Should providers charge patients for portal access?
Patient portal adoption among healthcare organizations is growing, in part because of the Stage 2 meaningful use requirements for patient engagement and in part because an increasing number of Americans like the idea of being able to connect with their healthcare providers digitally.
But the fact remains that adopting a patient portal is still a costly investment. And with the costs of running a medical organization rising, practices are looking at ways to pay for technology.
Some providers are exploring charging their patients to use a patient portal, an option that raises ethical and practical questions. For example: Is it right to charge patients more money than they're paying already? Or, is it only fair considering they're reaping major benefits from being able to e-mail clinicians anytime and schedule appointments online?
The answer, it seems, depends on who you ask.
The cost-benefit analysis
"The portal charge represents an incremental and recurring revenue stream for the practice in an era of challenging financial pressures like rising operating expenses and decreasing reimbursement," said Stephen Armstrong, senior vice president for Hello Health, in an e-mail to Healthcare Dive.
Hello Health has gotten a lot of attention for its business model, which is centered on providing medical practices with a portal as part of its integrated health platform in exchange for a $69-per-patient ($99 per family) annual fee (practices get 25% of the fee).
"Should a patient pay for a portal? It comes down to the value that the portal offers the patient and that value is in large part driven by the joint participation of the practice and the patient to adopt it as a primary means of communication together," Armstrong said. "Scheduling appointments online, sending and receiving secure messages, receiving summaries of a visit and lab results, maintaining a personal health record with data shared by the doctor, receiving targeted educational content, keeping your doctor aware of your health life between visits, having a video consultation—these are some of the ways value is generated for the convenience of the patient and their wellness."
Such is the case at Ottenheimer Health, a New York, NY-based private practice that uses Hello Health's portal and gives patients unlimited e-mail access to physicians and lots of other perks—but only for that $69 a year. However, to sweeten the deal, physician Deborah Ottenheimer, who runs the practice, offers a 30-day free trial.
"Many, many practices in NYC charge patients some sort of additional fee for out of office contacts," Ottenheimer said in an e-mail. "It may take the form of a membership… or a per encounter charge. Providers are very, very busy, and patients don't realize how time consuming the phone tag and prescription call-ins are in the larger scheme of things. We have entered into an era in which insurance really just covers the basics, for both patients and providers. The extra conveniences of fast access to providers, electronic communications, digital lab results, etc., take time on the part of the provider, are not reimbursed by insurance companies, and is a burden that the patient needs to share."
Yet for physicians who aren't charging, the fear that some patients may be resistant to paying a fee is a legitimate one.
OBGYN Michael Salesin, who practices at Walnut Lake OB/GYN in West Bloomfield, MI, told Healthcare Dive that more than 90% of his patients, or about 4,000 people, have enrolled in his practice's cloud-based Cerner patient portal (for which his practice pays a small monthly fee). But after receiving the benefits of a portal for more than four years for free, he is concerned that the idea of paying for the service might be a turnoff.
"We have a given expense for our technology and we do pay a small price for the cost of the portal," says Salesin. "We feel it is an incredibly important part of the patient experience."
Also, he adds, the portal already pays for itself because it saves his practice money on labor and paper costs.
However, if there is a huge uptick in the number of patients who want e-mail-based consultations or answers to medical questions, he isn't opposed to exploring the possibility of charging a fee for his staff's time.
"It's still not at a point where it's so difficult to deal with," says Salesin. "If it got to a point where patients were avoiding office visits and it were taking up a lot of our time, it might make sense to implement some sort of charge for it. Right now, I feel so strongly on not wanting to charge patients for it."