American College of Physicians: Internal Medicine — Doctors for Adults ®


Two new ACP papers explore time pressures, e-consults

From the May ACP Observer, copyright 2003 by the American College of Physicians.

By Phyllis Maguire

SAN DIEGO—During Annual Session week, the College released two new position papers that touch on issues affecting most internists: time pressures and reimbursement for e-mail consults.

Time pressures

Many physicians struggle with having less time to devote to patient care. The Board of Regents approved a position paper that addresses that growing concern.

William E. Golden, FACP, Chair of the College's Ethics and Human Rights Committee, said that while many physicians complain they have less time for patient visits, studies show that the actual amount of time physicians spend with patients has remained the same.

What has changed, he explained, is the number of administrative hassles associated with patient care. Physicians also have to spend more time during visits on tasks required by government regulations, such as discussing advance beneficiary notices with Medicare patients.

The position paper outlines the ethical implications of physicians' growing time constraints. It also addresses specific time-related problems, including failing to convey respect for patients, overlooking patients' psychosocial concerns and not adequately partnering with patients to make decisions about their care.

The paper is being submitted for publication.


Another new ACP paper urges Medicare and other payers to reimburse physicians for consultations performed via e-mail and other electronic means. (The paper received final approval from the Board of Regents in March but was released at Annual Session.)

The paper states that insurers should pay physicians for communicating with patients electronically, but it says that payers must not reduce physician reimbursement for face-to-face services by a corresponding amount to make up for those costs.

It also states that "e-services" must meet a certain level of work to be reimbursed as a separate service outside of usual fees for face-to-face care.

The paper urges insurers to cover "virtual visits" in which physicians diagnose new conditions, such as a urinary tract infection, in existing patients. The paper claims, however, that physicians should not be paid for e-mail services like reporting normal test results when they don't make any new management decisions.

Finally, the paper calls on Medicare and other payers to work with the physician community to develop reimbursement guidelines for health-related communication, consults and other electronic services.

The paper is available online.


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