Patient portals: no thanks for now

I recently read a blog post by Jennifer Dennard discussing an interesting electronic service for doctors and patients called Patient Point.  Apparently, it’s a service with strength in HIPAA-compliant doctor-patient communications. On one hand, I think this is a great idea. The concept of having electronic access to your doctor works well for most modern-day computer aficionados.  On the other hand, how does the doctor get reimbursed properly for time spent in this type of work?  If we’re talking about eliminating an office visit, but the work to be accomplished is basically an electronic office visit equivalent, then the payment to the doctor should remain the same.  How does this system allow the doctor to bill appropriately for potentially a lot of money?  Without such a clearly ironed-out rubber-meets-the-road provision, I think most private doctors will pass on this opportunity, which would then just be equivalent to an uncompensated time sink.

To further illustrate my point, about six months or so ago, I was excited to find CPT billing codes for telephone consultations, based on time spent providing healthcare by phone.  We tried billing this, for services rendered, to several patients’ insurance companies , including Blue Cross Blue Shield, Aetna, Cigna, and Medicare.  Every single one of these claims – each for about $10-$15 — were denied without exception, despite completely reasonable services rendered.  These phone conversations dealt with issues such as managing medication side effects, changes in current prescription medications, new prescription medications, and evaluating and managing new symptoms.  When we called in inquire with each insurance company as to the reason for denial, all said that while these codes existed for “some plans”, the specific patient that we were treating “unfortunately” didn’t have this plan feature.  All I can say is, yeah right.  I’m sure this is some type of loophole that makes the insurance company look good in some sense without actually providing any service to patients.

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.

About the author

Dr. Michael West

Dr. Michael West

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

7 Comments

  • Can they really respond with “some plans”?

    Things like this really make me sick when it comes to insurance billing. It makes no sense.

  • John, yes, absolutely they can. Each major payer uses about a 100 (it seems) different plans, which affords them a lot of flexibility in what they can tell you on the phone. Seems everyone has a different plan these days. We always have to call for specific details. It’s not transparent at all. Talk about a potential for insurance companies to take a huge advantage here…

  • Forgive the ignorant patient who has never gone to an individual doctor’s practice but always larger (and usually superlative) practices like UCSF, PAMF, Stanford, etc., but…

    How is having patient portal access (wherein I, as a patient, can see my data, my lab results, and my own medical data, along with a history of my clinical visits) taking away compensation from doctors? I get from that many doctors do NOT want to provide free electronic or telephone consulting to a patient about results or anything else – but how is doing this electronically any different from keeping a nurse on-staff to answer telephone calls? If I see an abnormal value in my lab test, I appreciate the ability to email my doctor (or his/her nurse).

    In my personal experience, the better large clinics and medical practices allow patients to call or email an advice nurse – or a doctor’s assigned nurse – to ask basic questions or clarifications about their care, symptoms, or lab results – in order to determine if they need to go back in to schedule another appointment – at no additional charge to the patients.

    While this scale of service may not be possible for individual practices, for those with 20, 50, 500 doctors… it is a service that ensures that 1) a doctor’s time (and the patient’s money) is not wasted, and 2) that if there is a real need, the patient will always return to that place first, because of the quality of service. The doctor/nurse who refuses to let me see my medical data online (if I am a returning patient) or triage even basic questions over the phone sends me, as a patient, the clear message that all they care about is money.

    As a patient, I expect a patient portal – to be able to see and view my lab results and other data online (in fact, I’d prefer to see my complete PHR, but that’s a discussion for another day). If a doctor isn’t willing to let me see my own data (to facilitate obtaining second opinions on serious diagnoses, if nothing else), and provide the most basic of triage services via phone or (ideally) online portals, that’s their choice, of course… but I won’t waste my time going back. There are other providers that have better service; perhaps they charge a little more per visit (with health insurance the way it is, it’s hard to tell), but that is a price I am more than happy to pay.

    Frankly, customer services such as these let patients feel like their doctors care more about the patients’ health than the patients’ money. I don’t begrudge doctors’ getting paid, but considering I get charged between $100-$600 for a 15-min doctor’s visit, I do expect that I get services from my clinics outside of the visits. Once again, I acknowledge that these services are perhaps outside the abilities of a small practice to grant, but for any larger-scale practice? I respectfully submit it’s not.

  • Hi Michelle. This highlights fundamental differences between small and large practices, salaried (university-level) and non-salaried (solo or small private offices with partners) positions, and portals that let you see your own test results (which I’m not currently aware of any that do this) and those that just give you access to ask a medical question (which may require an office visit to address) and perhaps see your diagnoses in list form. Also, if your doctor is contracted with your insurance plan provider, then by the contract, he or she cannot just “charge a little extra”. However, if they are really not contracted with your provider, then yes they can charge whatever they feel like and send you a bill or collect the whole thing up front and eliminate the billing altogether. Patients need to understand that medicine is a caring professional art, but it is also a business and needs to be run as such [unless the doctor doesn’t mind going bankrupt]. It’s not all about the money, but at the same time doctors need to keep some mature boundaries for services that can be reasonably expected. If you ever think something should just be included outside of an office visit because you paid your copay already at the time of the visit, I always advise calling your insurance company and ask them if it actually is included. Let them tell you the truth of insurance-supported medical models. That’s what concierge medicine was created for. Pay us $3500 annually per doctor, and I and every other doctor out there will answer all your questions by email, all you like.

  • I believe that Provider / Patient contacts via email or phone are best suited to the capitation reimbursement model. In a situation where a Provider receives a set PMPM for a panel of patients, he or she has the opportunity (in some cases) to conduct an electronic visit in lieu of an office visit. In this model, the Provider can become well-acquainted with the Patients (or at least the frequent flyers) and may be comfortable triaging the need for a face to face visit.

    In a model where the “group” or partnership accepts risk in exchange for the panel’s capitation – an electronic triage intervention can prevent a problem from becoming a serious and expensive inpatient episode.

    Additionally, some Patients are happy to eliminate a trek to the office. It is much more difficult for some than others to just get to the office.

  • Hi Wes. Agree with most of what you say. Unfortunately, most practices lose a ton of patients when they switch to a PMPM model. Furthermore, I’m happy to eliminate patient treks to the office as long as I could get a full insurance reimbursement for the services rendered by phone and email. So far, none of the insurance companies allow this and I have only very few patients willing to pay out of pocket for such.

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