What is E-Consult?
Access to specialty care continues to be a major challenge for low-income and underserved Californians. With provider shortages and long wait times for appointments, demand continues to outpace the safety net’s ability to meet the needs of its growing patient population. To address this challenge, many health centers, systems, payers and policy makers are turning to electronic consultation and referral, or e-consult.
As the use of e-consult expands across the country, federal Medicare and state Medicaid policies have been evolving to support reimbursement and sustainability. As policies evolve, e-consult definitions are also expanding. In 2017, the E-Consult Workgroup refined its definition of e-consult as one of its first tasks. In 2018, CMS included a definition of e-consult in its revised Medicare Physician Fee Schedule. In Ausgust 2019, DHCS released a version of the Medi-Cal Provider Manual with an updated telehealth policy that incorporates e-consult reimbursement and includes an e-consult definition. These three definitions are the following:
E-Consult Workgroup E-Consult Definition
An e-consult is an asynchronous dialogue initiated by a physician or other qualified health care professional seeking a specialist consultant’s expert opinion without a face-to-face patient encounter with the consultant.
To capture the service rendered, the specialist will report a CPT code for inter-professional consultation. E-consults provided by consultative physicians include written reports to the patient’s treating/requesting physician/qualified health care professional.
CMS E-Consult Definition
Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional.
Medi-Cal E-Consult Definition
E-consults are asynchronous health record consultation services that provide an assessment and management service in which the patient’s treating health care practitioner (attending or primary) requests the opinion and/or treatment advice of another health care practitioner (consultant) with specific specialty expertise to assist in the diagnosis and/or management of the patient’s health care needs without patient face-to-face contact with the consultant.
Spreading Adoption of E-Consult in the Safety Net, an Initiative Funded by Blue Shield of California Foundation
To improve the way that California’s safety net providers coordinate care for their patients, from 2014 to 2018 Blue Shield of California Foundation has supported the spread of e-consult in the California safety net. E-consult reduces wait times for specialty care, eliminates unnecessary appointments, and also strengthens relationships between providers, enabling them to more effectively and efficiently meet the healthcare needs of low-income families and individuals across the state.