E-mail good for patients, not so much for docs

There was an interesting article in the Portland Business Journal a few weeks ago which intimated that as physicians increase their use of e-mail with patients, their incomes may decline:

For physicians’ offices, e-mail between patients and providers may prove a mixed blessing.

Patients who use e-mail to communicate with their medical providers are apt to visit the doctor’s office less and are also less likely to phone the doctor’s office, according to recent data from the Kaiser Permanente Center for Health Research.

Technology usually means higher productivity and less work all around; if you run a business such as a help desk or service center email is great since each call you receive means extra expense. But, if you’re a doctor and you’re getting paid per patient visit it helps to have more patients coming into the office, not fewer.

the Portland Business Journal cites a report by Kaiser Permanente Center for Health Research which indicates that patients who consult with their physicians via e-mail are less likely to visit their physician and less likely to call their doctor’s office. Kaiser reported a decline of almost 10% in office visits for patients who use e-mail (the bad news). The good news is that also report that patients who use email did not call their doctors’ offices as much (as we all know docs don’t get paid for phone calls so a reduction there is a good thing).

Of course patients making fewer doctors visits is great for insurers and employers but for docs who depend on office visits to help maintain their incomes it’s actually a wake up call to make sure they give due consideration to whether or not e-mailing is such a good thing. If they care only about their patients, it’s a great idea; however, if they also care about their income, well, that’s another story.

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6 thoughts on “E-mail good for patients, not so much for docs

  1. 2 possible solutions:

    1. Create a fantasticly complicated mechanism (complete with a software solution) that allows providers to charge payers for email managed health incidents.

    2. Pay the provider on retainer and measure success with a well population.


  2. I think we will see a change over time in the definition of “patient visit” to one more inclusive of virtual encounters. The issue they are describing shows the need to evolve the business model, and is only going to be a disaster for providers who want to cling to a system in which their convenience has been more important than that of the patient. Per-incident billing for virtual support encounters is a problem for which the algorithms are straightforward and relatively uncomplicated. It’s a political rather than a technical problem.

    To me a bigger issue is security. I would absolutely forbid email that is unencrypted and unsigned. Since most people don’t know how to do that, it does rule out email for the time being. In exchange I would provide a secure Web form where patients can enter the same information and questions they would put in an email. That approach allows better validation of patient identity.

    The nice thing about virtual encounters from a provider perspective is that most of them can be handled by a PA or nurse. The doctor can still sign off and be the responsible party. The cost to third party payers would be lower – it should not be zero as it is now in many cases, but again that is a business model problem that is easily solved (politics aside :-).

    Maybe the situation is different elsewhere, but I live in a place where physicians abound, and most are not worried about finding patients. Instead the concern is how to handle more patients in the limited time available with the same or better quality of care.

    I hope the third-party payers come around on this and work out a win-win solution.

  3. I could see how this could cut into visits, and therefore doctors income. But as you mentioned, doctors don’t get paid for phone calls either, which cut into their time and money. Emails are much shorter and to the point and could be answered by doctors at their convenience, which may save some the doctor some money.

    Also, helping a patient through an email may prevent an otherwise scrupulous visit and save the patient money. This would translate into greater patient satisfaction, better patient retention, and possible recommendations to other patients.

    A solution could be to charge a small fee for emails. But in the long run, I think it all equals out.

  4. Not everyone would necessarily use this system right away anyway. More than half the people I know with diabetes don’t even use e-mail. I can see how 5 years down the road this would be more accepted and widely used. Thanks for the updates.

  5. Perhaps a system founded on the basis of Universal Healthcare would result in more visits to the doctor’s office.

    It’s no secret that people in the United States don’t seeking professional healthcare, even when needed due to financial related worries and reasons.

    Canadians often complain of long wait times when visiting the doctor, clinic or hospital. Could this be because Canadians don’t have the financial drawbacks that their neighbors to the south have?

    It seems that Universal Healthcare results in more and more people going to the doctor. Universal Healthcare most definitely results in increased early detection rates, which helps to cut treatment costs substancially.

    But wait, aren’t extended treatments a result of late detections which greatly contributes to the United States being the richest country in the world!

    Personally, I don’t think our nation’s policy makers want to adopt such a system as Universal Healthcare. There’s simply not enough profit in it.

    What’s your opinion?

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