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Motivated to reduce the number of messages physicians respond to, many health systems now charge patients for sending emails.
Why it matters: Health system executives want to compensate providers for their time answering emails, according to a report by KFF Health News.
Email messaging physicians and other clinicians exploded during the Covid-19 pandemic. Some health systems saw a 50% jump in patient emails, with primary care physicians facing most of the burden.
Who’s in: Some of the nation’s top health systems have adopted billing for some e-visits, including Cleveland Clinic, Mayo Clinic, San Francisco-based UCSF Health, Vanderbilt Health, and the U.S. Department of Veterans Affairs.
By the numbers: After UCSF started charging in November 2021, the rate of patient messaging dipped, but only by about 2%.
At Cleveland Clinic, only 1.8% of eligible email visits are billed to patients.
- Cleveland Clinic has three billing rates based on the clinician’s time to prepare the message — five to 10 minutes, 11 to 20 minutes, and 21 minutes or more.
Yes, but: Patient advocates worry that billing for e-visits could reduce patients’ access to care. Particularly, e-bills could impact medically and socially vulnerable patients. It’s a concern shared by many healthcare professionals, too.
Also, there are questions about price transparency — whether patients know if or how much they’ll have to pay for an email visit. Costs vary depending on their personal health plan’s deductibles and copays.
What they’re saying: “It’s been a frustration for many physicians for many years that we weren’t reimbursed for our ‘pajama-time’ work,” said Sterling Ransone, the chair of the American Academy of Family Physicians’ Board of Directors. Ransone’s employer in Virginia started billing for e-visits in 2020. “We do it because it’s the right thing for patients. But rarely do you see other professions do all this online work for free,” he said.
“We see physicians working two to four hours every evening on their patient emails after their shift is over, and that’s not sustainable,” said CT Lin, the chief medical information officer at the University of Colorado Health, which has not yet adopted billing for email visits. “But we worry that patients with complex disease will stop messaging us entirely because of this copay risk.”
Go deeper: Read more about charging email fees at KFF Health News.
