Implementation of Billing for Patient Portal Messages as E-visits in a Large Integrated Health System.

BACKGROUND

Patient-provider communication through the patient portal has markedly increased in recent years. Some health care facilities implemented programs to enable providers to bill for responding to patient-initiated messages that require substantive medical decision making through an e-visit.

OBJECTIVE

To evaluate the effect of billing eligible patient-initiated portal messages as e-visits using a mixed-methods approach.

DESIGN

Retrospective observational pre-post comparison and prospective survey.

SETTING

Large integrated health system with sites in 4 U.S. states.

PARTICIPANTS

Patients initiating portal message threads and health system providers completing an online survey.

INTERVENTION

E-visit billing was implemented 18 August 2023.

MEASUREMENTS

The volume of patient-initiated medical advice message threads pre- versus postimplementation of e-visit billing was compared. Health system provider perceptions of e-visit billing were assessed using an online survey.

RESULTS

In the 6 months after e-visit billing implementation (18 August 2023 through 18 February 2024), the volume of patient-initiated medical advice message threads decreased by 8.8% (from 1 813 818 to 1 653 708) compared with the same dates the year prior ( = 0.002). A total of 5183 (0.3%) medical advice messages were billed. There was no difference in 7-day use of emergency services (emergency department visits or hospitalizations) in patients who proceeded with sending a message versus those that did not send a message after viewing the billing disclaimer on the patient portal. Providers reported overall acceptance of e-visit billing but expressed concerns about increased workload with the current process.

LIMITATION

Cannot assess changes in other forms of contact, including telephone calls.

CONCLUSION

These findings suggest that implementation of e-visit billing was associated with a modest decrease in patient-initiated portal message volume and was overall acceptable to providers in a large integrated health system.

PRIMARY FUNDING SOURCE

None.