At the onset of the pandemic, Medicare made a pivotal move, announcing its intention to reimburse healthcare providers for the time spent managing patients’ digital messages. This landmark initiative, which primarily focused on messages involving at least five minutes of medical decision-making, marked a significant shift in healthcare policy. While these asynchronous “e-visits” conducted through secure patient portals may have received less attention compared to video and phone telehealth visits, recent research indicates that they have become a routine aspect of healthcare for some of the 30 million older Americans under traditional Medicare. Approximately 1% of this demographic engaged in patient portal messaging, prompting their healthcare providers to bill Medicare for their time. However, these billed e-visits represented only a minuscule fraction (0.05%) of all visits aimed at evaluating or managing health conditions in this population.
The study, led by researchers from the University of Michigan and published in Health Affairs Scholar, revealed that nearly half of the billed e-visits involved primary care providers, primarily assisting patients with hypertension or diabetes. Following a surge at the pandemic’s onset, the rate of billed e-visits in traditional Medicare stabilised consistently until the end of 2022. Nonetheless, it’s important to note that a considerable volume of patient portal messages circulate daily without generating a bill, such as requests for prescription refills or updates on the patient’s well-being, which were not part of the study due to the unavailability of data without billing information.
The transformation in care delivery, particularly the increasing use of patient portal messaging, has significantly impacted the workflow of primary care clinicians. Dr Terrence Liu, the study’s lead author and a National Clinician Scholar at U-M’s Institute for Healthcare Policy and Innovation, emphasises the need for a deeper understanding of how such care modalities can be optimally utilised by both patients and providers. He highlights the potential implications on clinic operations, provider burnout, and patient outcomes. For instance, while e-visits offer a convenient tool for chronic disease management, they also pose challenges for clinicians, especially those managing large patient panels, as even a few lengthy e-visits can consume significant time not accounted for in their schedules.
To effectively handle the influx of patient portal messages, some clinics have implemented triage systems, assigning dedicated staff members to screen and allocate messages to appropriate responders. This strategic approach helps preserve physician and advanced-practice provider time for addressing inquiries that require their expertise the most. However, variations exist in how different clinics triage portal messages, underscoring the need for standardised protocols to ensure consistency and efficiency across healthcare settings. This discussion on managing patient portal messages presents an intriguing area for further research and development in healthcare delivery.
Despite the potential benefits of e-visits, concerns linger regarding the financial implications for patients. At the same time, Medicare covers e-visits and insurance coverage for such services varies, leading some providers to hesitate to bill portal exchanges to avoid passing costs onto patients. Dr Liu underscores the importance of further research to assess the impact of e-visits on overall healthcare utilisation and explore the content and outcomes of these interactions, particularly regarding chronic disease management. Additionally, it’s crucial to evaluate whether adopting patient portal e-visits exacerbates healthcare disparities, potentially widening the gap among patients with differential access to and proficiency in communication technologies.
More information: Terrence Liu et al, National trends in billing patient portal messages as e-visit services in traditional Medicare, Health Affairs Scholar. DOI: 10.1093/haschl/qxae040
Journal information: Health Affairs Scholar Provided by University of Michigan Health
