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Computer Consult: Collect from patients online?


For a low price and little risk, you can cater to computer-savvy bill payers.


Computer Consult

Collect from patients online?

By Bob Lowes

• Twenty-four million households paid at least one bill online in 2002.

• E-payment messages should be encrypted and sent to a secure Web server.  

• Firms specializing in physician Web sites have started to make online payment a standard feature.

The practice Web site of Cincinnati internist William Miller doubles as a cashier. Patients visiting the site can pay their bill for last month's office visit with a credit card.

Like other doctors who offer online payment, Miller says he wants to cater to a small, but growing number of computerites. So far, he receives only $500 a month over the Web, but online credit card payment is a collection tool with a big upside, says practice management consultant Michael Wiley in Bay Shore, NY.

"The best thing is to get the credit card payment in the office, but if you don't, the ability to pay online gives the patient one less excuse for not paying," says Wiley. "And if you eliminate a second or third billing statement in the process, you've cut down on paperwork."

The number of patients inclined to pay online is sure to increase—24 million households paid at least one bill online in 2002, an increase of 26 percent over 2001, and that figure is expected to reach 52 million households in 2006, according to New York-based Jupiter Research.

How to pocket money online

Online payment isn't simply a matter of someone sending you a credit card number by regular e-mail. To keep the wrong eyes from seeing patient information, you must take the same precautions as if a patient asked an online question about his asthma. The message should be encrypted and sent to a secure Web server, which uses a firewall to protect data from hackers. Nobody should be able to send or retrieve messages unless he enters a user ID and password.

You can hire a Web programmer—perhaps the company that designed your site—to add a page for accepting credit cards. Expect to pay about $500 to $1,500. The Web programmer typically incorporates a commercially available, secure payment service that's the equivalent of a credit card "swipe" terminal. This service, called a payment gateway, connects to a company that actually processes the transaction and forwards you the money.

One payment gateway is Payflow Link from VeriSign ( www.verisign.com ) in Mountain View, CA. The company charges $19.95 a month (for up to 500 monthly transactions) on top of a $179 set-up charge. In addition, you pay a fee for credit card processing, which is generally 2 to 5 percent of each transaction. Other companies that offer payment gateways include Cardservice Internat-ional ( www.cardservice.com ), First National Merchant Solutions ( www.foomp.com ), and PayPal ( www.paypal.com ).

Firms specializing in physician Web sites have started to make online payment a standard feature. Last spring, Medem, created by the AMA and other medical societies, introduced a feature called Secure Pay. Medem charges clients $1 per payment received while a company that processes the credit card transactions deducts another 3 percent. Medem also allow patients to pay by credit card for online consultations, but this is a separate service. The sites themselves are free to all physicians.

A company called Medfusion in Morrisville, NC, also builds physician Web sites with e-payment capability. Or it can incorporate a payment gateway into an existing Web site, as it did for the 36-doctor Oklahoma Cardiovascular Associates in Oklahoma City. Another plug-in option comes from IDX Systems in Burlington, VT, a recognizable name in the practice-management software industry. It sells a suite of interactive Web services called Patient Online, which includes billing.

Beat the drum for online payment

Practices that allow patients to pay up on the Internet generally report low usage. The 125-doctor Iowa Clinic in Des Moines, for example, receives five e-payments per month on average through IDX's Patient Online. Granted, most practices have introduced the service only recently, but doctors and administrators say they need to promote it more heavily among patients.

"We're trying to figure out how to drive people to online services," says Beth McGuiness, director of information technology and billing at The Iowa Clinic. "We plan on reformatting our billing statements to tell patients that they can pay at the Web site."

Online payment might be more popular if patients could view an electronic version of their patient statement that details services and charges. That feature, found on some hospital Web sites, would require an interface to a doctor's practice management system that could cost as much as $10,000, says Bruce Sperka, president of a Web design firm in Torrance, CA. However, Medfusion president Steve Malik says he's working with several practice management software vendors to offer doctors online patient statements that are more affordable.

Clearly, online payment in healthcare is in its infancy, but many in the industry envision lots of money changing hands over the Web. Ed Brown, The Iowa Clinic's CEO, is glad that his group is an early adopter of this technology. "It's just a matter of time," he says, "before patients start using it in large numbers."



The author, who is based in St. Louis, is a Senior Editor of Medical Economics.


Robert Lowes. Computer Consult: Collect from patients online? Medical Economics Dec. 5, 2003;80:23.

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