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No one is billing for answering portal messages except primary care physicians


Even within primary care, very few physicians are charging for answering portal messages as allowed by Medicare

Doctor responding to portal messages: ©Halfpoint -

Doctor responding to portal messages: ©Halfpoint -

During the COVID-19 pandemic, Medicare initiated a significant policy shift, announcing that it would compensate health care providers for the time spent managing patients' digital messages through "e-visits". While these asynchronous patient portal messages received less attention compared to video and phone telehealth visits, a recent study suggests they've become a staple in the health care routine of millions of older Americans under traditional Medicare.

Conducted by researchers from the University of Michigan and published in Health Affairs Scholar, the study reveals the utilization rates of e-visits among the elderly population. Among the findings, approximately 1% of older Americans with traditional Medicare have engaged in patient portal messaging significant enough to prompt billing to Medicare for the provider's time. However, these billed e-visits represent a mere 0.05% of all visits aimed at evaluating or managing health conditions in this demographic.

Primary care providers accounted for roughly half of the billed e-visits, with the majority revolving around assisting patients in managing conditions like high blood pressure or diabetes. Following an initial surge at the onset of the pandemic, the rate of billed e-visits stabilized, indicating a sustained integration of digital messaging into health care delivery.

Dr. Terrence Liu, lead author of the study and a National Clinician Scholar at U-M’s Institute for Healthcare Policy and Innovation, highlighted the need for further research to optimize the utilization of e-visits, considering their implications for provider workload, patient outcomes, and clinic operations.

A key challenge lies in aligning the reimbursement policies with insurance coverage, as the variability in coverage may deter providers from billing for e-visits, potentially impeding patient access to this mode of care. Liu said there is a need for understanding patient portal usage patterns and their impact on health care disparities, urging comprehensive investigations into these aspects.

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