Physician-Patient E-Mail Can Save Both Time and Cost

Cheryl Clark, for HealthLeaders Media , May 13, 2009

Scherger, and a growing number of physicians around the country, say this hybrid model of physician practice, by which patients pay a fee out-of-pocket for the right to get e-mail care in addition to office visits reimbursed by their health plans or other payers, is the best bang for the buck.

"This is the sort of system that works best for people with chronic conditions such as diabetes, asthma, heart disease, and depression," says Scherger, former editor of the journal Hippocrates, a member of the Harvard/Kennedy School of Government Health Care Delivery Policy Project.

You'd only have to be an Eisenhower patient to be eligible.

Certainly the concept–sometimes called "concierge medicine" is not new, and according to recent reports, even the slumping economy has not dampened patients' willingness to participate. The very name implies that only people who can afford expensive hotel rooms would sign on.

Not so anymore, says Scherger, who formerly worked with Revolution Health and E-Doc, and who has held a special interest in the redesign of office practice using IT. For patients with multiple issues, there would be vast savings in avoided co-payments, for example.

Scherger says he borrowed the model for Eisenhower from Charles Kilo, MD, of GreeenField Health in Portland, OR, an internist he called a "guru" on the hybrid model of healthcare.

Kilo says he launched the concept in 2001 after spending time creating "idealized clinical office practice design" with the Institute for Healthcare Improvement.

"Most primary care physicians for the most part are on a hamster wheel, seeing a new patient every 15 to 20 minutes," he says. "There are multiple visits for multiple problems in the same patients and a high rate of physician burnout, which is not also healthy for the patient."

"We are very deeply engaged in system change," he says. GreenField health's success, he says, is in part because of its full electronic health record, secure messaging system, and efficient connectivity to laboratory results. Patients receive responses to e-mails within 24 hours, but usually within three or four, Kilo says.

"I order a lab test, it gets done, it's generally back on my desktop in 12-18 hours. I can sign off on it and get results back to the patient," he says.

GreenField's nine physicians charge prices for e-mail privileges ranging from $250 for children under age 10 to $650 for patients age 60 to 70. Today, he says, his four-physician practice has several thousand participants.

Questions come in about diarrhea, sore throat, or rashes, sometimes accompanied by digital photos, he says. Patients e-mail from as far as Mexico City and Italy, he says, and some 1.5 hours away on the Oregon coast. Many patients with blood pressure issues can e-mail their results.

The system also improves efficiency and communication with patients and instills better compliance with their prescribed regimens. That may be in part because patients may be more eager to use what they're paying extra to have.

That goes for patients in his practice who are on Medicaid and Medicare as well, many of whom are allowed e-mail privileges for free, he says.

He predicts a much more expansive use of e-mail by physicians to interact with their patients in the next few years. "Surveys say many doctors are already doing it, but what that means is that they gave their e-mail addresses to 10 patients. Today, most doctors are not doing it as a core part of the way they practice. I hope we get there. We need to get there," he says.

Does he have any proof that he's saving money?

"We have data from one insurer who says that we're 20% less expensive than the average practice in the area," Kilo says.

In time, he says, many more physicians will be using e-mail with their patients. And newer models of reimbursement will actually pay for it.

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Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.

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