Denise Scott MM, BA, RN-BC
Manager HIT Consulting
Masspro
 Should
physicians be reimbursed for the
medical care/advice they currently
provide outside of a visit if it:
• Improves patient access to care
• Reduces office visit utilization
• Allows for better management of patients
with chronic conditions while
• Increasing patient and provider satisfaction?
2
Secure electronic communication improves
access to service and improves efficiency
and communication, therefore
Secure electronic communication is probably
a useful tool to use in medicine.
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Is there a role for electronic visits in the
management of the Medicare population?
Will the Medicare population use the
technology?
Does payment for electronic visits
incentivize use by physicians?
Is there a cost savings or cost neutrality in
reimbursing physicians for e-Visits ?
Does communicating via secure messaging
improve patient and physician satisfaction?
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Office of the National Coordinator for
Health Information Technology (ONC)
◦ Yael Harris PhD. - Project Officer
 Abt Associates – Contractor
 Masspro – Technical Assistance
 Private payers
 Regence
 Providence Health Plan
 Anthem
 Kryptiq –Secure messaging technology
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Pilot project in two diverse delivery areas
 Providence Health & Services
Portland, Oregon
 Large metropolitan healthcare delivery system
 Eastern Maine Healthcare System
Bangor, Maine
 Large rural healthcare delivery system
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Recruitment of 50 primary care providers
for intervention and 50 control practices
with similar demographics in each state
◦ Intervention sites were to adopt secure
messaging technology within first year of the
pilot
◦ Control sites were to refrain from adopting
secure messaging technology for the duration of
pilot
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Baseline surveys –patient and physician
satisfaction
Original intent - analyze claims data of
Medicare patients using the technology
HITECH Act
Qualitative study from audited charts of
Medicare patients
Additional analysis by sites
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Refinement of definition
Physician payment
Rate of adoption
Rate of implementation
Registration process
Physician acceptance
Geography
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1) Must be an established patient
2) Patient presents with a clinical problem
3) Complaint reviewed within the context of
the medical chart
4) A change in plan, reaffirmation of
current plan or a new plan is communicated
Physician to respond within 1 business day
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E-Visits – 80% of 99212
◦ 20% audit with denial or reduction possible
◦ Partial payment if e-visit was followed within 72
hours by an office visit - $15.00 reduction
◦ Amount paid to physicians varied by site
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Secure Messaging – $5.00 per member per year
◦ Rx refill, appointment request, referral request,
return lab results, questions
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Analyze 20 different data elements
abstracted from a 20% random sampling of
all submitted claims
Use patterns
Potential impact on delivery of care
Potential impact on clinical outcomes
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Usage by age/gender
Usage beyond office hours of physician
Response time to messages
Number of exchanges to deliver plan of
care
Usage by patients with chronic disease and
co-morbidities
Treatment recommendations
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Total e-Visit Distribution by Age Group
16%
13%
8%
35%
28%
< 65
65-69
70-74
75-79
>80
e-Visits by Those Over 80
Age
80
83
84
85
87
88
89
90
94
97
# of e-Visits
1
3
3
2
1
2
1
1
1
1
e-Visit Usage by Gender
Male
Female
55.1%
44.9%
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Time Patient Wrote Initial e-Mail
12 MN – 9AM
18%
9AM - 12 noon
15%
12 noon– 5PM
5PM-12MN
22%
45%
e-Mail Sent During and After Office Hours
Outside of
In Office
Office
hours
Hours
59%
41%
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Response Times to Initial e-Mails
More than
24 Hours
16%
Less than 24
Hours
Less Than
12 Hours
61.70%
Less Than
6 Hours
45%
Less Than
3 Hours
34.30%
84%
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Number of e-Mail Exchanges
to Communicate Plan
73%
23%
1
2
4%
>2
Patient-Physician e-Mail Exchanges
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Number of e-Mail Exchanges to
Communicate Plan
e-Visits for Existing Problems
e-Visits for New Problems
79%
58%
39%
3%
17%
1
2
3%
>2
Patient-Physician e-Mail Exchanges
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e-Visit Distribution by Chronic Disease (n=71)
Arthritis
6
*Other
Hyperlipidemia
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19
Diabetes
20
Hypertension
40
*Other includes: Stroke, Depression, Celiac Disease, Asthma, Alcoholic Hepatitis
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Days of the Week Initial e-Mail was Written
6%
20%
13%
23%
21%
17%
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday/Sunday
e-Visit Initiated By Patient/Physician/Proxy
Proxy
5%
Physician
16%
Patient
79%
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Type of Plan Communicated by e-Visit
71%
49%
29%
22%
Change in Plan
New Plan
Reaffirmation of Current
Reaffirmation
Plan
or
Change of Current Plan
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Patient
Referrals as Part of Plan
Request
Follow-up
4%
Part of Plan
19%
after
Consult
4%
Not Part of
Plan
73%
Prescriptions as Part of the Plan
42.1%
26.2%
31.8%
Prescriptions
Prescriptions
No Prescriptions
Ordered
Changed
ordered or changed
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Medicare population will use technology
Access is improved
Majority of users were those with
existing chronic (expensive) conditions
Physician adoption varies greatly
Payment incentivizes use
Patient and physician satisfaction - TBD
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Potential for improved management of
those with chronic disease – lowering
healthcare costs
Improved access with PCP shortage and
increase of insured lives
Reimbursement for care currently being
routinely provided by PCPs via the phone
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Adoption of secure messaging in a small
clinic setting – the cost-benefit ratio of
implementation to:
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Improve access and communication
Improve efficiency
Improve management of care
Improve satisfaction
Improve outcomes
Lower health care costs
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Contact information
dscott@masspro.org
781-419-2896
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