Doctor redefines visits with phone, e-mail

A Virginia family physician has established a cash-only practice model based largely on electronic patient interactions.

By Mike Norbut, AMNews staff. Oct. 20, 2003.

Unlike the typical physician starting a new practice, Alan Dappen, MD, likes to see an empty waiting room and only a few appointments on his schedule. As long as his telephone keeps ringing, the family physician is happy.

Dr. Dappen has created a practice model based almost entirely on telephone and e-mail contact, and he touts it as the future of health care. After scheduling an initial office visit with new patients, he runs his practice like he's perpetually on call, stressing to patients the convenience of a phone call as an alternative to a potentially long wait for a routine exam.

It may sound like a revolutionary idea, but Dr. Dappen, based in Vienna, Va., near Washington, D.C., calls it "the standard of care that's been around forever." The practice developed not only out of his frustration with managed care, but also his feeling that the need to physically examine each patient is quickly becoming an anomaly.

"The notion that you have to see every cough that walks in the door because it may be pulmonary edema or tuberculosis -- give me a break," Dr. Dappen said.

Dr. Dappen's practice also puts the spotlight on a notion that is gaining momentum in organized medicine: paying physicians for health-related communication, either over the phone or Internet. AMA policy states physicians should be compensated for telephone and e-mail services provided to established patients, and it calls on the Centers for Medicare & Medicaid Services and other payers to recognize this communication as a separate billable service.