- Billing for patient messages sent to providers has risen in the wake of the COVID-19 pandemic, according to a study published in JAMA.
- Charging for e-visits, or asynchronous messages that require medical decision making and take at least five minutes of clinician time over the course of a week, spiked at the beginning of the pandemic as health systems shifted to virtual care. But billing fell after the early pandemic peak before beginning to steadily increase again in mid-2021.
- More than 470 healthcare organizations billed at least 50 e-visits in the third quarter of 2022, an increase of nearly 40% compared with the same period in the previous year. The upturn suggests organizations now see e-visits as a long-term source of potential revenue, researchers said.
The pandemic forced health systems to rapidly shift to virtual care to preserve access, aided by loosened Medicare regulations that aimed to boost adoption and use of telehealth during the public health emergency.
But the shift also meant a spike in the number of electronic messages sent to providers. Clinicians argued the increase in messages overwhelmed their inboxes, pushing them to take on additional uncompensated work after-hours to handle the volume.
Charging for messages is controversial, as patients are unsure what kind of questions could result in a bill. That could discourage them from contacting their clinicians, according to the study.
Many health systems began to bill for e-visits to bring in revenue from the growing number of messages. The study found an average of 103,127 e-visit claims per month in 2020, which sank to 77,164 in 2021 and rose again to 100,541 in 2022.
Nearly 45% of claims were billed for five to 10 minutes of provider time, while about 15% were charged for 21 minutes or more, the research found.
The most common diagnoses for the five to ten minute code were acute sinusitis, urinary tract infection and acute respiratory infection. For the code that recorded the longer use of provider time, e-visits were usually linked to hypertension diagnoses.
“This variation may suggest that shorter, lower-cost messages may substitute for synchronous acute care, whereas longer, more complex messaging is more often an additional care touch point,” the study’s authors wrote.