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

Publish date: NOV 01, 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.

The important role of Medicaid health plans in states where landmark healthcare reform efforts are under way is highlighted in a new report, Medicaid Health Plans: A Turnkey Solution for Expanding Health Insurance Coverage for the Uninsured. Sponsored by the Association for Community Affiliated Plans (ACAP), the report focuses on health plans in California and Massachusetts – two states breaking ground in expanding coverage to uninsured residents.

Today, hospitals and other facilities are implementing forms of pay for performance in previously unimaginable ways. Such programs typically use established ratings methods and indicators to measure levels of quality, then offer incentives or compensation to entities or providers who are rated highly based on these indicators.

An effective use of hospitalists is to have them available to free up general practitioners from hospital rounds. Appropriate use of hospitalists can also enable physicians to visit patients more than once a day in the hospital setting.

With transparency becoming a given, pharmacy benefit managers (PBMs) have taken a new approach to marketing their services. The primary marketing/sales strategy for Express Scripts, headquartered in St. Louis, is direct sales with a reliance on intermediary consultants and advisors.


Technology


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