E-visits

Boston-based American Well has opened its “online healthcare marketplace,” where, for a fee and cost of treatment, patients can consult a doctor in real-time via a web camera or phone. The June launch garnered mainstream media hoopla from The Wall Street Journal’s Health Blog, USA Today, and on MSNBC’s site, among other sources.

The service started with a commitment from Blue Cross Blue Shield of Hawaii, which expects to begin reimbursing physicians for online encounters with its 710,000 members by early 2009.

While convenient for the patient, the online marketplace may not be worth the time and energy for participating consultants.

On the upside, American Well will reimburse your service automatically (assuming one of your carriers has signed up) and handle collections itself. Patients’ co-pays will be charged to their credit cards prior to the encounter. American Well also offers additional malpractice insurance to piggyback on your own coverage. On the downside, web cameras are an improvement over phone encounters, but still no replacement for office visits, and only one insurer has signed on so far.

MedEc polled a few doctors to see what they think of the service and whether they would sign up if it were offered by one of their carriers.

“I would love to try out American Well,” wrote Stephen Fischer, a general practitioner from Spring, TX, in an e-mail. Fisher, who contends that he does not endorse any commercial medical sites, is also the chief medical officer of an EHR provider. “Now, whether or not I would continue to use it would depend on how well it worked.”

Yul Ejnes, an internist in Cranston, RI, and a regent on the American College of Physicians, says his association does not endorse online medical services where there is not a pre-existing doctor-patient relationship. He would, however, use the service if it were something his patients demanded.

“I have a problem with providing medical consultation and advice to someone I have never seen solely via an online encounter, but others might not,” says Ejnes. “Even if reimbursed, I would not venture into online consultations with persons who are not already my patients.”

E-visit advocate Elliot Sussman, an internist and CEO of Lehigh Valley Hospital and Health Network in Allentown, PA, believes if American Well and the patient can supply the appropriate records and health information -- which the company vows it will be able to do -- the lack of a pre-existing relationship is no more of a concern than a patient who walks into your office for the first time.

“It’s certainly more challenging to do [a first visit] online,” says Sussman, who tested a demonstration version of American Well. “It’s going to require significant amounts of judgment in terms of what kinds of information can be gleaned from the discussion.”