Could e-Health see GPs charge like lawyers?

The advent of virtual consultations may change GP business models

Will the widespread introduction of e-Health services see General Practitioners charging for their services like lawyers?

That was the question addressed to the author of the Commerce Commission’s report e-Health and e-Learning, at a Health Informatics New Zealand conference in Auckland late last year.

The report, authored by former TUANZ CEO Ernie Newman, is the second of three papers produced by the Commerce Commission which looks at the demand side of high speed broadband services.

It was released last week, but Newman foreshadowed much of its content at the conference for health professionals. In the report he writes: “The use of telephone, internet, and email as alternatives to some face to face consultations also offers considerable promise, with leading edge examples here and overseas proving highly successful both in terms of patient outcomes and sector efficiencies.”

At the conference an audience member, who identified himself as a Wellington GP, asked how e-Health services would affect the business model of GPs. He said his brother, who is a lawyer, charges for every minute spent on the phone with clients – and he questioned if patients would be willing to be charged in a similar manner.

“These conversations I have going back and forth with patients about a visit they’ve already had. The first two emails are free and then it starts to morph into a longer, more substantive consultation, and then I’ll charge,” the GP told the audience.

“Are the consumers, patients out there, are they willing the let me go down my brothers compensation technique of having that counter ticking the moment I’m on the phone or emailing them?”

Newman replied that he thought health consumers would be open to charging for consultations that were not conducted face to face, as long as it was clearly explained to them why. “For my part I would much rather receive a bill for $25 for an email consultation then having to get in the car and have to get along for a physical consultation that may or may not be needed and be charged twice that amount.”

Newman says that remuneration of GPs and other health professionals needs to be considered in conjunction with changes in IT. “In many respects change management has to go concurrently with the piloting and not wait until there are final rollouts.”

The Health IT board intends to have Shared Care Records for every New Zealander by 2014, which “will be the single biggest determinant of how we utilise the internet in modernising health service delivery,” Newman writes in the Commerce Commission report.

Virtual consultation trial

Midlands Health Network (MHN), an alliance of 99 GP practices with around 500,000 patients in the central North Island, is trialling virtual consultations – phone or email consultations - at three practices in Hamilton.

Since April last year, around 3,000 enrolled patients have signed up to “Manage My Health”, which enables them to access their health record by logging onto the MHN website. The patient must first go through a process with their GP before they can sign up and only certain services are available virtually, says spokesperson Charlotte Fitzpatrick.

A phone consultation with a GP is around 50 percent cheaper than a face to face visit but for now an email consultation is free.

The patient management system from Medtech, which is used by most of the GPs in the MHN network, isn’t integrated with systems outside the area so the records are not available to health professionals in other parts of the country. If a patient gets sick in another part of the country, or overseas, they can log in to the website and share their records with the medical professional if they choose to.

Reaction to e-Charging

Health and disabilities commissioner Anthony Hill told Computerworld that the “relationship payment mechanism” needed to be discussed openly with consumers, and that it should be made clear to them what payment was expected prior to the consultation – virtual or face to face.

Computerworld sought comment from the Royal New Zealand College of General Practitioners but the organisation declined. “While we would like to be helpful, it sounds like this is an emerging issue and we’re not quite in a position to comment yet,” spokesperson Helen Morgan-Banda said via email. “Worth checking up on later in the year though.”

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