Thursday, January 7, 2010

Health Insurance Companies should be required to Reimburse for “Virtual Office Visits”

This is a guest post by Tessa G. Lebinger, M.D. If you're interested in submitting a guest post, please contact me.

Health Insurance Companies should be required to Reimburse for “Virtual Office Visits”

I am a Pediatric Endocrinologist who for more than 10 years has utilized e-mail as a supplement to office visits in the management of children with diabetes. Patients send me records of their blood sugars, food intake, insulin, and exercise along with comments and questions and I e-mail back recommendations and answers. I have provided this service for free because insurance companies do not reimburse patients for “Virtual Office Visits”. If the patients were to come into my office with their logs and receive the same advice “face-to-face” from me, medical insurance companies would pay for these services as a routine office visit.

Frequent adjustment of the treatment plan is necessary for children with diabetes whose needs are constantly changing. Although they should be seen in person a few times a year to evaluate their growth, physical development, and have their thyroid glands examined, many children need to have their insulin doses revised much more frequently than this. E-mail is the perfect way to provide this comprehensive care in between office visits. This is good for the children because they don't miss school and good for the parents because they don't miss work. For families who live a long distance from a Pediatric Endocrinologist, communication by e-mail can save them the inconvenience of frequent, long trips.

Diabetes is a chronic disease which if not properly controlled can lead to life threatening complications. Patients with diabetes have the ability to collect an enormous amount of information themselves through frequent self- monitoring of their blood sugars at home, but they often need professional advice to adjust their insulin based on these results. Patients with other chronic diseases like hypertension or asthma also have the ability to collect data such as blood pressure readings and peak flow measurements (an indication of lung function) at home. Many of these individuals can also benefit from “Virtual Office Visits” to facilitate frequent fine tuning of their medications.

There is a growing trend towards providing health services online for an increasing number of both acute and chronic disorders. Many healthcare providers already offer advice by personal e-mail. As more physicians implement electronic medical records, they will have the capability of secure online written communication with their patients that will automatically be recorded in the medical record. Private companies are entering the market of facilitating web-based “Virtual Office Visits”, either in “real time” utilizing audiovisual teleconferencing or with a short delay through secure online messaging. “Virtual Office Visits” may take place between individuals and their own personal healthcare providers or, with some services, patients can request a “Virtual Consultation” any time of day from an independent physician who is on call. Often laboratory tests can be requested and prescriptions ordered online.

Clearly, not all symptoms and diseases can be managed online. If a patient is having chest pain or severe abdominal pain, he/she needs to be examined in person. However, most medical questions that are typically asked over the telephone can both be submitted and answered by e-mail – without playing “phone tag”. With audiovisual conferencing capabilities, more extensive evaluation of the patient can be performed.

A “Virtual Office Visit” does not require the services of a medical assistant or secretary and does not need to be done during office hours or even in a medical office. Therefore the cost is usually significantly less than that of a traditional office visit. Many patients are willing to pay out of pocket for the convenience of these “Virtual Visits” and some large employers are subsidizing e-Consultation services for their employees to decrease absenteeism. A few health insurance companies have recently started to pay for “Virtual Office Visits”, but most don't yet.

In my opinion, insurance companies should be required to reimburse for these services. Healthcare Providers incur medical liability every time they give medical advice, whether face-to-face in the office, over the phone, by fax, or by e-mail. If they incur liability, they should receive compensation for their services and time.

I propose mandatory reimbursement for “Virtual Office Visits” as part of health care reform.

This guest post was written by Tessa G. Lebinger, M.D., Pediatric Endocrinologist and Medical Writer, Baltimore, MD


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