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    More on E-visits (From TECHNOLOGY, NOV. 2007)

    To define e-visits, CPT code 0074T was adopted in 2004, says Lynn Gonzalez Monson, director of health information technology for Blue Cross and Blue Shield of Florida. The code requires documentation of history, system review and complexity of medical decision-making similar to those for office visits and consultations, establishing a firm basis for review. Reimbursement is limited to established patients. The Florida Blues allowed payment for the code since its inception, even for fully insured clients, and have reviewed every case it has been billed.

    "We've only had one instance where a physician didn't fully understand the intent of the code," which calls for consultations including a history and evaluation, Monson says. That doctor was billing for sending out lab results, but stopped when counseled on the code requirements.

    The Florida Blues also check to see if the same diagnosis code is used by the same patient in another setting, and have found that e-visits mostly replace encounters in offices and emergency facilities. The utilization has not been additive, and they have not seen much overuse, Monson says.

    Terry McGeeney, MD, MBA, president of the TransforMED pilot project, believes e-visit and related technology will play a role in improving primary care. He is currently helping 18 practices implement portal technology as part of a 24 month demonstration project measuring the effects of the medical-home approach to family medicine, with another 18 practices implementing on their own.

    While quality and cost influenced the Florida Blues' decision to reimburse e-visits, their desire to enhance the patient-doctor relationship—and move it online—was a major concern, Monson says. In its pay-for-performance program, the insurer awards credit not only for providing e-visits, but for online access to records summaries, prescription renewal and other services.

    "The employee doesn't have to miss a half-day or whole day of work to take care of a minor problem," Monson says. Many encourage e-visit use by lowering copayments by $10 or $15.

    The convenience of online access is also an increasingly important factor, especially with consumers' growing expectation of self-service.