Article From Wall Street Journal
Technology and Health - June 17, 2002
 

Medem To Enable Physicians To Charge for Online "Visits"
By Ann Carrns

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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