To Message or not to Message: that is the Question

Aug 16, 2023

It’s been months of debate and controversy surrounding what to do about the ever increasing rates of patient portal messages. Healthcare is adept at finding ways to charge for things. And so, along come patient portal messages and this line from this recent article from STAT:

“Introducing fees might remind patients that there’s a human on the other end of the patient portal who has to spend time answering each question, pushing them to “pause and think before they send a message.“

Friendly reminder: There’s also a HUMAN (aka the patient) sending the message in the first place who is often:

confused and desperately seeking answers
struggling to navigate barriers to care, i.e., prior authorizations, missing referrals, insurance denials, out-of-network care, etc
scared of concerning symptoms, treatment side effects, disease progression
trying to determine whether they need to come in for an appt or go to the ER

The healthcare industry has been seeking the holy grail of patient engagement for decades and yet, here we have a prime example of successful patient engagement that’s growing at scale and we are being “reminded to not overuse it”. [Head. Desk.]

It is disappointing to continue to see that the best solution we have to increasing numbers of portal messages is labelling them as a patient overuse problem and just billing for them.

We need to seize the opportunity to incorporate more tools to better support patient engagement and patient autonomy by way of:

telehealth and virtual care
peer health support communities
digital heath tools
RPM
patient-reported outcomes
AI powered predictive decision support interventions

This means we need policy levers and reimbursement frameworks to enable access to said solutions.

Some messages, IMO, should be billed for. I frequently send detailed messages on behalf of the patients I support. Many are not basic questions but intricate messages. It’s unsustainable to think this can be supported. But without access to the aforementioned solutions above, the alternative is having patients call the main office lines and leave lengthy messages with the receptionist or voicemails.

There are more strategic ways of supporting real-world, asynchronous and remote patient engagement than simply billing for portal messages.

Questions that are top of mind:

In cases where patients are being charged for sending certain types of messages, are the doctors answering said messages receiving the benefits of direct compensation?

What time are messages being sent?

during office hours?
weeknights?
weekends?
holidays?
post-discharge?
lunch hour?

What is triggering the message being sent?

The usual? (refills, scheduling appts, referrals, insurance denials, etc)
Treatment related side effect questions?
Disease/condition progression concerns?
Is it serious enough to come in/go to the ER?
Angry venting/complaining due to barriers to care?

We have much to consider and significant opportunity for growth when it comes to solving for increasing volumes of patient portal messages.

To Message or not to Message: that is the Question

Related Article

Patients Can’t Wait: It’s Time to Unblock Health