Electronic communications between patients and physicians don't have to contribute to physician workload if you use the technology properly.
The results of a study published in Health Affairs indicate that electronic communication between physicians and patients improves the patient experience. However, it is a double-edged sword — the added communication contributes to physician workload.
Michael Nusbaum, MD, medical director of The Obesity Treatment Centers of New Jersey, agrees with the study findings regarding improving the patient experience. It’s the added workload portion where he sees things differently.
“I actually think it does the opposite,” Nusbaum says. “If it’s done properly, it actually reduces your workload.”
He’s not alone in his opinion.
“Our patients love it,” offers Bradley Block, MD, with Block, Nation, Chase & Smolen Family Medicine in Florida. “[Electronic communication with patients] has worked out very well from the perspective of all of our docs.”
Doing it properly
Nusbaum and his colleagues use the MedXCom provider and patient apps that enable secure HIPAA-compliant instant messaging through MedXCom Patient. Patients are able to download the MedXCom Patient app in the iTunes Store and communicate directly with practice physicians at any time.
“All my patients download the app on their phones,” Nusbaum explains. “And whenever there’s an issue, instead of calling in and having a lengthy conversation, it’s easy for them to just text a quick question.”
That’s not the way it used to be. Previously, patients would phone in to speak with Nusbaum, and ask him questions about diet or nutrition. He found himself on the phone having to explain that the patient would be better off speaking to the dietician or nutritionist about that.
“Now, they just text me, and I say that’s a good question for the dietician,” he explains. “I’ll text her, and speak with her the next day in the office. So, I’m able to really reduce my workload.”
Block uses the eClinicalWorks Patient Portal that enables patients to communicate with their physicians and access important information over the Internet, and his results have been the same.
“It saves time because I can send messages to patients without any delays or extra work on my nurse’s part, and I can respond to patient messages whenever I have time instead of waiting on my nurse to check their voice mails and create messages for me,” Block explains. “It definitely streamlines and improves the process of communicating with patients, and utilizes a lot less staff time.”
Nusbaum says that in addition to saving time, using the MedXCom Patient app has provided tangible monetary benefits. From the perspective of pay-for-performance and the patient-centered medical home, Nusbaum knows that a patient readmission or trip to the emergency room counts against him.
“If my readmission rate is higher than the next surgeon, then potentially my reimbursement is going to go down,” he explains.
In the past, if a patient said his or her wound was red and swollen, Nusbaum would have the patient go to the emergency room so it could be examined properly.
“Now, I just say, ‘Well, use the app and let me take a look at it,’” he explains. “And they put the app up against their wound, I can see it and, if necessary, prescribe an antibiotic — which is all they probably would have gotten anyway had they gone to the emergency room.”
Another plus with MedXCom Patient is that the conversation with the patient is recorded, allowing for transcription. Nusbaum says that enables him to bill for the telephone consultation if the patient is not admitted or seen in his office within a certain period of time.
“That increases your revenue,” he says. “It’s not like an attorney who can charge $500 an hour — I think it comes to about $30 an hour — but it’s some kind of reimbursement for conversations which, in the past, you would be uncompensated for.”
Both physicians agree that patients have readily accepted the boundaries and understood the guidelines associated with the electronic communication.
“We made sure to post a reminder at the portal log-in web page, and on the initial ‘web-enabled’ information for patients, that the portal is for non-urgent medical concerns,” Block states. “They know that [the portal] should not be used for a potentially unstable or urgent health issue.”
Nusbaum echoes those thoughts.
“There may have been one or two patients who initially were messaging me more than anybody else would,” he says. “But these are the same patients that would have been calling me on the phone and chewing my ear off for an hour. And I was able to limit it by saying, ‘This is really more appropriate to be speaking about this in the office. Let’s set up an appointment for you to see me.’ And that’s easier to do in a text message than it is to do on the phone.”