Study examines physician, patient attitudes toward portal message billing
Click Here to Manage Email Alerts
Key takeaways:
- Clinicians and patients expressed confusion and altered expectations about billing for electronic messages.
- Health systems should review the advantages and disadvantages before instituting policies.
Billing for electronic messages through the patient portal can cause confusion and create communication barriers between clinicians and patients, according to study results.
Interviews revealed patient expectations changed because of billing, and clinicians feared people might not share pertinent medical details due to monetary concerns.
“The findings highlight just how much primary care physicians care about their patients because they realized how important the patient-physician relationship can be,” Jordan M. Alpert, PhD, health communications scientist at Cleveland Clinic, told Healio. “Physicians wanted to maintain an open, healthy relationship and feared that patients would view interactions with them as ‘transactional’ if billed for asking a question.
“Although patients were generally accepting of the billing policy, there is potential for patient behavior to change in response,” Alpert added. “At the prospect of being billed, patients expected faster, more detailed replies from physicians. These expectations can have implications for the health system and for physicians.”
Background and methods
As Healio previously reported, patient messaging through portals increased 157% during the COVID-19 pandemic.
CMS approved billing for messages clinicians had to make medical decisions about and required at least 5 minutes of their time, according to study background.
Several health centers instituted billing practices since then to reduce burdens on clinicians and increase revenue. Cleveland Clinic started billing in November 2022.
“When policies to potentially bill patients for sending medical advice messages were first introduced, there were a lot of instant, anecdotal reactions from both patients and physicians on the subject,” Alpert said. “We wanted to conduct an in-depth analysis to better understand how patients and physicians truly felt about the policy now that they had some experience with it, and whether their attitudes and approaches to messaging their providers have changed.”
Alpert and colleagues conducted interviews with patients treated at Cleveland Clinic who had sent a portal message. All patients had a primary care visit between June 2021 and April 2023 and sent a secure portal message.
Researchers invited 52 patients to participate, and 13 agreed (mean age, 58 years; 69% white; 62% women).
Investigators also interviewed randomly selected clinicians from Cleveland Clinic’s primary care directory. They invited 49 clinicians to participate, and 16 agreed (average years of experience, 13 years; 63% women).
Opinions on billing of electronic messages served as the primary endpoint.
Results and next steps
Researchers identified multiple themes among responses.
Patients had negative initial reactions to billing for electronic messaging but also understood the rationale.
“I am feeling torn about the fee,” one patient told researchers in an interview. “Everyone’s time is worth something. I feel it should be based more on the purpose of the message.”
Clinicians said they hoped billing helped patients understand the value of their time and expertise, and that they would be charging for office visits to answer the same questions.
Both patients and clinicians expressed confusion regarding billing criteria. Patients did not know how long a question might take to answer. Clinicians felt uncertain how to charge for multiple queries, or if they should differentiate between follow-up from a visit or a new issue.
Both parties had altered expectations due to billing, as well.
Patients viewed fees like a subscription service, which entitled them to quick responses. Clinicians voiced concerns about their patients not detailing their problems in full for fear of fees.
“Part of the reason I’m in primary care is that I know my patients and I want them to feel [like they can reach me],” one clinician told researchers in an interview.
Responses indicated clinicians and patients could change their behaviors due to billing. Patients may seek to book an office visit instead. Clinicians worry about charging individuals who may not have the means to pay.
“If I know that historically [a patient] has had a hard time paying bills, I would be less inclined to bill that patient,” one clinician said in an interview.
Alpert acknowledged study limitations, including its single-institution design and the potential for selection bias.
Alpert and colleagues suggested automated billing could help, and education for all parties would be beneficial.
“Most of the messages our patients send their physicians and other advanced professional providers through MyChart are handled quickly and without medical decision-making, and won’t be billed,” Alpert said. “Our providers receive an average of 130,000 MyChart messages each week. So far, we have billed 1% of these messages each week.
“Digital health is an important part of the care delivery model and may be more convenient for patients,” Alpert added. “MyChart messaging is an additional way patients can access care, in addition to in-person appointments and several virtual visit options.”
For more information:
Jordan M. Alpert, PhD, can be reached at alpertj@ccf.org.
Collapse
Read more about
Click Here to Manage Email Alerts