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Web messaging boosts clinician productivity.

SAN FRANCISCO -- Giving patients access to online communications with physicians and their offices not only decreased phone calls but also decreased the volume of all messages and increased revenues in a controlled study, said Eric M. Liederman, M.D.

The idea that incorporating Web messaging into practices can boost clinical productivity is "a very controversial conclusion. It took my institution a couple of years to really believe it. Now they do, because they've not only seen my data, but there's a lot of anecdotal evidence as well," said Dr. Liederman of the University of California, Davis.

He and his associates studied their institution's efforts to introduce Web messaging, which allows messaging through a secure Web portal and which differs from e-mail in a number of ways. (See box.)

Over 13 months, the volume of phone messages dropped significantly, and the volume of phone and Web messages also dropped significantly at a clinic with Web messaging while volumes remained unchanged at a similar clinic used as a control.

"Why? Because phone calls create more phone calls" as providers and patients play phone tag, he explained. "All of that goes away with electronic messaging."

With the increased efficiency, the clinic with Web messaging was able to handle 11% more patient visits per day than the control site. "Annualized, that's a lot more access for patients. We're in a part of the country that has fewer doctors than we need. This is a big help." Dr. Liederman said.

Similarly, physicians at the site with Web messaging generated 10% more relative value units (the method of determining compensation based on productivity) each day, compared with physicians at the control site. That translates into extra revenue of approximately $19,000 per physician per year, he said. The true gain would be higher today, because at the time of the study, the physicians were not reimbursed for time spent on Web messaging, but now reimbursement usually is available, he added.

Of the 168 staff members (physicians and nonphysicians) at the intervention site, the nonphysicians preferred the new technology for managing nonurgent problems but the clinicians said they still preferred office visits.

"Now that we're paying" physicians for Web messaging, "we're seeing a big shift in that direction from doctors," Dr. Liederman said.

The university currently has 11,000 patients signed up for Web messaging, and the number is growing. The volume of Web messages per month is holding steady, however, at about 3,000. That's because the 20% of patients who account for most of the volume of care signed up early for these services, generating an initial rise in Web messages that doesn't increase much further when other patients get recruited through marketing efforts, he said.

The cost of introducing Web messaging was low because the university already had the infrastructure--computers and Internet connections. Dr. Liederman said. "The nice part about this is that it's an ASP [active server pages] model, which means that it's all Web services through a browser. Any size practice can do this" by paying licensing fees and either building its own system or hiring a company to customize it.

Experience showed that some of the older computers were too slow to handle the robust browsers, he added.

The study's findings should allay physicians' fears that electronic communication with patients would overwhelm them or that patients might abuse the system, Dr. Liederman said.

In 2.5 years of using Web messaging, none of the university's physicians have had to employ the two tools available to them for dealing with patients who might send too many messages or send obscene or slanderous messages. Physicians have the options of charging patients by the message or cutting patients off the Web messaging system in these cases, but no one has had to do so.

RELATED ARTICLE: Payers Come on Board with Messaging

Thanks to previous data from a controlled study showing that Web messaging decreased the cost of care, 80% of nongovernmental payers now reimburse the university for online clinic visits, Dr. Liederman said. Medicaid and Medicare do not yet pay physicians for online services.

The data came from the webVisit study, sponsored by Blue Shield of California and conducted by investigators at the University of California, Berkeley, and Stanford University. The comparison of claims data by 282 physicians for 3,688 patients from 2000 to 2002 found a net reduction in spending related to physician office visits of $1.92 per patient per month among those using Web messaging services, compared with controls. Total healthcare spending decreased $3.69 per patient-month in the intervention group, compared with controls. The cost of reimbursing Web visits averaged 31 cents per member per month.

"This was really big potatoes" and helped convince payers of the value of these services, Dr. Liederman said.

Patients and providers said that they liked the Web messaging and found it easy to use.

A new CPT code (0074T) for e-mail and online consultations with patients became available for use in July. The American medical Association is considering creating a graded series of codes for electronic clinical visits that would differentiate visits for simple problems, like colds, from more complex problems, like exacerbation of congestive heart failure, Dr. Liederman said.


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Title Annotation:Practice Trends
Author:Boschert, Sherry
Publication:OB GYN News
Date:Nov 1, 2004
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