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If you wanted to talk to your doctor before the pandemic, you typically had to make an appointment in person. But the sudden and rapid expansion of telehealth means that patients typically can now text or email their healthcare providers.
“When you wanted to get a Zoom visit or an audio visit, you had to sign up for the patient portal, and I think a lot of people realized they could message for the first time” during the pandemic, she says A Jay Holmgrenhealth information technology researcher at the University of California at San Francisco.
Patients love direct contact with their doctors, so much so that their messages are overwhelming in doctors’ mailboxes. Now, some patients are being billed by hospitals or health systems for some answers to their message queries.
Holmgren has tracked down how the doctors spent more time during the pandemic managing electronic health records. Even after the lockdowns end, doctors were receiving over 50% more messages from patients than beforenotes in a research letter published in JAMA. That compounded stress for doctors already dealing with a pandemic, so they’re responding to emails after hours, essentially working for free.
« Doctors who get a lot of portal messages they tend to report being burnt outthey tend to report being more cynical about their work, they tend to report that they are considering leaving clinical practice,” says Holmgren.
Many hospitals and health care systems, from Johns Hopkins to Houston Methodist and Cleveland Clinic to Veterans Affairs, now charge patients for receiving clinical counseling over text. Such expenses are usually covered by Medicare and Medicaid, as well as most private insurance companies, although patients can incur fees, ranging from $5 to $75, depending on the type of plan.
Holmgren says the goal of charging for these messages was both to reimburse doctors, and to discourage patients from over-emailing. In reality, however, he says the new allegations haven’t solved any of those problems. His research shows doctors bill only a small fraction of messages, about 3%. And the move to charge them hasn’t reduced email volume. The fees led to slight decreases of about 2% in the number of messages.
“Adoption hasn’t been very high among our clinical workforce,” Holmgren says, in part because the billing for messages itself is complex and time-consuming. Furthermore, doctors do not want to alienate patients by charging them for communication.
In short, there is still no business model that supports the reality of how patients and healthcare professionals now talk to each other.
But Caitlin Donovan, senior director of the nonprofit National Foundation for Patient Advocate, says finding one is essential. It represents patients who are chronically ill or live in rural areas.
“We’ve realized over the past few years that telecommunications are a health issue,” Donovan says, adding that the ability to email doctors has been transformative for many patients: “Sometimes patients just don’t have the energy to make that call, let me come to the office by myself. » Plus there are people who live hours away from their doctors.
Donovan hopes the ability to email physicians can remain in place, without adding more cost to patients: « We’re balancing both this need to rapidly expand access and really entice providers to make it a part of their practice by looking to make sure it’s accessible and convenient 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. “It is an incredible privilege for me that my patients share their fears, concerns and questions with me and I can speak directly to them,” she says.
But it also has to be sustainable, Rittenberg argues, and what’s needed are better ways to screen the problem constant flow of messagesfilter administrative tasks and allow you to focus on answering clinical questions only.
Part of the challenge is the compensation model itself, the most common of which is what’s called a fee-for-service. Healthcare companies bill for each service performed by doctors and nurses. Rittenberg he says he wants to see payment schemes instead compensate doctors for providing general care, whether it’s in an office or through email.
He says it would give doctors and patients the flexibility to decide what works best for them. “Finding ways to make clear communications sustainable is really, really important,” she says.