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Should physicians be compensated for time spent e-mailing patients?

Patients who communicate with their physician via e-mail are in the minority, according to findings released yesterday from the Center for Studying Health System Change.

The report (.pdf) showed 34.5 percent of U.S. doctors providing office-based ambulatory care in 2008 reported that technology for communicating with patients about clinical issues was available in their practice. Overall, only 6.7 percent of all office-based physicians regularly e-mailed patients.

Among the barriers to physicians e-mailing patients is a concern about increased workload without reimbursement. The authors wrote:

Financial incentives also may play a role in encouraging or discouraging the use of e-mail: physicians who received a fixed salary used e-mail more frequently than physicians who were compensated by other means. Physicians who are paid a fixed salary may communicate more with patients generally, including via e-mail, because they can devote more time to activities that are not directly reimbursed, compared with physicians who face practice revenue or productivity incentives. While physicians in larger practices and group/staff-model HMOs were more likely to receive a fixed salary, these differences in e-mail use remained after taking practice size and setting into account.

Physician blogger Westby G. Fisher, MD, is one of several doctors that have weighed in on payments to health-care providers for using electronic forms of communication with patients. Fisher writes:

Electronic medicine is here with all its bells and whistles - I get that. But it does not come for free nor without consequences to doctors' time and personal lives. Establishing appropriate boundaries for electronic physician access will be our next great challenge.

But the question of if doctors should charge fees for e-mailing patients is, ultimately, part of a larger discussion about payment reform, which Stanford physician Abraham Verghese, MD, commented on a few months ago in this San Francisco Chronicle op-ed.

Via Health Blog
Photo by patrickcoe

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