One oft-heard complaint is how difficult it is for patients to talk to an actual physician.
The reasons are myriad, but the main factor is that doctors are not reimbursed for e-mail and telephone communication with patients.
A group in California is going to find out how badly patients would like to use e-mail as a communication tool. For an annual fee of $60, patients get the privilege of sending an e-mail to a doctor’s receptionist, who then forwards the message to the physician. The doctor’s reply follows the same onerous path through the receptionist.
It seems quite cumbersome for such a simple task.
That patients have to pay to ask a question through e-mail is, in itself, ridiculous. But that’s the scenario that the payment system has wrought. Now with Twitter gaining mainstream acceptance, I can envision an idealized scenario where a doctor can spend dedicated time on various social media platforms addressing patient concerns. I suspect that would significantly cut costs and increase patient satisfaction.
But, as long as physicians continue to only be paid via face-to-face visits, there is not much incentive to take that next step forward, and embrace e-mail and social media as a way to talk to patients.
Related posts:
- How Twitter can strengthen the doctor-patient relationship
- Can Twitter be used for doctor-patient communication?
- E-mail utopia fantasy
- E-mails and telephone calls to the doctor cut down on patient office visits
- Physician-patient social networking
- Hospitals are using social media, like Twitter, Facebook, and blogs, for advertising to patients
- Doctors and e-mail
{ 14 comments }
I would gladly pay for this service. Often times, I have questions that don’t require a physical examination and/or diagnostic test. I can call and ask some questions, but I don’t feel right asking in depth questions over the phone and via a nurse. My daughter’s pediatrician has been gracious enough to call us personally several times, but I know that he is not directly paid for this. I do not find it strange that he should be though, especially if it is a new issue and not a follow up question. At certain times, it would be wonderful not to have to go to the office, wait in the waiting room, and then wait in the exam room. I might suggest a smaller fee per question though. I would guess there will be some who would take advantage of the system and some who wouldn’t use it enough at a yearly flat fee.
I would also suggest that patients using email might be a benefit to the doctor too in that a patient would more likely follow up with results for the doctor with an email. In some instances, a physician has to assume a treatment worked. That may not be the case if a patient just goes directly up the chain and to a specialist or goes to another doctor entirely.
If my family’s doctors started doing Twitter, there’s a good chance I would follow them on that too to learn about more local health issues/ their responses to national health news. All in all, the more patient/doctor communication, the better in my opinion.
“…as physicians continue to only be paid via face-to-face visits, there is not much incentive to take that next step forward…” The technological milieu will force changes regardless of how badly doctors (or anyone else for that matter) want to cling to outmoded delivery and service models that have long passed the point of diminishing returns. New opportunities abound where doctors (and others) can reclaim their expertise for the benefit of others, to the betterment of themselves.
Chuck Brooks
FutureWare SCG
Anyone know if it’s possible to bill medicare patients directly for email access, while still maintaining “par” status as a medicare provider? I believe that this is neither covered nor bundled into an office visit, by medicare, and therefore separately billable.
Somebody please correct me if I’m wrong.
Thanks.
With what I currently know about the medical profession, this certainly sounds like a blunder from a diagnostics standpoint. Neither the patient nor physician will be able to do justice to the situation at hand, that is, providing a proper history/examination. Hopefully, e-mails won’t substitute a face-to-face visit anytime soon.
As you suggest, going through a secrectary sounds annoying. I can imagine it would be tempting for the Doctor to delegate emails to his helpers and still charge the same rate as if you were getting the services of an MD.
Since I already receive this service from my health plan I can’t say how much I would pay for it broken out. I suspect that it’s added at least $60 to our yearly premium, and frankly I don’t really want to know for certain!
I’ve emailed my doctor twice in the past two years. That would make each communication “cost” $60 under this plan.
I would probably prefer to purchase emails like a book of stamps. Maybe 10 emails at a time. so I’d pay $60 and get 6. If I was in the middle of some involved treatment or had a problem that involved a lot of test results that would be worth it I could re-up, if I continued on at my current rate I’d be set for six years.
I can email my oncologist directly but have to contact my internist by phone or a special website. Phone call means wasting time with the outgoing message (the inevitable "Please listen carefully as our options have changed…."), wading through the menu, sitting on hold for ages, talking to the receptionist, sitting on hold again or waiting for a call back, talking to the nurse, then waiting for another call back after she talks to my doctor. The website works OK if I don't need an immediate answer, but it's rather tedious to have to keep checking a website I don't otherwise visit just to see if I have a reply. However, I also understand why my doctor doesn't use email; she's practically drowning in patients & works long hours, so adding email would just be overwhelming.
I'm aware that docs don't get paid for email so if they give me their address, I use it sparingly and am very brief and to the point. In 4.5 years I've emailed my oncologist twice and my geneticist once, each time with brief questions that couldn't wait until my next visit but weren't urgent enough for a phone call.
Early on in the computer revolution, I was taught not to put anything in an email that you wouldn’t mind seeing on the fron page of the newspaper.
In other words, security and privacy were problems.
Has that problem been solved? To me, that’s the first hurdle. Payment is second.
Even the governor of Alaska in 2008 had here email account hacked!
-Steve
Reimbursement for telephone calls remains a real problem. There is, in fact, CPT codes for telephone calls. However, I have never met anyone who has tried to bill for them. It is true that telephone care is frequently not reimbursed by most health plans. There are many reasons including no RVU value assigned by CMS and that many plans feel that telephone care is a part of the normal peri-office care. Quite frankly the reimbursement (if you can get it) is so low that you would lose money trying to collect it.
To address Dr. Parker’s question. Yes, I believe the security question has been solved. However, not for everyone. Essentially you need to either be within a health care system that provides for something termed “secure mail”, which essentially provides you and your patient with a way of exchanging email securely, or you need to pay for a third party to provide such a service.
Finally, I personally allow many of my patients email access to me. However, people reading this should be aware that a physicians burden of time is multiplied across hundreds to thousands of patients. For those in primary care (family practice and such) this burden could become overwhelming quickly. For myself (an acute care surgeon and surgical intensivist), the burden is manageable but it still costly to my time. Also, recognize that all patients are not the same. I gave one patient access to me who underwent a minor procedure without any complications. That patient emailed me 5 times before surgery and 8 times after. I can’t imagine how many times I would have exchanged email had the surgery been complex or had any postoperative complications.
Finally, its well known that society allows lawyers to bill for every minute that they pick up a phone (no matter if they are talking directly to you or if they are simply talking to someone about you), but we have clearly decided that doctors cannot engage in the same practice of billing. That’s OK. But we need to be frank. We can’t ask our doctors to work any harder and continue to reimburse them less. So therefore there needs to be a better plan than simply asking your doctors to start responding to email all day and not pay them for it. New systems of health care need to be designed, but the mess that we are in now is so complex its almost impossible to figure out how we are going to clean it up.
JFS
In a free market, which medicine has not been for at least a generation, doctors and patients would be innovating new payment mechanisms and contractural arrangements to account for the time cost to the physician, even for any added liability risk.
Security would remain a problem. How secure is “secure” email? I can’t know as that is not my profession. I do know that security professionals declare things secure only to see them hacked later–happens all the time. So where it is really a concern, there must be continued unease about outsourcing the trust to third parties not directly under my doctors control.
One problem with the privacy issue, is that people will often not really care at one moment “I don’t care if I am leaving a hackable paper trail–it is just my blood pressure” and care a great deal at another when a different set of circumstances arise that they had not imagined might occur making the matter more salient.
The free market you speak of is emerging. A retainer physician has this covered!
How much will a doctor pay to not get your e-mails?
Security issues aside, One of the most important aspects of good medical care is communication. If a patient and doctor miscommunicate, it is the doctors fault (IMHO). We are required to make sure our message gets through. And conversely, we need to use all of the tools at our disposal to ‘hear’ our patients. Email is communication – plain and simple. And if we do not, as doctors, communicate with our patients, then someone else will. And again doctors will have missed the boat…BTW, how much would you pay to send snail mail to your doctor? And if he/she did not respond what is the consequence?
Kaiser Permanente already has this service, at no cost to the members. And the docs are paid a salary, so it is not an issue regarding reimbursement for them.
My wife is undergoing six weeks of chemo- and radiation therapy for cancer at Washington Hospital Center in DC. We’ve benefitted enormously from the medical oncology nurse practitioner’s eagerness and responsiveness via email. It is, in this case, part of the service, and I think it ought to be, but it’s certainly worth many dollars per week to us in saved time and peace of mind.
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