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

Area of Science:

• Health Informatics
• Digital Health Communication
• Healthcare Management

Background:

• Patient portal messaging has significantly increased, prompting healthcare facilities to explore billing for substantive e-visits.
• This study addresses the growing need to manage and potentially monetize patient-initiated electronic communications.

Purpose of the Study:

• To evaluate the impact of implementing e-visit billing for patient-initiated portal messages.
• To assess provider perceptions and system-level changes related to this new billing model.

Main Methods:

• A mixed-methods approach combining retrospective pre-post analysis with a prospective provider survey.
• Comparison of patient-initiated medical advice message volume before and after e-visit billing implementation.
• Online survey assessing provider experiences and perceptions of the e-visit billing process.

Main Results:

• A modest 8.8% decrease in patient-initiated medical advice messages was observed post-implementation (P = 0.002).
• Only 0.3% of eligible messages were billed, indicating limited uptake of the billing system.
• No significant difference in emergency service utilization was found between patients who saw the billing disclaimer and those who did not.
• Providers reported general acceptance but raised concerns about increased workload associated with e-visit billing.

Conclusions:

• Implementing e-visit billing was associated with a slight reduction in patient portal message volume.
• The system was largely acceptable to providers, though workflow adjustments may be needed.
• Further research is needed to understand the broader implications on patient engagement and alternative communication channels.