1. What is Secure Messaging (SM)?
- SM is a Medem service that allows physician practices to communicate safely and privately with patients, and others, to reduce administrative burdens, improve office communication efficiency, and generate practice revenue. SM complies with national liability carrier (eRisk) Guidelines and proposed HIPAA standards.
- SM allows for online appointment requests, prescription refill requests, address updates, and other general messages to be sent to the practice, thereby streamlining office operations, minimizing phone calls, and enhancing efficiency. There is no charge to the patient for using these SM features.
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2. What is Online Consultation (OC)?
- OC is an additional SM feature that allows patients to pose a clinical question, or request a clinical consultation, online from their physician. OC was created in response to both patient and physician demand. National surveys indicate that more than half the patients online and more than three-fourths of physicians want the option of using secure fee-based e-mail as an alternative to mandatory office visits, for some of their physician-patient communications.
Patients access SM and OC conveniently from the practice's Medem Web site. The practice may "grant SM/OC privileges" on a patient-by-patient basis-- a provision insisted upon by physician liability carriers. Practices post in advance their average response times to set patient expectations and reserve the option of asking patients to schedule office visits or call the office if the SM/OC request dictates.
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3. Do patients want SM and OC, and are they willing to pay for OC?
National surveys by Deloitte Research, Harris Interactive, Jupiter Communications and others confirm that the overwhelming majority of online consumers desire e-mail access to their physician:
40% of surveyed patients would pay for electronic access to their physicians, because they forget to ask all of their questions in the office. Harris Survey 2001
Patients list the following as their primary reasons to want to communicate online with their physicians according to a Harris Interactive National Survey from 2001:
- "Forgetting to ask all my questions when I'm with my doctor" (60%)
- "Having to see my doctor in person to ask questions that he or she could answer by telephone or e-mail" (41%)
- "Getting through to someone who could answer my questions" (35%)
Medem's own national survey of physicians shows that the average physician believes that 5-10 patients per week would use the fee-based OC service. It is also important to note that patients have real out-of-pocket costs when visiting a physician that drive their interest in fee-based Online Consultations. A patient who earns $20/hr has a net out-of-pocket cost well in excess of $50 for a typical office visit when lost wages, co-payment, gas, parking and related costs are totaled. Beyond these cash costs to patients there are the costs of inconvenience, employer issues, childcare, etc.
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4. How do patients find my Web site on the Medem Network?
Each month, over half a million patients who are looking for a doctor at their health plan's Web site (including
Aetna, United, CIGNA, major 'Blues, etc.) are sent exclusively to Medem physician Web sites - including yours.
Patients looking for a doctor are also sent to your Web site from other Physician Directories, including the AMA,
other medical societies, Medem, and various employers' directories.
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5. Must physicians use Online Consultation in order to use SM?
No. Medem OC is an option within SM and practices may elect to use SM without OC.
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6. Aren't physicians already using e-mail?
According to The 2002 AMA Study of Physicians' Use of the World Wide Web about twenty-five percent of physicians, based upon specialty, are now using e-mail with some of their patients, and a growing number of providers are offering fee-based e-mail services. Most physicians, however, appear to be using standard unencrypted and un-secure e-mail for their patient-related communications. Standard e-mail does not live up to national liability carrier (eRisk) guidelines nor HIPAA standards.
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7. What's wrong with standard e-mail?
- Standard e-mail is not encrypted or authenticated.
- Standard e-mail can be used by anyone to access a physician if they simply know the physician's e-mail address.
- Standard e-mail has no "terms of service" or legal disclaimers to protect physicians.
- Standard e-mail can easily expose patient e-mail addresses and identities to unintended third parties.
- Standard e-mail often breaches patient privacy by using employer e-mail networks.
- Standard e-mail offers no charge capture function.
- Standard e-mail has no template or medical records features.
- Standard e-mail is not consistent with HIPAA or eRisk standards.
- Standard e-mail has not been "safety-proofed" for healthcare.
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8. How are The Medem Network's secure online communications services different from regular e-mail?
Traditional e-mail is neither authenticated nor encrypted--it's similar to sending a postcard in the U.S. mail: it can be intercepted and read by others as it travels across the Internet to its intended recipient. In addition, patients often use their employer-provided e-mail addresses for these communications, making the content of these communications the property of their employers. And standard e-mail fails to meet the guidelines of either the eRisk Medical Liability Guidelines or any of the HIPAA standards.
Medem's SM/OC service is encrypted and confidential, so only the intended recipient can read a message. Because a user ID and password are always required to view both patient and physician messages--which are stored in a secure server environment--the identities of both parties must be authenticated before messages are read. Medem also provides physicians with sample office protocols, terms of service, informed consent language, and other tools to maximize communication security and minimize practice liability.
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9. Besides improved security, do Medem Network secure online communications services have other benefits that are lacking in conventional e-mail?
Medem provides for the creation of templates physicians can use for frequently asked administrative and health-related questions. The service also allows physicians to add links directing patients to Medem's Medical Library of medical society-provided content, includes integrated charge capture/billing, and features other tools that make secure online communications safer, more comprehensive, and more convenient for both patients and physicians.
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10. How will physicians be paid for OC?
Medem's OC service has an integrated third-party credit card service allowing patients to provide payment to physicians. Patients submit a credit card number online that is charged only if their physician accepts the OC request and if the physician elects to charge for the OC. Physicians have a no charge (N/C) option that may be used for simple questions, follow-up questions or at the physician's discretion. Physicians may either receive monthly checks for OC services rendered or have funds deposited directly into their accounts.
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11. What is the charge for an OC?
Physicians decide for themselves what they will charge for an OC. Medem does not determine fees nor does Medem negotiate or amend charges. National surveys indicate that patient expectation for fee-based online communications with physicians is ~$25/consultation. Medem's network fee for the OC service will be $3.50/OC but will only apply if the physician charges for the OC. A N/C from the physician will result in a N/C for Medem.
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12. Is there a CPT code for OC?
Yes. The American Medical Association has announced the introduction of new Category III CPT code 0074T for reporting online consultations between physicians and patients. The code descriptor is: online evaluation & management service, per encounter, provided by a physician, using the Internet or similar electronic communications network, in response to a patient's request; established patient.
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13. Does OC meet with malpractice carrier approval and are physicians covered when using OC to communicate with patients?
For nearly two years, Medem has worked closely with malpractice carriers (the eRisk Group), representing more than 70 percent of insured physicians, to establish guidelines for physician online communications. The Medem network fulfills the requirements of the eRisk Guidelines. Physicians are encouraged to confirm details of their liability coverage with their carriers.
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14. Are health plans paying for OC? Will a physician providing OC violate his or her contract with a health plan or HMO?
A few health plans are experimenting with pilots for fee-based physician-patient e-mail, but most are not. Most health plans consider OC a non-covered service. Two areas in which the OC fee may conflict with existing contracts are in fully capitated contracts and in areas of "unbundling" (i.e., using OC in follow-up for a treatment for which the provider has been given a global payment).
Medem has worked with the law firm of Foley and Lardner to provide physicians with payer guidelines associated with health plan contract issues, similar to Medem's work with the malpractice carriers in developing eRisk Guidelines. The terms of service agreed to by patients using Medem's OC also require the patient to confirm with his or her insurance carrier that the OC fee is consistent with his or her health coverage. Physician offices are encouraged to consult with their payer regarding any potential conflicts, but in most cases OC appears to be a non-covered service.
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15. Is Medem practicing medicine by providing OC?
Medem is providing network communication services to physicians and patients, much like an e-mail service provider or telephone company. Medem receives a flat transaction fee for providing these utility services, when a physician charges a patient for an OC. Medem does not edit or amend physician messages or physician bills, nor do we suggest or negotiate fees for physicians.
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16. What if the doctor doesn't respond to a submitted OC?
Physicians provide Terms of Service (TOS) to patients through Medem OC. Part of the TOS includes a physician-provided statement suggesting the frequency with which physicians may respond to OC requests, thereby setting patient expectations and providing legal notification to an "informed patient." Physicians may choose to provide patients with additional terms of service prior to providing OC services.
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17. What if the patient doesn't read the OC response from the doctor?
If messages are not read within the time frame determined by the physicians (typically 3-5 days), a notification message will be sent to the physician so that the physician's office may follow up with the patient as appropriate.
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18. What is the difference between Medem's service and others?
The differences between Medem and its competitors:
- Medem provides physicians with access to new insured patients through exclusive provider directory links to millions of covered lives-our competitors do not.
- Medem provides a quality practice Web site, Secure Messaging/OC, and an award winning library of peer-reviewed articles from the nation's medical societies.
- Medem has the endorsement of the nation's medical societies.
- Medem's customers are physicians and our message is "Increase your revenue and improve patient care." Others sell to insurance companies and employers by saying: "Lower your overall payments to doctors."
- Medem services help protect physician liability. Medem spearheaded the eRisk Guidelines and rallied to gain malpractice carrier and Federation of State Medical License Board participation and support.
- The Medem Network is the largest of its kind with over 90,000 physician subscribers and over 10,000 Secure Messaging users.
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19. How does OC fit with Medem's initial business strategy?
From the beginning it has been Medem's goal to build a secure communications network between physicians and their patients featuring the trusted clinical information from the nation's medical societies. Medem began by providing practice Web sites featuring clinical content and then integrated Secure Messaging, Online Consultation™, and Secure Pay. Online Consultation™ is in line with Medem's development and strategic path and is in response to the substantial demand by physicians and their patients.
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