Proposed criteria for reimbursing eVisits: content analysis of secure patient messages in a personal health record system

Abstract

The Institute of Medicine called for healthcare organizations to provide care whenever needed, using the Internet as appropriate. Few organizations currently offer clinical electronic messaging services for their patients. Many believe that broader adoption of online services will not occur without a change in reimbursement policies. We propose modified Evaluation and Management (eVisit E&M) criteria derived from the current office-based E&M codes as a means of qualifying whether an online encounter should be reimbursed. Physician reviewers applied the proposed eVisit criteria to 120 randomly selected electronic messages sent by 112 patients to 69 physicians through a personal health record system. Twenty-two percent of clinical messages to physicians contained sufficient patient-history data and medical decision-making components to warrant reimbursement according to our eVisit criteria. Among a subset of patients with multiple chronic diseases, this would have generated an estimated 1.2 eVisits per patient annually. Across a broader patient population, we estimate that 0.7 eVisit encounters would be generated annually per patient. Sixty-five percent (65%) of patients felt that electronic communication with their physicians saved one or more office visits per year. Reimbursing for qualified eVisits may encourage broader use of electronic communication to improve access to care and reduce overall healthcare costs.

Figure 1

Proposed Evaluation and Management Criteria for eVisits (eVisit E&M codes)