Are Patient Portals Loss Leaders for Practices?

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Secure patient portals offer physicians and practices the opportunity to conduct virtual patient visits, but these electronic “consults” are not always reimbursed. Many who have ventured into this frontier say they look for “softer” ROIs such as patient satisfaction and practice efficiency.

Using the internet

The number of U.S. consumers using the internet to shop or bank has increased steadily over the last decade. Despite security concerns, two-thirds of online Americans bought something online in 2007, up from 46 percent in 2000, and 53 percent of online Americans used the internet for banking in 2007, up from 18 percent in 2000, according to a 2008 Pew Internet and American Life Project report.

Also on the rise is the number of Americans using the internet for healthcare reasons, such as refilling prescriptions and scheduling transactions. However, more and more Americans expect to be able to communicate with their healthcare team via email. In 2009, nearly 40 percent of patients communicated with a physician office via a secure email messaging system, up from 31 percent in 2007 and 25 percent in 2006, according to a survey by Manhattan Research.
In many cases, practices are not paid for online consults and patients’ increased use of the internet for healthcare has often resulted in a decrease in office visits. Are patient portals, therefore, loss leaders for practices and hospitals? Not necessarily.

A study by Chen et al at Kaiser Permanente of its implementation of a patient portal in 2004 in Hawaii found that three years after go-live, office visits had dropped by 26 percent, while scheduled phone visits and email messaging had increased significantly (Health Affairs 2009;28(2):323–333). Researchers suggest that the reduction in office visits indicates a greater efficiency of care with an integrated EHR. “With complete patient data available, unnecessary and marginally productive office visits are reduced or replaced with telephone visits and secure e-mail messaging supported by easy access to patients’ medical records. For example, doctors reported that the EHR enabled them to resolve patients’ health issues in the first contact or with fewer contacts,” they wrote.

In 2008, CMS added CPT codes for phone contacts that are intended to supplant office visits and for online management. But Medicare has listed both services as non-covered. Reimbursement by private payors for phone and online healthcare transactions is limited. (However, in April, Virginia passed a law requiring insurers to cover and reimburse for healthcare services provided through telemedicine.) In contrast to fee-for-service systems, physicians at Kaiser receive a fixed salary regardless of the number of services rendered. But the return on investment for patient portals has to be measured by other yardsticks, say Chen et al.

The researchers noted that it’s important to align nonfinancial incentives when dealing with patient connectivity to the practice. In Kaiser’s case, 85 percent of users said the ability to communicate electronically with their physicians enabled them to better manage their health. Yet, the National Committee for Quality Assurance relies on office visits as the predominant indicator of quality-related activity, according to Chen et al. This may have to change as many patients, and an increasing number of physicians, are willing to conduct virtual office visits because they are perceived as a good value by both parties.

Heart to heart

Most patient portals offer similar options, including the ability to send non-urgent email messages, access lab results, schedule appointments, refill prescriptions and view portions of the EMR. The Heart & Vascular Center of Arizona (HVCA) in Phoenix went live in late March with its patient portal and so far, “it has been very successful,” reports Barbara Watkins, administrator for HVCA, two weeks after go-live.

Thus far, patients at HVCA are utilizing the portal to view lab results, ask questions about medication titration and discuss topics such as cholesterol or blood pressure. “In the past, all this communication would have come to our front office, either in person or via the phone. The new portal has established an incredibly efficient process,” she says.

The practice does not bill for phone or online consults. “We really do not provide ‘medical consults’ online or by phone,” Watkins clarifies. They utilize their staff—physicians, nurse practitioners, physician assistants