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| Nina McCollum is using electronic communication to care for her 80-year-old mother. Daniel Lozada |
For Nina McCollum, it was a "slap in the face" when her clinic in Cleveland started charging for email communications between patients and doctors.
She relies on her electronic communications to care for her ailing 80-year-old mother, Penny, who is a cook. "She doesn't have money, so every $15 or $20 is a problem," she said.
Electronic medical communications and telemedicine have exploded in recent years, boosted by the coronavirus pandemic and the relaxation of federal rules regarding billing for these types of medical care. As a result, the nation's leading hospital systems, clinics, and healthcare organizations, including other groups such as the Cleveland Clinic, are turning to secure electronic portals such as MyChart to save time. We have started to charge a fee for responding to inquiries from patients.
According to the Cleveland Clinic, the number of emails he receives has doubled since 2019. But he added that he has been charged to respond to less than 1% of the roughly 110,000 emails the provider receives each week since the charging program launched in November.
But it's unlikely that at least a small percentage of patients receive medical advice via email, as a mere $3 out-of-pocket costs him $35 to $100, according to some agencies. It's new. they have shown in research. Some doctors said they were in the midst of a debate over fees, while others expressed concern about the impact of fees on health equity and access to care.
Eve Littenberg, M.D., a physician in charge of women's health at Brigham and Women's Hospital in Boston, said in a study examining the impact of medical communication with patients, female practitioners had a more significant communication burden. rice field. I understand.
"The high volume of messages combined with the expectation of a quick response is very stressful," said Dr. Littenberg. She remembers one day when she took her teenage daughter to the doctor. She was preoccupied with responding to messages from patients on the phone. She recently shortened her clinic schedule and cut her salary accordingly, freeing up a few hours after hours to handle other tasks such as messaging patients.
The Centers for Medicare and Medicaid Services in the United States introduced the Medicare Billing Code in 2019. The pandemic has prompted institutions to expand the reach of telemedicine, and hospitals have significantly expanded its widespread use.
Federal regulations stipulate that billable messages must be in response to a patient inquiry and take at least five minutes for her, effectively making it a virtual visit. Private insurers have broadly followed Medicare's precedent by reimbursing physicians for their e-mail services and may charge patient co-payments. Rising postage rates have created new revenue streams for several major hospital systems in the country.
Blue Cross Blue Shield says some state and local plans are making refunds to doctors' emails. But David Merritt, his senior vice president of policy and advocacy at insurers, said:
It's free for Medicaid patients, according to the Cleveland Clinic. Medicare beneficiaries who do not have an additional health insurance plan must pay a copay of $3 to $8. If the deductible is high or your insurance plan doesn't cover it, the clinic's maximum charges range from $33 to $50 per replacement.
Ms. McCollum and other clinic patients are given the option to avoid such charges by choosing to drop the query or request an appointment instead. McCallum continued to email on behalf of her mother. "It's crazy," she added.
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| Eve Rittenberg, M.D., an internist at Brigham and Women's Hospital, said: She recently cut back on her schedule to take a few hours to message her patients. Sophie Park |
Not all patient-physician interactions are free. Emails for simpler concerns, such as refilling prescriptions, scheduling appointments, and follow-up care, remain largely free. According to some hospital systems and insurance companies, electronic claims prompting correspondence correspond, for example, to medication changes, new medical problems or conditions, or long-term health changes. He charges the patient only once.
An unofficial New York Times study found that nearly a dozen of the largest hospital systems in the United States charge for some of the emails sent by healthcare providers to patients, or begin piloting their programs. doing. I am here. They say I'm here In addition to the Cleveland Clinic, this also includes the Houston Methodist. In Illinois, he is responsible for the health system at North Shore University, Lurie Pediatrics, and Northwestern Medicine. Ohio State University; Pennsylvania's Lehigh Valley Health HIS Network. Oregon Health & Science University; University of California, San Francisco and his U.C. his San Diego. and the U.S. Department of Veterans Affairs.
Other major hospitals are watching this pioneer of new billing practices closely, according to A Jay Holmgren, an assistant professor of medicine at the U.C.S.F.
The Health Insurance Portability and Accountability Act (HIPAA) allows physicians to send unencrypted emails or texts to warn patients about the risks of insecure channels. But to protect patient privacy, prevent hacking, and comply with other HIPAA requirements, most healthcare companies and organizations rely on cryptocurrencies like MyChart, which have become ubiquitous over the past decade. It depends on the currency. Varies by currency. Varies by currency. Discourage the use of unencrypted portals.
Hospital officials say young people are the most tech-savvy and may be addicted to app-based communications, but they are generally healthier and more likely to stay in touch with doctors. more likely. said to be of low sex.
“In my own experience, most messages are from individuals in their 50s and 60s. Perhaps they are more tech-savvy, have learned how to use the letters, and have access to screening and disease-related messages. Either way, the need is starting to grow: Daniel R. Murphy, internist and chief quality officer at Baylor Medicine in Houston, no longer charges for email.
Before the pandemic, Dr. Murphy found in his study that primary care physicians spent about an hour a day managing their inboxes. But a recent study by Epic Data, led by Dr. Holmgren, showed that the rate of patient-to-medical emails has increased by more than 50% over the past three years.
Dr. Holmgren said:
Many doctors and their assistants need more time to reply to patients during working hours. Doctors find themselves accommodating to such demands during "pajama time" before bed, says Anthony Cheng, M.D., associate professor of family medicine at Oregon Health & Science.
"We know this contributes to burnout," says Dr. Littenberg. “Burnout and the resulting decline in physician jobs is becoming a crisis for our healthcare system.”
Dr. Littenberg, in collaboration with her husband Jeffrey B. Liebman, an economist at her Harvard Kennedy School, studied the responsibility of the attending physician's electronic medical records at Brigham University. An article published in the Journal of General Internal Medicine in January 2022 found that female doctors spent more time responding to messages than male doctors and received more messages from both patients and staff. I was. she said. Write. she reports They speculated that this difference might help explain the higher burnout rate among women in the medical community.
Some physicians have reported cases of patients communicating frequently or continuously via online portals.
“People now expect these communications to be more text-like and get responses quickly,” she said. He said he sympathized with what may have been causing fatigue in the pandemic era.
Attaching fees to physician-patient emails can be a step toward recognizing the value of this particular practice. But another bill's addition has fueled the anger of some Americans who are experiencing "pandemic fatigue" and whose inflation, including rising health care costs, is weighing on their household budgets.
Marketing writer McCallum sells some of Cook's belongings online to raise extra cash to care for his mother.
Kedar Mate, Ph.D., chief executive of the Institute for Healthcare Improvement, a Boston nonprofit, said providers' email charges have reached a "very complicated and slippery slope" that exacerbates health inequalities. said that said it is possible. I was told it was sexual.
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| Kedar Mate, Chief Executive Officer of the Institute for Healthcare Improvement, said. Carlos Bernate |
Caitlin Donovan, senior director of the Patient He Advocate Foundation, says even small expenses can keep people on the payroll away from their paychecks.
"We write a lot of $5 checks to this organization," she said, referring to copays and other out-of-pocket medical subsidies.
Some point to exchanging messages as a time-efficient way to fill these gaps when patients have to wait months to see a specialist due to a severe shortage of doctors.
Letesia Montgomery, her senior vice president of system patient access at Houston Methodist, said:
Some patients believe that charging providers for their time and expertise is the only fair and valid use of their time.
Kacie Lewis, 29, is one of those people managing their health issues electronically. Her Etna premiums were high because until recently she worked as a product manager for a healthcare company. She said she was charged $32 for each of her three email threads asking for treatment for eczema and yeast infections.
“Time is money,” said Lewis. "And being able to turn in something very simple and get in touch with a doctor via email means it takes her over 20 minutes one way and over 20 minutes the other way and she's in the waiting room. Go by car. You can sit in it. Much better."
In his Jan. 6 paper published in JAMA, Dr. Holmgren and his colleagues stated that U.C.S.F. Health will begin billing him for his postage in November 2021 and will continue to provide patient mail to providers. reduce the number of The numbers have gone down a bit. The researchers suggested that it could be a result of patients' reluctance to be charged.
In its first year, the U.C.S.F. investigation charged her thread with 13,000 messages. This equates to about 1.5% of her 900,000 threads and her over 3 million messages. (Other hospitals bill her less than 2% of her threads, she told The Times.) For each claim, about $20 from Medicare and Medicaid, $75 from private insurers, and mail Fees cost her $470,000. takes. $5.6 billion in system revenue in 2021
Critics say that unless hospitals set aside work hours for patient inquiries and reward clinicians for their efforts, charging for a fraction of an email could lead to physician burnout. The U.C.S.F. has begun awarding physician communication “productivity points,” a metric used for rewards.
American Medical Association President Jack Lesneck Jr. said he supports email reporting as a way to adapt the medical model to a rapidly changing era.
