Good reasons to charge for telephone advice, pediatrician tells Conference audience

Charging parents for telephone calls is a policy that is already working for a number of pediatric practices around the country, Andrew Hertz, MD, told an audience of pediatricians at the AAP National Conference here today.

One practice has a policy that, if a diagnosis of conjunctivitis, pinworm, or thrush is established on a call, the calling parent is given the option of an office visit or telephone care, with the warning that the insurance company might not cover the telephone care.

The result? Of 158 such calls monitored in that practice during the study period, 129 of the parents elected telephone care.

Nine of 25 sites at Children's Physician Network in Minneapolis are now routinely billing for telephone care, said Hertz, and they find that the policy is working. They billed $12,166 for 518 calls in the first half of 2005.

That practice began its policy with careful concern about its impact on patient relations, Hertz noted. It notified all existing patients ahead of time with office announcements and now gives all new patients printed materials about the policy.

Hertz, who is medical director of the Rainbow Care Center of Rainbow Babies & Children's Hospital in Cleveland and a member of the AAP's section on telephone care, said that some of the reasons for charging are that calls are, in many instances, cost-effective compared to face-to-face encounters and that they increase physician productivity. But there are also several real "costs" attached to charges for calls, including associated medical liability, the required skill and expertise needed to make telephone diagnoses, and associated real practice expenses.

On the more positive side, charging for calls increases the doctor's accessibility and the patient's satisfaction and improves documentation of calls.

Money issues hang over many of Hertz' reasons for not charging for such calls, including managed care organizations' reasoning that paying for calls is a slippery slope: Pay for those calls and then be asked to pay for many other types of calls--and many other aspects of a physician's daily work.

And, Hertz acknowledged, some physicians believe that such calls are just part of their job, or that charging is unethical because it creates a barrier to health care.

As for how to charge for calls, Hertz advised that physicians decide what type of calls they will charge for. He recommended charging for more complex ones, such as those about: a new treatment (thereby helping the patient avoid an office visit); chronic medication management; chronic disease flare management; reporting lab results that call for a management change or referral; or extensive counseling on behavior.

He also recommended that the physician notify patients of the policy and, in particular, outline its benefits, such as the number of office visits that they will avoid.

Each call, Hertz said, should be documented. He recommended using a form on which the physician checks off the type of service, in addition to listing information about the patient and the call. That check-off area can indicate, for reimbursement purposes, that the call was more complex, such as "consultation or medical management" or "initiate or adjust therapy."

Hertz also advised physicians to be ready to submit the billing codes to insurance and to dispute the denials. And, of course, to remember to collect co-payments for calls.