On Valentine’s Day, Meriter-UnityPoint started charging for some messages patients send through an online patient portal system. As health advocates, we believe this does not convey the affection necessary to foster health for all.
It is one more example of how our fee-for-service health care system does not work for patients or providers.
When patient portals were introduced over 20 years ago, the aspiration was to enhance “consumer-driven health care” by further engaging patients in their care. By many accounts, these portals have been wildly successful. Patients are able to access information about upcoming visits, get test results and communicate with their care team.
Research shows these portals improve patient decision-making, autonomy and even health outcomes. During COVID, use increased by over 50%. In an busy life with competing work demands and child rearing, patient portals have ensured continuity of care and preventive health when an in-person visit made little sense for patient or provider.
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When in-person visits are often only 15 minutes, the portals allow patients to ask follow-up questions. Messaging through the portals allows patients to update prescriptions, inquire about whether a visit is warranted, check in about new symptoms and check on vaccination status without needing to come in for an appointment or play phone tag with their provider’s office.
So what is the problem? Health systems can’t manage the volume — and unless they bill, this work is uncompensated.
We have enormous empathy for physicians who are burdened. Many providers are answering patient portal communications late into the night This is so common it is called “pajama time.” Providers put their kids to bed and then spend several more hours working. And some patients send excessive or inappropriate messages.
We agree that the system is broken, but transferring the burden to patients’ pocketbooks is not the solution.
The problem with billing patients for some patient portal communications is it puts the onus on patients to understand when they will be billed and make the determination if they can afford it. Most patients don’t understand the general complexities of their insurance coverage. The natural human reaction to possible financial impact is to avoid all portal communication. Early research has documented this association.
Patients will still need care. Billing patients will likely drive more traffic to understaffed clinics, leading to more access issues and even more inefficiencies. Other patients will delay preventive care and then seek care when it necessitates an urgent or emergency visit.
As health advocates, we know firsthand that health systems, similar to school and library systems, are carrying an oversized share of the burden for social isolation, poverty and other social service needs. But discouraging use of patient portals is not a solution.
Ironically, health systems are charging for portal messages they want to encourage — those dealing with health services — while not billing for some of the communications better suited for senior centers, Instagram and neighborhood gatherings.
So what is the solution? In an insurance-based system, many efforts seek to ensure value. The goal is high quality care at low cost.
These efforts include paying a flat fee per patient. Under this method, insurance companies pay for outcomes. A group of patients — some who need lots of care, and some who need minimal care — are bundled together to achieve desired quality metrics for all. This avoids the nickel and diming by airlines, hotels, movie theaters and now health care that is exhausting many of us.
Another solution is to bill insurance, and not surprise patients with a big bill. If insurance will cover it — great — they are paying less than for an in-person visit. If not, don’t try to collect from weary patients. The administrative costs of collecting $35 to $70 can’t really be worth it.
We feel health systems’ pain, and we advocate for a nuanced solution that encourages the healthiest behavior for patients with the least burden for providers.
Davis and Jacklitz are co-directors of the Center for Patient Partnerships at UW-Madison, which teaches health advocacy: patientpartnerships.wisc.edu, Sarah.Davis@wisc.edu and email@example.com.