Sunday, April 5, 2009

How much is an e-mail worth?

According to the Santa Cruz Sentinel, doctors in Palo Alto, California are offering a new service to their patients: e-mail with their doctors. The fee is $5 per month. The e-mail option is apparently too new to tell how patients feel about it.

I've been exchanging e-mails with my patients for over 15 years, although I've never charged for it. It is much easier than playing phone tag and cheaper for the practice than involving a secretary and a nurse in message handling. (The toughest part right now is attaching the patient's birth date or record number to the message and getting it filed in our (still paper-based) record system. A dedicated secure e-mail portal could take care of that easily.) The volumes have never been very large and I have no fear of being overwhelmed.

How does it effect income? In my experience it almost never replaces a visit. Rather, it substitutes for one or more phone calls. And, like phone calls, it sometimes ends in "You had better be seen."

I'm not tempted to charge for the service, but it does seem like a smart thing to include in a capitation fee or medical home charge. Many insurance companies encourage patients to call or e-mail a health plan nurse for general advice. It seems logical that they should support the patients contacting someone who can give them even better advice: their doctor!


  1. I have e-mail access to my PCP and to one specialist who I see intermittently. My PCP is not a huge fan of e-mail, and it can take a while to get a response, but it happens. I don't know the extent that he provides this access to other patients. I work at the hospital where he works, so it's possible that I have "preferential" access. The specialist loves to communicate by e-mail, and as you stated, it often leads to a visit.

    As a patient and someone who works in the healthcare industry, I ty very hard to never abuse that access, but it is there when needed. If I were charged $5/month for that option, to be honest, I think I would feel entitled to e-mail the providers more frequently, and for minor things. I might even try to use e-mail to replace visits.

    On the other side, given that a standard PCP has a panel of approximately 2000 patients, do those providers really want 2000 people to have e-mail access to them? Given the reimbursement rates from government-paid insurances, most providers are pressured to see so many patients in a day already, and adding e-mail accessibility might simply increase stress on the provider.

    Plus, sooner or later, if it hasn't happened already, a comment in an e-mail from a provider will be used in litigation against the provider.

  2. E-mails are very much a part of the medical encounter and can definitely be used in a law suit - just like phone calls and in=person exchanges. The good news is that they are a lot easier to document and you can proof them before you hit the send button. And, they can be used to defend a provider, too! ("Your honor, these e-mail transcripts show that my client did, in fact, warn the plaintiff about the possible side effects of the treatment.")

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