April 20, 2024

Sending a message to your doctor through a patient portal could cost you : Shots

Doctors are facing a flood of messages from patients and some healthcare companies are billing for clinical advice delivered in this way.

Jose Carlos Cerdeno Martinez/Getty Images


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Jose Carlos Cerdeno Martinez/Getty Images


Doctors are facing a flood of messages from patients and some healthcare companies are billing for clinical advice delivered in this way.

Jose Carlos Cerdeno Martinez/Getty Images

If you wanted to talk to your doctor before the pandemic, you usually had to schedule an in-person appointment. But the sudden, rapid rise of telehealth means that patients can generally text or email their healthcare providers.

“When you wanted to have a Zoom visit or an audio visit, you had to sign up for the patient portal, and I think a lot of people became aware that they could send messages for the first time” during the pandemic, he says To Jay Holmgrenresearcher in health care information technology at the University of California San Francisco.

Patients love that direct contact with their doctors – so much so that their messages are overwhelming doctors’ inboxes. Now, some patients are getting billed by hospitals or health systems for some responses to their message inquiries.

Holmgren traced how doctors spent more time during the pandemic managing electronic health records. Even when lockdown ended, doctors were submitting over 50% more patient messages than beforehe notes in a research letter published in the JAMA. That added to the stress for doctors already dealing with a pandemic, responding to emails after hours, essentially working for free.

“Physicians who get tons of portal messages reporting tends to burn outtend to report being more cynical about their job, tend to report thinking about leaving clinical practice,” says Holmgren.

Many hospitals and health systems, from Johns Hopkins to Houston Methodist and Cleveland Clinic to Veterans Affairs, now charge patients who receive clinical advice via text message. Such fees are generally covered by Medicare and Medicaid, as well as most private insurance, although patients may bear a co-pay, ranging from $5 to $75, depending on the type of plan.

Holmgren says the goal of charging for these messages was to compensate doctors and discourage patients from sending too much mail. In fact, however, he says that the new fees have not solved either of the problems. His research shows doctors only bill for a tiny fraction of messages – about 3%. And the move to charge for them hasn’t reduced the number of emails. As a result of the charges there was a slight decrease of about 2% in the number of messages.

“The uptake has not been very high among our clinical workforce,” says Holmgren, in part because billing for messages itself is complex and time-consuming. In addition, doctors do not want to alienate patients by charging them to communicate.

In short, there is still no business model to support the way patients and providers talk to each other now.

But Caitlin Donovan, senior director of the non-profit National Patient Advocate Foundation, says finding one is essential. She represents patients with chronic illness, or who live in rural areas.

“In the last few years we’ve realized that telecommunications is a health issue,” says Donovan, adding that the ability to email doctors has been transformative for many patients: “Sometimes patients don’t have the energy to make that phone call, let alone come into the office.” Also there are people who live hours away from their doctors.

Donovan hopes that the ability to email doctors can remain in place, without incurring significant costs to patients: “We’re balancing this need to expand access quickly and really attract providers to make it part of their practice, and try to make sure it’s accessible and affordable for patients.”

Eve Rittenberg, a primary care physician and assistant professor at Harvard Medical School, also wants a system that supports the relationship between doctors and patients. “For me it’s an incredible privilege that my patients share their fears and concerns and questions with me and I can talk to them directly,” she says.

But it also needs to be sustainable, argues Rittenberg, and what is needed are better systems to filter through the a constant influx of messagesfilter out administrative tasks, and allow her to focus on answering clinical matters only.

Part of the challenge is the compensation model itself, which is most commonly known as fee-for-service. Health care companies bill for each and every service performed by doctors and nurses. Rittenberg she says she’d like to see payment systems instead that compensate doctors for providing complete care, whether that’s in an office or over the mail.

She says that would give doctors and patients the flexibility to decide what works best for them. “Finding ways to make clear communication sustainable is really important,” she says.

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