Digital communication improves care, but payment still elusive

By Jonah Comstock
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CampusMD doctor A qualitative study by Weiss Cornell Medical Center found many benefits to digital patient-physician communication.

A new qualitative study from Weill Cornell Medical Center, published in Health Affairs, suggests that physician-patient communication by email or a secure patient portal offers significantly more advantages than disadvantages. However, the study authors speculate adoption of electronic communication is stymied by the lack of reimbursement under a fee-for-service model.

"We identified a number of organizations that use electronic communication extensively for clinical care. They reported that their experiences with electronic communication were, on the whole, very positive," Dr. Tara Bishop and colleagues write in the study. "Unfortunately, traditional payment models are not equipped for a shift from care provided predominantly in the office to care provided electronically. Until different payment models emerge that compensate practices for nontraditional models of care, electronic communication is unlikely to be widely adopted by physician practices."

The study authors identified 21 practices around the country that made use of electronic communication to augment face-to-face patient care and spoke to each of them. They then conducted more in-depth interviews with physicians from six groups: Colorado Permanente Medical Group, Eisenhower Primary Care 365, Fairview Health Services, Group Health Cooperative, the Palo Alto Medical Foundation, and Southcentral Foundation. They were chosen from a larger sample because they all used electronic communications extensively and varied in size, location, and payment models. Four groups had a fee-for-service model, while two had a negotiated budget payment model.

The groups all used electronic communication to allow patients to request prescription refills, schedule appointments, and ask questions. Many of them used it more extensively, including a full "e-visit" program in some practices.

Not all 21 respondents were asked all the same questions, but 14 doctors said electronic communication was convenient for themselves and patients and 18 said it resulted in higher patient satisfaction than just having face-to-face visits available. In addition, doctors said that having their patient communication in electronic form left a paper trail which improved both efficiency and quality of care. The only disadvantage identified by the authors was the creation of more work for physicians, who might receive messages at any time. This was mitigated in some practices by having nurses and other staff members triage communications.

However, doctors in the study had trouble finding a viable payment model for electronic communication, partially because the dominant paradigm is to offer it for free. One hospital group had a $60 fee for electronic communication, but had to drop it because their competitor offered those same services for free. Another practice told the authors that health plans refused to pay for e-visits because they felt doctors would conduct them anyway.

As the medical system moves away from fee-for-service reimbursement and toward accountable care and patient-centered medical homes, the authors suggest electronic communication with patients could become more viable.

In May, Manhattan Research looked at how many doctors are making use of digital communication. In their latest survey of 2,950 physicians, the firm found that nearly half of doctors "had done some sort of email or electronic consultation with their patients."

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