The downfall of casual patient-physician interactions

A quick email here, a follow-up question there. These informal interactions used to be considered a standard part of care for patients in between physician visits. But the rise in telehealth, for all its benefits, has complicated this. 

Nowadays, patients can expect nearly every interaction with a physician, no matter how casual it may seem, to count as some form of billable "visit," Zoya Qureshi wrote in a March 30 piece for The Atlantic.

Why? Because telehealth's main benefit of making care more accessible has also been its greatest downfall, with physicians having little time to respond to a constant flow of patient questions or concerns sent through online portals. 

"These in-between interactions, once considered a standard part of care, are being reframed as separate services, many of which warrant additional charges. Having an informal relationship with your doctor is now just fiction: You get the care you pay for," she wrote. 

The story offers the example of a patient who had a five-minute phone call with his physician to ask a few questions after contracting COVID-19. The patient was satisfied after the call, but less so when receiving a $180 bill. 

"For a patient, five minutes is fleeting; for a doctor, five minutes on the phone generates a chunk of associated work, including reviewing the patient's chart, updating notes, and putting in orders for medications, tests, or referrals. Most doctors work for health systems that use 'relative value units' to calculate how they get compensated," Ms. Qureshi wrote. 

Physicians must get a certain amount of work done in order to get paid — essentially productivity points, Jay Holmgren, PhD, an assistant professor at UC San Francisco who researches asynchronous messaging, told The Atlantic. And charging for the influx of messages and requests is, in many cases, a part of that. Providers have been permitted to bill for both synchronous telehealth (video visits) and asynchronous telehealth (emails and messages) since March 2020. For some health systems, it's a way to recognize physicians' time spent responding to queries as actual work, and not something they're expected to do outside of working hours, Dr. Holmgren explained. 

In recent months, more health systems have moved to charge patients for requesting physicians' advice through online portals, such as MyChart. Such policies vary from system to system, and several have said a very small proportion of messages actually incur charges. 

"Ultimately, these bills for all encounters with a doctor are a more honest representation of how medicine works now than one in which a friendly doctor can field questions as a complimentary service," Ms. Qureshi wrote. 

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Whitepapers

Featured Webinars