Patient Email Volume Stays Steady After E-visit Fees Are Put in Place

Patients sent about the same number of emails to clinicians after UC San Francisco’s health system, UCSF Health, began charging for certain types of messages, a new study found.
 
In line with many of the nation’s major hospital systems, UCSF Health began charging in November 2021 for messaging that constitutes a “virtual visit.” The Centers for Medicare and Medicaid Services and private payers expanded billing options for these visits in 2020 if the visit involved medical decision making and at least five minutes of clinician time over seven days.  
 
“Patient preferences for how to seek and receive medical advice have shifted. Billing for written e-visits helps support the necessary medical decision making and time required by clinicians, and patients can access care more conveniently if they choose to,” said senior study author Maria Byron, MD, a UCSF internist and associate chief medical information officer. “Our health care models need to adjust to keep pace with the multiple ways we now deliver care, but it’s also critical to evaluate the impact of those changes on our patients and their health.”

Biggest drop is for those 18 to 49 years old

The study, which appears Aug. 9 in JAMA Network Open, is the first to look at this question. The researchers measured the volume of e-visit messages from Oct. 1, 2020, to Aug. 20, 2022, as well as the race, ethnicity, preferred language, age and payer category of the senders, to see if the policy had an undue effect on specific groups.  
 
Among 5.5 million messages analyzed, the researchers saw a 2% overall drop in messages after the policy changed – a change that was not statistically significant. Messages from Latinx and Asian patients declined by 5% – a significant finding that was not mediated by language preference – while there were no significant drops in other racial and ethnic groups. Patients aged 18 to 49 years had the largest significant drop (10%) in messaging across age groups, while those aged 66 years and older sent more messages (6 to 8% increase). 
  
People in their 30s and 40s may message clinicians more as they start to have health problems for the first time, Byron said.
 
“It could be that, once these patients realized they could be billed, they pulled back a bit and decided to save some questions until their next appointment,” said Byron. “It’s also possible there is a confounding effect in the drop by race and among 18- to 49-year-olds, which we aren’t able to discern in this type of study.” 
 
There were no significant differences by preferred language or most payer categories, including Medicare, Medi-Cal and commercial insurance. Self-pay patients, a small group of UCSF Health patients, reduced their messaging by 14% after the billing change. 
 
“Overall, the study gave us a good start for future research into why we’re seeing these trends, and whether or not they have an effect on health outcomes,” said Byron. 

UCSF Co-Authors: A. Jay Holmgren, PhD, Carrie K. Grouse, MD, Aris Oates, MD, and Julie O’Brien, MD.

Funding: None

Disclosures: None.

About UCSF Health: UCSF Health is recognized worldwide for its innovative patient care, reflecting the latest medical knowledge, advanced technologies and pioneering research. It includes the flagship UCSF Medical Center, which is a top-ranked specialty hospital, as well as UCSF Benioff Children’s Hospitals, with campuses in San Francisco and Oakland, Langley Porter Psychiatric Hospital and Clinics, UCSF Benioff Children’s Physicians and the UCSF Faculty Practice. These hospitals serve as the academic medical center of the University of California, San Francisco, which is world-renowned for its graduate-level health sciences education and biomedical research. UCSF Health has affiliations with hospitals and health organizations throughout the Bay Area. Visit www.ucsfhealth.org. Follow UCSF Health on Facebook or on Twitter.