Doctor House Calls in the Information Age

EDITOR'S NOTE: This article was originally published in the March 2009 issue of Kiplinger's Retirement Report. To subscribe, click here.

You may have thought that physician house calls were a thing of the past. But now many doctors are finding a new way to pay a visit to your home: by e-mail.

Joseph Halperin of Berkeley, Cal., has received several "e-visits" from his internist. Halperin, a sculptor and retired oncologist, says he e-mailed his doctor to get prescriptions before a recent trip to Mexico and to ask about a pulled muscle. "It's extraordinarily convenient," Halperin says, noting his doctor responds more quickly to an e-mail than to a telephone call.

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Halperin, 67, is not pulling doctor privileges. His internist offers this high-tech version of the house call to all of his patients. He is among a growing number of doctors who use the Internet to treat patients while getting paid for their time and expertise.

Less than one-third of doctors communicated with patients online in 2007, according to Manhattan Research, a health-care research firm in New York City. But big insurers, including Aetna and Cigna, now reimburse doctors for Web-based visits. Kaiser Permanente encourages patients and staff doctors to use e-mail, as do Health Net of California and several of the largest Blue Cross Blue Shield plans.

In most cases, a patient logs on to a secure Web-based program. The patient chooses from a list of problems or symptoms. A new screen will ask specific questions that lead to a final answer.

Common problems handled during a Web visit include sinus pain, back problems, colds and flu. Patients can also schedule appointments and ask about lab test results and medications. If your physician offers such a service, ask about the privacy policy and how much time it usually takes to get a response. You should be comfortable using a computer before using this service.

If a doctor can't easily diagnose by e-mail, the patient will be told to pay an office visit. "This happened when I had a persistent cough after a cold," says Halperin. "He saw me and checked me out."

Take Two Aspirin, and E-mail Me Later

About 150 procedures can be handled online, according to McKesson Corp.'s RelayHealth, an Atlanta company that provides Web sites to Aetna, Cigna and other insurers for online visits. Aetna, for example, approves payment for Web visits in primary care and more than 30 specialties, including cardiology, oncology and rheumatology.

Dr. Lisa Rankin, a family practice physician in Port St. Lucie, Fla., says the convenience is a big reason she's used Web consultations for nearly three years. One-fifth of her practice's 8,000 patients use the system. Rankin gets $30 for the Web visits from several insurers and from her uninsured patients.

Rankin uses RelayHealth, which employs detailed templates that, she says, "ask the same questions that I would ask. If there is anything else I need, I will ask for additional information from the patient." She says her diagnosis is usually based on her knowledge of the medical history of a patient. "If a patient has a complaint that I do not feel comfortable with, I will tell them they need to come into the office," she says.

Web-based visits are not suited for emergency care. Nor are they usually appropriate for someone with serious multiple conditions, such as diabetes and a heart condition, which can complicate a diagnosis.

Health plans typically pay doctors $25 to $35 for a Web site visit, says Ken Tarkoff, vice-president of RelayHealth. Some health plans require a patient co-payment, which may be the same as an office visit co-pay or less.

Halperin, a Medicare beneficiary, pays $25 to his physician for each virtual visit. "I'm happy to have the service even with the expense," he says. Medicare doesn't cover Web visits, but Cigna HealthCare and Aetna offer Web visits to some Medicare Advantage patients.

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