Billing patients for portal messages could decrease message volume and ease physician workload

Embargoed for release until 5:00 p.m. ET on Monday 30 December 2024     

@Annalsofim          
Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.          
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1. Billing patients for portal messages could decrease message volume and ease physician workload  

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-01711  

URL goes live when the embargo lifts            

A retrospective observational study found that a program that enabled billing patients for portal messages slightly decreased the volume of patient-initiated messages. The results suggest portal message billing could help to reduce portal message burden, which contributes to provider burnout. The study is published in Annals of Internal Medicine.  

Researchers from the Mayo Clinic studied data between 18 August 2023 through 18 February 2024 to determine the effects of the implementation of billing for patient-initiated portal messages on patients and physicians and advanced practice providers at Mayo Clinic sites in four U.S. states. The researchers compared the results with electronic health record (EHR) data from the same period between 2022 and 2023. Portal messages eligible for e-billing met the following criteria: patient-initiated, established patient, new or multiple symptoms or concerns, and requiring 5 minutes or more to assess and respond. Before sending a portal message, a pop-up screen notified the patient of the potential to be billed for a response to the message. The researchers identified all instances where a patient initiated a message and viewed the billing disclaimer. They then compared the use of Mayo Clinic facilities, including emergency departments and outpatient office visits, in the seven days after viewing the billing disclaimer and proceeding to send a message versus those who did not. Finally, the researchers conducted an online survey to assess providers’ perceptions of billing for patient portal messages. The results found that implementation of e-visit billing was associated with an 8.8% decrease in patient-initiated medical advice messages between the two time periods. Only 0.3% of medical advice messages were ultimately billed, and there was no difference in 7-day use of emergency services in patients who sent a message versus those who did not after viewing the billing disclaimer. Providers with experience using e-visit billing reported overall acceptance of the process, however, 66.1% of providers did not perceive an effect on the volume of messages received. These findings suggest that billing for portal messages is both feasible and acceptable to providers and has potential to decrease provider workload.  

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Shannon M. Dunlay, MD, MS please email Vincent Jacobbi at Jacobbi.Vincent@mayo.edu.  

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2. ACP develops framework to standardize approach, use of economic evidence for clinical guidelines 

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-02149 

URL goes live when the embargo lifts          

The American College of Physicians (ACP), in recognition of accelerating health care spending and the impact on patients, has developed a framework that aligns with ACP principles of promoting high-value care, to standardize its approach to identifying, appraising, and considering economic evidence in the development of ACP clinical guidelines. The framework is published in Annals of Internal Medicine. 

The framework presents and explains the process that ACP’s Clinical Guidelines Committee (CGC) utilizes for incorporating economic evidence into clinical recommendations. Eligible economic evidence includes cost-effectiveness analyses, economic outcomes in randomized controlled trials, and resource utilization (intervention cost) data. To develop a clinical recommendation, the committee first and foremost assesses the best available evidence for the clinical net benefit of interventions, weighing the benefits and harms. In addition, patient values and preferences play a major role in formulating the recommendations.  After assessing if an intervention has clinical net benefit, economic evidence may be considered in prioritizing among recommended interventions of equal effectiveness or modifying the strength of recommendations. The committee’s goal is to always inform clinicians about intervention cost to enhance awareness about the burden on our patients and support shared cost-conscious prescribing in real-life settings. 

ACP has been a global leader in the development of clinical guidelines and advancing science and methods. This framework represents a new advancement in guideline development that will continue to ensure that clinical recommendations consider factors important for physician, patient, public, and health system decision-making to deliver and receive high-value, sustainable health care. 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with someone from ACP, please contact Andrew Hachadorian at ahachadorian@acponline.org. 

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Also new in this issue: 

The Nuances of Performance Measurement and Clinical Guidelines 

Amir Qaseem, MD, PhD, MHA et al. 

Ideas and Opinions 

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-02092 

Medical Reference Tools and Pharmaceutical Promotion: A History of Entanglement 

Andrew S. Lea, MD, DPhil; Jai Krishan Khurana, AB, AM 

History of Medicine 

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-01959 

Misinformation, Identity, and the Basis of Belief 

Dhruv Khullar, MD, MPP; Dannagal G. Young, PhD 

Ideas and Opinions 

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-02844