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Medem To
Enable Physicians To Charge for Online "Visits"
By Ann Carrns
![[Online Doctors]](http://gulfcoastpain.com/images/medem-chart.gif) Medem
Inc. the for-profit Internet company
backed by the American Medical Association
and other physician groups plans to launch a
new service Monday that will enable doctors
to charge patients for online "visits."
If it catches on, the new service could
diminish a view among some patients that
doctors have been slow to adopt Internet
technology to make communications easier.
In numerous patient surveys, the majority
say they want to seek advice from their
doctors via e-mail. Doctors, however, are
less enthusiastic: Recent studies find less
than one-quarter of surveyed doctors report
using e-mail with patients.
A study at the University of Michigan Health
System in Ann Arbor, published in the May
issue of the American Journal of Managed
Care, suggest that e-mail can actually increase
the workload of doctors' offices, and recommends that doctors educate
patients
about when its use is "Appropriate." Medem,
however, says its online consultation feature
lets doctors manage e-mail efficiently and
addresses physicians' biggest concerns:
potential liability and the lack of payment.
San Francisco-based Medem says the service
meets so-called eRisk guidelines for online
medicine, which have been endorsed by
33 malpractice carriers, the AMA and other
medical societies. Medem's service also allows
patients to pay with a credit card, which means doctors won't have a
handle extra work
without compensation. But it will largely be out of patients' own
pockets, at least
for now: Outside of a few experiments by companies and insurers, e-mail
consultations aren't reimbursed.
Other Internet medical firms have drawn scrutiny
from physician groups and
regulators because they offer patients anonymous consultations with
doctors
they have never met, a practice deemed ethically questionable. But
this Medem
service is meant for physicians to use with patients already under their
care.
Doctors pay Medem $2.50 per online visit, if the doctor bills the
patient for it.
A simple question might not result in a patient fee.
The consultation service expands Medem's "secure
messaging" option,
which lets patients request appointments and prescription refills and
ask brief
questions. Roughly 10% of Medem's 80,000 doctor users already offer the
messaging
option, which patients use free of charge. (Less than 5% of the doctors
in Medem's
network are overseas, in Europe, Asia and Latin America.) Unlike
standard e-mail,
secure messaging is encrypted to protect privacy; if it goes awry by
mistake, the
message appears garbled.
The new consultation service allows patients --
for a fee -- to ask detailed
clinical questions and receive detailed answers, and possibly a
prescription
authorization for minor ailments. Physicians can field requests
directly, or
designate a nurse or colleague to screen them first. Doctors set the
fees:
physicians interviewed said they expect to charge $20 to $30 a visit.
Here's how it works: Once doctors enroll in the
service through Medem,
patients register with their doctor and obtain a password. (Doctors can
choose to offer it to all patients at once, or offer it on a
patient-by-patient basis.)
Patients must agree to the doctor's terms of service, which spell out
the cost of
the service and the expected length of time within which the doctor will
respond.
Luke Kegan, a family and sports-medicine doctor in
Richland, Wash.,
started offering online consultations as part of a limited Medem test
three
months ago and now fields about five requests a week. He says he
typically
responds within 24 hours.
Leon Dotson,
80 years old, a Richland retiree, used the service to follow up with
Dr. Megna after visiting the emergency room for an attack of vertigo. He
finds
online communication convenient: There's no delay in securing an
appointment,
as there sometimes is with an office visit. "These are professional
people and you are
taking their time," he says, "so you should expect to pay for this."
Lynne Carr
Columbus, a Tampa, Fla., pain-management specialist, says the online
option is useful for her patients, many of whom take drugs for chronic
pain and need
periodic monitoring for side effects and proper dosage. It's often
difficult for patients
with back pain, for example, to sit and wait in the office. "So we let
them do two
online consults, and then come in for the third one to be seen in
person," she says.
"It wouldn't work for emergency situations; it's for routine consults
and follow-ups."
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Dr.
Lynne Carr Columbus, D.O.
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