Pay for e-mail consults? Consider insurers' history on dodging reimbursement for phone calls

Regarding "Online consultation slow to grow" (Article, July 12): Physician-patient e-mail has been slow to take off despite availability of e-mail to the general consumer for more than 10 years now. Some have questioned the reluctance of third-party payers to reimburse for virtual office visits and e-consults. Consider the following hypothetical news report:

"An exciting new innovation in telecommunications is about to revolutionize the physician's office. This new technology for the first time offers the patient access to his or her physician nearly instantaneously without ever leaving the house. Using this technological marvel, the patient can quickly and easily notify the physician of a new medical problem, follow up from a recent office visit, or simply ask the physician a question related to a specific disease or health care issue. The patient never has to make an appointment or wait as a walk-in patient in a crowded waiting room. Likewise, the physician does not have to tie up valuable office staff. This innovative technology will certainly improve the so-called turnaround time for information flow of vital health care information between physician and patient, and in so doing has all the potential for making significant contributions to improved quality of care.

"One potential stumbling block was raised by the physician community. Most physicians we spoke with said they have encountered difficulty obtaining reimbursement from a number of health insurance companies for providing this new service for their patients. In fact, claims specialists from several of the larger health insurance companies questioned whether this sort of physician-patient interaction represented a genuine physician visit and should even be reimbursed at all.

"It remains to be seen, at this juncture, whether or not the telephone will ever take its place alongside the stethoscope as a routine tool in the delivery of health care in America."

Although this "news report" itself is of course fictional, the descriptive facts and historical context are not. The first commercial telephone line was installed in Boston in 1877. E-mail arrived on the scene approximately a hundred years later.

To the dismay of the physician community, it has been the policy of most health insurers for the past 50 years to deny direct reimbursement for telephone calls with patients. Now, whether physicians will be successful in their attempts to convince health insurance companies to pay for e-mail and virtual office visits (e-visits and e-consults) remains to be seen.

What is not disputed is the glitz, glitter, dazzle and hoopla of this new high-tech form of physician-patient communication has as yet failed to demonstrate any purported improvement over the tried and proven, user-friendly and less expensive telephone that has served both physicians and patients quite nicely in three different centuries.

In the excitement of new technology, we sometimes lose sight of the e-elephant in the center of the clinic.

Jim Bowman, MD, Raleigh, N.C.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2004/09/27/edlt0927.htm.