Judging by the PMs I get, many patient questions can take a lot of time to answer. I think doctors should charge for their time. To avoid charges, I recommend patients:
• Save questions that require involved answers for scheduled visits. Although you think it is a "quick question," the answer may be more involved than you suspect.
• If you want an opinion of some study you've seen, email it ahead of your visit with a short note saying "I would like to discuss this at our upcoming meeting." Only email links to peer-reviewed articles in professional journals. Do NOT send articles from random internet sites (including mine! I always provide links to the peer-reviewed articles), or anecdotes from patients.
• If there are a lot of subjects you want to discuss, do send an agenda on the portal before the meeting. The doctor may want to put aside more time for the meeting.
• Do not ask for proof on a patient portal.
• Be as concise as you can be. Avoid giving unnecessary history- get to the point quickly. This is true for in-person visits too. We all want to tell our stories and need to be heard. But doctors are not therapists. Maybe join a patient support group for more empathy and emotional support. I have 3.
• Write your questions before your meeting, and take notes on the answers. Bring someone with you, if you can. You will always think of something you should have asked. If it is an involved discussion, ask for another meeting.
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Tall_Allen
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great advice @Tall_Allen for everyone to consider. As emergency funding COVID-19 falls away, I expect other medical systems will follow this practice. I’m getting my PCa care at UCSF and saw their notice about this policy change. I wondered if this was happening, but I’ve already maxed out my annual co-pay limit so it hasn’t affected me yet!
A most helpful post! I found documentation on the CMS website. ( unless this is changed post Covid….Hopefully they will be able to continue this) cms.gov/newsroom/fact-sheet....
1. It's good and reasonable if they do this properly.
I can imagine them doing this poorly at first... and insurance refusing to pay for it.... with the patient getting stuck with a large bill for useless advice.
2. It would seem to me they will generally get better advice from this forum. Certainly, it would be a better first stop.
And Tall_Allen, when you are willing and able to give someone fulsome advice here, it is implausible that anything a patient might get, via email or text, will begin to compare with the quality and utility of the info they can get here from you.
3. It might be interesting for Cleveland Clinic and UCSF patients to submit their Cleveland Clinic and UCSF questions and answers here for critical review by patients here. REALLY! I think that would be good all around. I think if Tall_Allen is willing to play, our home team will kick their but. LOL
By the way, if anyone wants to bring up HIPAA... HIPAA distills into: "Your health information is yours, not theirs"
In most of the largest medical institutions the patients portals are not managed by doctors.
They are usually managed by MA, RNs or RN practitioners.
The cancer center I deal with does not want patients to use the portal to report medical problems or ask medical questions. The portal is just for administrative or procedural questions.
If one has a medical problem or question they want the patients to call the clinic.
Since using the portal for medical questions produces a written record, I think UCSF and the Cleveland Clinic have found a way to charge the insurance for services which were usually done by phone calls without any charge.
I know this well because my wife, a pediatrician, received a lot of phone calls from patients when she was on call at home and she could not charge the patients or the insurance. This continue to happen in private practices all over the Country.
Epic is a multi-billion dollar company started by a smart woman and still privately held. Digital medical records and communications between doctor and patient have improved substantially because of technology, but there have been and will continue to be growing pains. Doctors were not trained to be data processors, and they are not fond of answering questions during a very busy day of constant distractions. Everyone is stressed, and Medicare wants to reduce the reimbursements while Rick Scott having stole his pile before becoming a pol wants to eliminate Medicare completely. Oh, sorry, this is a non-medical off-subject sort of digression. TA - great advice.!
when I worked on Medicaid issues, we did manage to get physicians reimbursement for phone calls but the rate was so low that it wasn’t worth billing. With the 2020 CMS policy I posted above, more practices will charge for this very valuable service.
I use My Chart at the Cleveland Clinic all the time, but I keep my questions as simple as possible. I haven't received the letter yet, but I hope they are clear on what they think they should be charging for. If they're going to nickel-dime us, it won't go over well.
The time spent managing phone calls and messages SHOULD be compensated.
Especially in primary care where there are few treatments or procedures, and time is everything.
I am so glad to see this. I am an RN and have seen some practices’ nursing staff cut to beyond bare bones because there is no compensation for the hours of phone triage. If this helps alleviate the one nurse for FIVE providers model that I am currently seeing, that will be amazing!
I agree generally with your assessment of using the patient portals. However, reaching doctors or any member of their staff between appointments can be almost impossible.
Obviously, articles and such should be discussed at appointments and long and complex questions cannot be addressed electronically. I have found that the majority of my interactions on portals is with MA's, PA's or nurses. They may have a word with the doctor and then provide the answer later. That has worked fine for me and they will tell me if it's something that needs to be discussed in my next appointment.
Unfortunately, sometimes waiting three months until your next appointment isn't feasible. My experience that a telemed appointment isn't possible either, unless it's an immediate or primary care clinic.
Perhaps there needs to be another mode for communication, similar to calling your insurance company's oncall nurse advice line, perhaps live chat, etc. which might give patients that direction on how to submit and get a response to a concern. We have more ways to communicate but they aren't always the best for how they are used.
Thanks for the tip that hospitals are starting to charge for patient portal questions. It was just a matter of time...
Agree. Problem is, a phone call rarely gets the person you need, live, but rather gets a person who tells you that other person will call you back... you means you need to be available at THAT time, whenever that may be.
That's always been the beauty of email to me: you get to it when you can and so does the other party, rather than needing the coincidence of both being available at the same time for a phone call. Phone tag is the worst, especially when it involves being on hold.
Seriously? Rick Scott is the former Governor of Florida and a current Senator from Florida. As the founder and CEO of Columbia/HCA, the nation's largest private for-profit health care company, he was responsible for the biggest Medicare fraud in history. As a Senator, he has proposed subjecting Medicare and Social Security to ‘review’ (potential elimination) every five years. That appears to have become a significant part of one party’s platform. Note: these are not political opinions, they are facts. Everyone on Medicare and Social Security needs to be aware of this.
I’m sure MSK in NY is employing the same as it relates to portal e-mail communication. I noticed they began documenting the communication for without doing so they wouldn’t be able to charge.
after one of my radiation treatments the nurse asked if I was feeling alright I responded by saying I was having a difficult time urinating… My RO was not in the office that day so she asked another RO what should I do about my problem he suggested I take an an anti-inflammatory… Mind you I never saw the saw doctor… but he charged 250 dollars for that advice…. Smh…
I was sent to get an xray by a PCP new to me (mine was on vaca) and was told someone would call in a few days. It was the same doc who called back, said negative for the issue at hand, but you have a lot of mets back there. Duh. We discussed that already.
Two-minute call showed up billed as tele-med full appt on the next bill. I think the industry is trained to try to rob insurance companies when possible. (After HCA and Rick Scott got caught, HCA kept doing it but less blatantly and less illegally.)
A couple years ago, I had suggested to our RO & MO (UCSF) they should charge for messaging through the portal (as there was a period of time quite a few issues were coming up and I messaged frequently). They said that's not policy. Since then, it has been implemented and I think it's proper. That being said, each message has the disclaimer that medical questions may be subject to being billed as office visits. I have messaged many times since it was implemented and they have not billed us once. Anyway, I am so grateful to have this accessibility to the doctors, I would gladly pay. These doctors are so incredibly busy, and yet they or a PA respond quickly and kindly every single time. Our RO even at times will email a "things are good" comment after Jim's monthly bloodwork without any prompting from us, and even though he knows I can see the results in the portal immediately.
It doesn't surprise me that it has come to this. Or that it will spread to other clinics and hospitals. I am guilty as charged in that I have used (and I think in my case, overused) my portals (I have five separate portals as of right now).
I did have a really serious problem with getting prescriptions filled when a RN decided on her own to delay a needed prescription without telling me. It took multiple messages back and forth to get it sorted out. And it never really got sorted out as the Rx fill was significantly delayed anyway. I suppose this is what would be considered an administrative issue. It certainly was not a medical issue per se.
I intend to stop using the portals for medical questions for my doctors. It seemed like a good way to get questions answered that I considered serious. For example, I had a consultation with my oncologist where they sent in a MD Fellow who was being rotated through different clinics for cancers she was not going into. She was very sharp and I could see having a good relationship with her if she had been a prostate cancer specialist. But she was not familiar with my history or with prostate cancer specifically.
Then after more than half the consultation my MO comes in and gives me the result of the PSA lab test that was done earlier that day. It was higher than last time. He then told me that I needed to have new CT and bone scans on an urgent basis. He left for his next patient before we could even discuss why it was urgent.
I sent him a portal message asking why. He dictated an answer to his RN (great RN's there) who told me via the portal that the doubling time (velocity) of the PSA increase was bad. In my mind it was something I really needed to know and I didn't get the answer that I normally would have had if the meeting had been normal. I don't see why I should be charged (or my insurance which would pay since I have MedSup with Plan G) for something that they screwed up. I do know they won't be having a Fellow do the initial consultation for me in the future, or if they do my MO will be in attendance. I am still upset about it. I still have questions about it. Portal messages are not a replacement for an in person, or telemedicine, visit.
I have not received any guidance from any of the clinics with portals on the etiquette and rules for using the portals. That would be very helpful and should cut down on the types of issues you have brought up Tall_Allen. Good conversation to start.
There is almost no chance of getting an appointment locally and zero chance for one at the big hospitals in a short period of time so I’m glad when the drs or nurse responds to my questions. So I pay if they charge. Glad for the few answers we actually get with this problem we have. So many unknowns.
KMU does this. I have learned to print out everything I want to talk about and hand it to the doctor at my visit. My memory isn't that good anymore and it helps reduce the conversations through the patient portal.
My experience while in practice was there were always cpt codes for phone calls but like many cpt codes you never got reimbursed when you submitted them. There are or were codes at that time for operating on high BMI patients that also were rarely reimbursed despite the clear increased labor involved. Also interesting fact is large institutions often get reimbursed better in general and for codes private guys don't.
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