Billing patient portal messages means fewer messages, somewhat satisfied providers
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Key takeaways:
- Patient messaging through a portal is an effective way to communicate but can lead to increased administrative burden.
- Billing patients for these messages could mean a balance for providers but reduces messages.
Billing patients for their messages in a patient portal led to a moderate reduction in questions for one large integrated health care provider but was generally accepted by clinicians, according to the results of recent research.
A survey of clinicians who participated in the program found that a slim majority said they were “satisfied” or “very satisfied” with the billing of certain patient portal messages as e-visits, while more than two-thirds said the billing process took little to no effort to complete. However, more than two-thirds of clinician respondents said that e-visit billing did not reduce the amount of time they spent responding to patient portal messages.
In recent years, communication through patient portals has notably increased, Shannon M. Dunlay, MD, MS, a cardiologist and researcher at the Mayo Clinic, and colleagues wrote in their observational study published in Annals of Internal Medicine. There has been a reported 157% jump in these messages since the COVID-19 pandemic. In response, some facilities have implemented programs that allow clinicians to bill patients for responding to any messages that require significant medical decision-making through the virtual visit.
“The ability to electronically communicate with providers is convenient for patients and has been increasingly adopted as a method to obtain clinician feedback about medical issues in lieu of an office visit,” Dunlay wrote. “As a result, many providers spend several hours a day, often outside of regular clinical hours, responding to portal messages. Responding to patient portal messages has increased provider and care team burden.”
The researchers conducted a retrospective observational pre-post comparison and prospective survey within the Mayo Clinic’s large integrated health system, including sites in four U.S. states, that implemented e-visit billing from August 2023 to February 2024.
The researchers found that, in the 6 months after initiation, clinicians billed a relatively small percentage (0.3%) of these messages. Also, patient-initiated messages dropped by 8.8% (1,813,818 to 1,653,708) compared with the same 6-month period from the previous year.
Dulay and colleagues reported no difference in emergency services use among patients who sent a portal message compared with those who did not after they viewed the billing disclaimer.
They additionally wrote that, overall, providers accepted the billing but also raised concerns about an increased workload. However, 69.2% of providers who responded to the survey said that the process of billing for virtual visits “took little to no effort to complete,” and 50.7% were satisfied with it.
“As digital health care practices continue to evolve, opportunities exist to optimize interactions to maximize patient satisfaction and outcomes and minimize care team burden and burnout,” Dunlay and colleagues concluded.
Perspective
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Far from the promises made regarding EMRs, the use of EMRs and patient portals has only added to physician’s workload; work that is almost universally uncompensated. Although modest, it is nonetheless encouraging to see research that demonstrates an opportunity to decrease physician workload and increase compensation.
To encourage patient and physician adoption of e-visit billing will require standardization of what types of portal messages would prompt an e-visit, what services are provided through e-visits, how much will patients be charged and how physicians will be recognized and compensated for their work. One challenge that will need to be addressed is how to incorporate e-visits into a physicians’ workflow. Trying to squeeze e-visits into an otherwise full clinic schedule is a recipe for failure. This study highlights these challenges and offers some hope that there are opportunities to make changes in the way health care is delivered and ease physician workload.
Perspective
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Dunlay and colleagues aimed to evaluate the effect of implementing a system in which bills are submitted for patient-initiated portal communications that meet the necessary criteria for billing. The main outcome measure appears to be the effect of this billing initiative on the volume of patient-initiated portal messages. Despite the modest decrease observed in patient-initiated portal communications in the billing group, the providers' perception of time spent on portal messages did not correlate; perhaps this reflects that they are viewing these communications as a service that deserves a higher standard.
The study did have some significant limitations. The authors mentioned the need to measure other forms of communication and also the actual time physicians spend on billed vs. unbilled communications. Effective triaging of portal messages will also play a significant role in filtering out those communications that do not require the direct attention of a provider. Needless to say, the insurance companies’ specific coverage policies for these services will bear a huge impact on their utilization. Another important consideration should be whether this initiative can maintain or perhaps even improve the safety and overall quality of care by incentivizing providers to thoughtfully respond to patient communications on a timely basis without as much of a bias toward requiring a visit while at the same time also helping patients to recognize and appreciate the value of these communications with their providers.
Notwithstanding the aforementioned limitations, portal communications are the prevailing trend in how patients communicate with their providers and have become a priority in the evolution of electronic health records/electronic medical records and other provider technology to help accommodate the growing need for the delivery of health care services outside of the exam room and virtual visits. How these services are handled from a reimbursement standpoint is crucial in terms of its sustainability, and I believe this study will help to open the door for further investigation.
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