HomeLearning LabsA Conversation with Dr. Michelle Eads

A Conversation with Dr. Michelle Eads

Pinnacle Family Medicine
Woodland Park, Colorado

Virtual office visits (VOVs) are a win-win situation in my opinion. Since starting them in my new electronic office in July of 2003, my patients and I have been thrilled with this alternative to face-to-face encounters.

I began using Medfusion for my practice's online medical visits in January of 2006, choosing them mainly for their flexibility, capability and security.

From the physician perspective there are numerous benefits. VOVs save you time because the patient's history is compiled prior to the online encounter, aiding rapid diagnosis and treatment. Customizable response templates also save time. And VOVs are cost effective because you don’t need staff or an office space and associated utilities to do them. You determine when you want to work on this task, and if the situation is appropriate to address in this format or needs to be done in a face-to-face encounter. VOVs free up your schedule for more appropriately used face-to-face encounters. Documentation is a breeze with cut and paste functions. Pharmacy communication can also be a snap. And there is less risk for error because interactions are typed rather than verbal or hand-written.

I frequently use online medical visits for URIs, UTIs, sinusitis and chronic disease management, such as follow up of controlled hypertension, diabetes, etc. I still see patients every 6 months if they are well controlled, but the 3-month in-between appointments are easily handled in this format.

From the patient perspective they are also quite attractive. They can be completed at any time of day or night, at any pace, from any computer with internet capability, and can include attachments such as images. They are more efficient and convenient since they don’t require a telephone call, being placed on hold, missing work, arranging for a sitter, paying for parking, etc. Your patients can read your response at their pace and review it or even re-review it when desired.

Some insurance companies reimburse for online consultations, some don't. In my experience, most patients don’t mind paying out-of-pocket for this visit option, because it's so convenient for them. However, from the outset of my online service offerings, Kaiser of Colorado Springs' community based partnership has covered this service for their patients, and studied its effects in my practice through a pilot project. Their independent analysis and survey revealed marked patient satisfaction, excellent clinical outcomes, and significant cost savings of $70 per online visit. This local Kaiser entity believes virtual office visits are valuable, should be encouraged and should be reimbursed adequately, as laid out in the IOM Crossing the Quality Chasm report.

Thus it was that in 2007, Kaiser of Colorado Springs agreed to reimburse me $50 per VOV for their members, at no cost to their members. This is about 95% of the reimbursement rate for a 99213 for the area. The vast majority of my VOVs would be a 99213 or 99214 had they been seen in the office. I use the CPT code 0074T (online medical services), which helps them identify this service, and link it with the appropriate ICD9 code.

All in all, VOVs work for my practice and my patients.

Dr. Michelle Eads is not a participant in the National Demonstration Project. She is a family physician whose innovative Pinnacle Family Medicine practice is located in Woodland Park, Colorado.

» Link to practice Web site