Electronic messaging via email and patient portals is an increasingly popular method that patients use to contact their physicians. Providers often cannot keep up with the volume of messages and are flooded with them. These real-world frustrations have been repeatedly expressed by doctors.
In recent months, a controversial issue regarding electronic messaging has surfaced. Should healthcare systems or providers charge a fee for responding to patient messages? Cleveland Clinic announced Last November, we launched a request for messaging consultations and found a list of health systems involved in similar practices last year.
While early billing practices largely resembled a fee-per-service model, some have proposed billing solutions that included charging patients a flat rate to cover all messaging. suggests, this may be factored into the total cost of all healthcare provided (such as the concierge medical model). Or it could be another narrower fee/subscription to cover more specific messaging needs between visits. Insurers can also develop compensation mechanisms for messaging (such as direct contracts). Especially since messaging could be a satisfactory and inexpensive alternative for patients to see their doctor while avoiding the overhead of an in-person visit.
With the looming possibility of charging patients to send messages, one question is clearly in my mind. Is it that the spread of electronic messaging will accelerate the trend towards concierge medicine?
to concierge
The Concierge Physician’s practice, as well as the message to the patient, increasingly commonMost prevalent in primary care, the concierge practice represents a model of care in which an agreed set of services are provided to patients under a subscription-based model. The patient pays the doctor a fixed fee upfront, usually over her one year or more, to cover all services provided.
Physicians participating in the concierge model often have small patient panels due to the guaranteed “subscription” revenue.in this way doctor’s noteconcierge medicine allowed him to earn more (seeing fewer patients) and enjoy more meaningful relationships with patients.
In theory, the concierge model gives patients more access to doctors without being bound by traditional appointment schedules and waiting lists. Smaller patient numbers provide greater flexibility, making it easier to see patients with acute needs. Messages and phone calls are often included as an advantage, as doctors are not constrained by clinic-based compensation structures. Messages can be delayed and asynchronous in response, much like replying to texts and emails throughout the day, so they can be the preferred means of interaction in many situations.
In an environment where healthcare worker burnout is rampant, gratuitous messaging with patients is unsustainable. As in all healthcare, compensation can be in the form of a fee per service or aggregated into a value-based or capita model.
My prediction is that the trend towards a concierge model, especially in primary care, will accelerate as a result of patient messaging becoming more prevalent. There will be an outflow of physicians from traditional clinics opting for a concierge set-up out of a desire to reduce burden and get better compensation. Although it is the most suitable model, we also expect more concierge models to be tested by providers in specialties such as pediatrics, psychiatry, cardiology, and endocrinology.
lingering question
Health system competition
As the trend toward private concierge models accelerates, health systems with extensive networks of ambulatory care will be forced to find ways to compete financially. They should create a system for providers to be compensated for their messaging, whether it involves direct billing or not.
A possible solution is that there should be a dedicated blocked time in the doctor’s schedule to allow time to respond to messages.Based on time spent responding to messages Physician salaries should be restructured as described in Line Salaries or Relative Value Units (RVU). Given the current American insurer and payer organization, it is impossible for the largest healthcare systems to move to a full concierge model. You must have a per-service fee or other capitation arrangement with your payer to cover your messaging coverage. You’ll likely need to hire more providers to make up for lost clinic time (not an easy task).
patient equity
Expanding the concierge model impacts health equity. While the wealthiest patients can already participate in the concierge model, a significant increase in market share for concierge practices will drive further inequities.
The premise of the concierge model is to reduce the number of patients seen by physicians, giving them time to respond to patient calls and messages. Primary care doctors are already in limited supply, so any attempt to reduce the number of doctors will only exacerbate the effects of shortages across the system. Over time, patients are classified into concierge tiers based on their ability to pay, and rates are set. As a result, more patients will be concentrated in already crowded clinics where they are more economically accessible.
in short
Responding to messages from patients is an additional responsibility for healthcare providers and currently unsustainable. Some systems have started charging for messaging, but doctors want to be rewarded for digital care provided. The concierge practice is an attractive model that allows you to incorporate messaging into your reward structure. Without a sustainable solution that balances the need to message patients and the time required to respond, physicians seek out concierge-like models of practice, presenting unique challenges to the healthcare system.
Logan Cho A medical student at the Icahn School of Medicine, Today’s MedPage’s “The Lab”.
