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  • Presentation

eVisits: Should We Be Billing for Portal Messages?

Description

Doctor Leah Gracie from Ascension Texas discusses the challenges and considerations of billing for portal messages in telemedicine during her presentation. With the rise in patient portal communications, particularly during the pandemic, Gracie highlights the increasing volume of messages and the associated burden on healthcare providers. She reviews historical data from institutions, noting a substantial uptick in messages since the implementation of the High Tech Act in 2009, and underlines the correlation between the volume of messages and the reduced work-life balance for providers. Gracie outlines the criteria established by CMS for billing e-visits, emphasizing the need for medical decision-making and patient consent. Many institutions are now billing for portal messages, with some reporting that a third of analyzed messages qualify as billable encounters. The presentation also reflects on the pros and cons of this billing practice, including the acknowledgment of physician time and potential reductions in unnecessary in-person visits versus possible patient dissatisfaction. Gracie concludes with recommendations for practices considering billing, stressing the importance of clear patient communication and the integration of technology for effective implementation. Despite varied uptake across specialties, the transition offers a new avenue for care delivery, transforming how providers engage with patients.

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Conclusions

  • The volume of portal messages has increased significantly, outpacing in-person visits, indicating a need for potential billing practices.
  • Billing for portal messages could provide compensation for unrecognized physician time spent answering patient queries.
  • The introduction of billing for eVisits aligns with the increasing usage of electronic health records and patient communication portals mandated by the HITECH Act.
  • During the COVID-19 pandemic, the rate of patient messaging increased by over 50%, leading to the establishment of new billing codes for eVisits.
  • Data from institutions shows that a significant number of portal messages may qualify as billable encounters, revealing previously missed opportunities for revenue generation.
  • Implementation of eVisit billing resulted in a modest decline in the number of patient messages but did not significantly alter visit rates or patient behaviors.
  • Billing practices for eVisits have had high physician acceptability, although actual billing uptake remains relatively low across specialties.
  • The financial implications of billing for portal messages vary considerably based on insurance coverage and patient demographics, raising concerns about access to care.
  • There are pros and cons to instituting billing for portal messages, including acknowledgment of physician effort against potential patient frustration and access disparities.
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