E-consults take up valuable physician time. It’s important to recognize that for both the consulting specialist and referring physician.
For the consulting specialist: E-consult programs generally reimburse specialists for each respective e-consult. These reimbursement rates vary by organization, payer, and time required. Mayo Clinic’s consulting specialists earn the same amount of RVUs (1.74) as they would for an in-person visit. This is a win for specialists since responding to an e-consult takes about one-third the time of an in-person visit. It’s a win for Mayo Clinic since e-consults are 1.4 times more likely to generate return visits to primary care over referrals to specialists. Given only Medicare and some other payers compensate physicians for e-consults, some organizations may choose to establish a lower RVU range determined by time spent. For example, one health system reimburses e-consults that take <10 minutes at 0.5 RVUs, and those that take 11-20 minutes to answer at 1 RVU.
For the referring physician: Many organizations already tie PCP compensation to quality and costs. In addition, organizations can incentivize referring physicians to use e-consults by reducing their workload. For example, L.A. Care Health Plan implemented an e-consult program to encourage PCPs to manage patients in primary care as much as possible. As an incentive, L.A. Care removes pre-authorizations for any referrals that go through this process. Given health plans’ interest in decreasing inappropriate referrals, consider partnering on e-consult implementation as a step on the bridge to value. This way, PCPs are making care escalation decisions solely with fellow providers’ opinions rather than a plan’s.
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