Emailing Patients: Profitable? Yes -- Here's How

Batya Swift Yasgur, MA, LMSW

Disclosures

June 13, 2012

In This Article

Efficient or Just a Lot More Work?

Many physicians feel that emails compound an already busy schedule by adding new tasks and obligations. "I have mixed feelings about emails," states Bill McCarberg, MD, Family Practitioner, Southern California Permanente Medical Group, Escondido, and Adjunct Assistant Clinical Professor, University of California at San Diego.

"Emails were instituted to facilitate ease of access to physicians, which promotes patient satisfaction," says McCarberg. "But the increased ease of access encourages some patients to email about potentially self-resolving issues or to use email when an office visit would be more appropriate. This adds a lot of pressure. I like patients being able to contact me, but there's no time to answer the emails."

A Cincinnati-based cardiologist who wishes to remain anonymous describes being overwhelmed by emails. "Now that the doctors have emails, my group has done away with the NPs who used to field routine questions, such as 'I just started a beta-blocker; is it normal for me to feel tired?' I'm drowning!"

Other physicians disagree.

"Email is a tool of convenience," says Allan Warshowsky, MD, a Rye, New York-based ob/gyn and integrative holistic physician in solo practice. "It has removed a great deal of my day-to-day burden and made it quick and easy to respond to patients' questions."

Matters of convenience are highly subjective. "It depends on the clinician's level of comfort in using email," McGraw comments. For example, typing speed is a factor, especially among some older people; younger people who have grown up with their fingers on the keyboard are "accustomed to technology and assume that it will be used in their professional -- not only their personal -- lives."

Extra Work Without Extra Pay

One of the major stumbling blocks to the widespread adoption of email is the lack of reimbursement. "The old model of reimbursement is structured around a face-to-face visit, with the expectation that follow-up (such as a phone call) is included." But the back-and-forth of emails and the number of email exchanges goes beyond the "ordinary expectations of reasonable follow-up," observes Jason M. Mitchell, MD, Assistant Director of the Center for Health IT at the American Academy of Family Physicians (AAFP).

On the other hand, many physicians report that the length of time they spend on the phone and amount of time they spend on "phone tagging" with patients --none of which is reimbursed -- are rarely factored into their comparison between emails and phone calls.

McGraw points out that skillful handling of emails should reduce, rather than increase, the time that providers are spending on unpaid follow-up by reducing the time spent on phone calls or phone tagging.

"I don't have time in my busy patient schedule to spend 10-15 minutes on the phone with each patient as I used to," says Warshowsky. "My emails with patients are short and to the point, and if they're getting too complex or onerous, I ask the patient to come in for an appointment."

Joseph C. Kvedar, MD, Founder and Director of the Center for Connected Health at Partners Healthcare in Boston, adds that "changes in reimbursement structures are afoot which will reward physicians for the efficiency of care they give to patients." He notes that emailing patients will be an increasingly important part of this transition.

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