This is a re-print of commentary from a past Kansas Business Group on Health newsletter.
In the past, doctors routinely engaged in “curbside” consultation, where one doctor stops another one in the hallway or calls her on the phone to ask a question about patient care that he wasn’t quite sure rose to the level of needing an official in-person consultation. This was great for the system: the enquiring doctor got the information needed, and the patient theoretically benefited, all at zero cost. But the consulting, curbsided physician was not rewarded for her expertise. Enter “e-consults.”
With e-consults the inquiring physician, instead of paging or stopping the other doc, puts the question into a written format, usually through a secure online portal. Then the consulting doc can submit a written answer for a nominal fee. [disclosure: Justin Moore is an endocrine consultant for RubiconMD, an e-consult service]
This monetization of the curbside consultation has benefits: It keeps the care of the patient centered around his relationship with the primary care provider instead of fragmenting his care. It keeps the stakes low; if the primary care doc has chosen the wrong specialist by mistake, or asked a question that has little value, no one tends to be charged for the trouble. In the traditional system of consultation up to 40% of specialist referrals lack either medical necessity, correct specialist choice, or timely transmission of relevant documents. Finally, e-consults can be had immediately, often same-day. In the traditional system our most vulnerable patients, such as those cared for in Federally Qualified Health Centers (FQHCs), only 40% of intended specialist consults are ever scheduled, and there is a 40% no-show rate in those that are successfully scheduled.
This all translates to a $500 annual per-patient savings in one randomized trial of cardiology patients. Medicare even covers asynchronous consults like this now. So if your health plan doesn’t currently cover e-consults, consider a change in your benefits.