TUESDAY, Oct. 15, 2024 (HealthDay News) — The policy of billing for secure messages changes patient expectations and can impact the patient-physician relationship, according to a research letter published online Oct. 15 in the Annals of Internal Medicine.

Jordan M. Alpert, Ph.D., from the Cleveland Clinic, and colleagues examined the perceptions and impact of the policy of billing for secure messages that require medical decision-making and at least five minutes of clinician time. Thirteen of 52 invited patients and 16 of 49 physicians agreed to participate in interviews.

The researchers described the patients’ responses as resigned acceptance, with initial negative reaction to the policy, but understanding that people abuse the system and recognizing the service that physicians provide by answering questions. Physicians were hopeful that the policy would reduce the volume of messages and confer recognition for their provision of free care via messaging, feeling that the work of answering questions was taken for granted by patients and the health system. The policy confused patients and physicians, with patients not knowing whether their message would require more than five minutes of a clinician’s time and physicians unsure about how to handle billing complexities (e.g., multiple messages from one patient). Changed expectations were noted, with patients expecting rapid, detailed responses if they were billed and physicians expressing concern that patients would withhold important information to avoid being billed. Patients and physicians may modify behaviors to avoid billing, with patients stating that they would call the office rather than use messaging and physicians being aware of the problematic nature of charging patients of low socioeconomic status.

“Health systems may want to review the advantages and disadvantages of similar policies before deciding on an appropriate implementation strategy,” the authors write.

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