patients with simple colds to stay home, counsel patients with chronic diseases or prescribe obvious treatments. But now clinic groups and insurers have begun to make this a more formal medical service. And insurers have agreed in the past year to pay at least for medical advice via e-mail, also known as e-care.

"The future is going to require us to do this," said Dr. Michael McGrail, associate medical director of HealthPartner's primary care division. He cited estimates that up to 40 percent of office visits are unnecessary.

Clinics and their leaders said they have an additional incentive to use e-care: They need to increase the speed and convenience of their services so they won't lose patients with simple infections or illnesses to the growing number of retail walk-in facilities such as MinuteClinics.

Three large Twin Cities clinic groups — Fairview, HealthPartners and Allina — have started offering the MyChart online service, which allows patients to e-mail their family doctors. Minnesota insurers have followed suit in the past year by agreeing to pay for e-mails in which doctors provide patients with a new diagnosis, prescription or treatment.

Blue Cross and Blue Shield of Minnesota, for example, announced in July it would pay for e-care in limited circumstances. Clinics receive $35, but some of that comes from patients through standard office visit copays.

The unanswered question is whether patients will be willing to pay for medical advice without seeing their doctors.

"As long as I'm going to pay the $15, I guess I'd rather go in," said Cheryl Lavey, 39, whose family uses MyChart to set up appointments at Allina's Farmington clinic. "It may be a wasted visit, but I'd rather find that out in person."

On the other hand, Mike Romanov, of Northfield, has used Fairview's MyChart service to seek advice from his doctor about his arthritis and other medical needs. If he were billed a copay for medical advice obtained through e-mail, Romanov said, it would be appropriate.

"It probably has saved me a trip or two," the 71-year-old said.

Insurance trends suggest more patients agree with Lavey. Medica and HealthPartners have plans that cover e-care, but report no more than 100 patients per year have paid for it. However, doctors said they are starting to provide much more advice by phone or e-mail, but they just haven't gotten in the habit of billing for it. Fairview's MyChart is adding 1,000 patients every month.

E-care is especially useful for college students at distant campuses or snowbirds traveling south for the winter, said Valerie Overton, a nurse practitioner with Fairview's primary care clinic in Eagan. She said it was hard to bill when only one insurer covered e-care, but it will be much easier now that most insurers allow it.

"We do have some issues in terms of fairness and charging for one patient and not charging for another," she said. "It will take off dramatically once we get the reimbursement issues taken care of."

Insurers provide little or no reimbursement for medical advice provided over the telephone, which is often referred to as telephonic care.

Medical advice by e-mail is safer, said Dr. Barry Bershow, Fairview's director of quality care and informatics, because there is a paper trail that can be used for billing and can remind doctors and patients of the medical information they discussed. He sees more hazards with medical advice over the phone. Once patients hang up, they might forget if their doctor said to take one pill per two days or two pills per one day.

However, the Minnesota Medical Association, which represents the state's doctors, is advocating insurers start covering medical care by phone. In cases when doctors make a diagnosis that relies entirely on a patient's history and response to questions, it shouldn't matter whether it is done in person or by e-mail or phone, said Dr. Macaran Baird, who heads the family medicine department at the University of Minnesota Medical School.

It is easier for doctors to tell patients via e-mail or phone that they don't need medical treatment just yet, or that they likely have a viral illness that doesn't merit antibiotics, Baird said. Conversely, doctors feel much more pressure to prescribe antibiotics or offer other treatments just so patients feel they got their money's worth once they have come to the clinic.

"There's a huge momentum by the time you cross the doorway to have active treatment," he said.

While physicians said they were moving toward these alternative forms of medical care anyway, they acknowledged that growing competition from retail services such as MinuteClinic played a role.

These popular low-cost clinics provide medical care, without appointments, for basic health problems such as strep throat. Family doctors see e-care as a way to match the speed of retail clinics, but also give patients the comfort of using caregivers who are most familiar with their conditions, allergies and histories.

"We're not at the shopping center or the Target," said Geoffrey Sylvester, vice president in charge of HealthEast's clinics. "If you want to do two things at once, we're going to have trouble competing, but we still feel much more pressure to emphasize convenience."

Clinics need to increase the speed and convenience of their services so they won't lose patients with simple infections or illnesses to the growing number of retail walk-in facilities such as MinuteClinics.