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The answer depends on whom you ask. A search of news archives turns up two reported experiments with reimbursement of physicians for e-mail communication with patients. In these cases, the most paid for a cybervisit is $25. But in a Deloitte & Touche survey, doctors thought that, on average, $57 would be a more desirable figure.

The Deloitte findings, released earlier this year, noted that 23 percent of physicians touch base with patients via e-mail — up from 19 percent at the start of 2001. Of those who do not, almost 80 percent say they'd rather communicate with patients in person. Within this subset, when asked what might motivate them to swap e-mail with patients, more than half said that money would. If they were to be paid for it, 54 percent said that they'd consider using it.

Expectation vs. reality: e-mail contact

What demonstration projects have been paid, compared with what physicians want

In 2000, First Health Group PPO announced that it would pay physicians in Illinois $25 for each clinical e-mail conversation with a patient. The consultation had to take place over a special e-mail network installed by First Health, which wanted to encourage physicians to stay in touch with patients with chronic illnesses.

Last year, six Silicon Valley employers cooperated on a pilot project in which physicians were paid $20 per clinical e-mail visit involving nonurgent health matters. The Silicon Valley Employers' Forum hoped to demonstrate how information technology could reduce costs and improve care.

Other than money, what might persuade physicians to make greater use of e-mail with patients? Time and staff concerns play largely into this decision. An ability to reallocate staff would make 43 percent of physicians who responded to the Deloitte survey consider it; 42 percent would if they thought it would save time, rather than be additive; and 37 percent like the idea if it would help them see more patients in a week.


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