Doctors are Making Virtual Housecalls via the Internet

AKRON, Ohio — Modern technology is giving a whole new twist to the concept of house calls. Thanks to the Internet, some patients now have the option of getting medical care from their doctor without leaving the comforts of home.

At least two major national health insurers _ Aetna and Cigna _ recently started paying participating doctors for “virtual visits” with eligible patients.

Thousands of doctors nationwide have signed up to offer online appointments through a secure Web site, .

To check in for Web-based appointments, patients log onto the site and then answer a series of questions based on their symptoms.

The information is later viewed by their doctor, who can ask more questions if necessary and then dispense medical advice online.

The service is reserved for established patients with minor health maladies, not those facing potentially life-threatening situations, said Dr. Elliot Davidson, medical director of the Akron General Center for Family Medicine, which offers the online appointments.

People with chest pain, for example, are immediately warned they need to call 9-1-1, not continue with the virtual visit.

On the other hand, Davidson said, mild upper-respiratory infections, back strains or urinary-tract infections all probably could be treated online, though follow-up appointments still might be necessary.

“You have to be careful that you’re not treating stuff … that you really should be seeing,” Davidson said. “There are very strong disclaimers in multiple places.”

When used appropriately, supporters say, online appointments can make health care more accessible and affordable.

“This is about increasing access to care,” said Dr. Bill Fried, medical director for Aetna’s mid-Atlantic region. “We feel that by allowing our members greater access to communicate with their doctor’s office, it will improve quality and potentially avert adverse consequences.”

On a recent blustery evening, Maryann Smrdel turned to the Web to seek care from Dr. Debbie Plate, her primary physician at the Akron General Center for Family Medicine.

The 76-year-old patient from Barberton, Ohio, had been suffering from gastrointestinal woes for weeks and needed help.

Her computer-savvy husband, Frank, helped her navigate the Web visit site, which can be accessed through Akron General’s My Health Online Web page,

Because Smrdel’s insurance company doesn’t pay for online visits, her credit card was charged $30 for the virtual visit.

Plate responded to Smrdel’s list of ailments by 6:27 the next morning, with recommendations for dietary restrictions and an over-the-counter medicine, along with advice to call the office if symptoms didn’t improve.

“I got my medicine first thing in the morning, and it worked,” Smrdel said. “In this instance, it was very good.”

Online appointments are a good way for busy doctors to provide better access to busy patients, Plate said, but “in no way does this replace what we do in person.”

“Nothing replaces the primary-care doctor in the office,” she said.

In addition to providing the online appointments, Plate encourages her patients to e-mail questions and use the Web site to request prescription refills or specialist referrals.

“It’s very convenient for them to be able to e-mail me,” she said. “It makes it nice, particularly in primary care.”

Virtual office visits benefit not only patients, but also the patients’ employers, said Joe Mondy, vice president of IT communications for Cigna.

“For the employer, it helps productivity,” Mondy said. “The people don’t need to leave work to go to the doctor’s appointment.”

And it saves money.

A typical doctor’s office visit costs insurers _ and employers, who often ultimately pay the medical bills _ anywhere from $65 to $85, Mondy said. By comparison, Cigna is paying doctors $25 per Web-based appointment.

Some doctors already were providing e-mail access to patients, but didn’t get reimbursed for the time they spent online, Mondy said.

“Doctors deserve to be fairly compensated for their work,” Mondy said.

Physicians pay Relay Health $25 a month to use the Web site, Mondy said.

But with Cigna reimbursing physicians $25 per Web-based appointment, he said, “it obviously pays for itself with one visit per month.”

Aetna also pays doctors $25 to $35 per Web-based visit, Fried said.

For both insurers, patients sometimes have co-pays, depending on the design of their plans.

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