The other day I had a simple question for my doctor; it did not warrant a full visit but was worth checking in with her. I searched everywhere for her email and realized I did not have it. I logged into my patient portal and sent her a message, only to get a pop up that she would respond within 48 hours. I ended up calling the office and going in for a quick visit. I asked myself – couldn’t this have been done via email? We live in such a digital world and doctor offices are certainly taking advantage of text messages to remind us to pay our bill or show up for an appointment, so why not communicate via email with patients? The truth is that the issue is much more complex than consumers might realize due to our current healthcare model and reimbursement issues:
- Fee-for-service model: Most consumers don’t realize that our healthcare system operates in a fee-for-service model. A physician gets reimbursed for every service performed. This means that more services result in more payments. Through the enactment of the Affordable Care Act, there has been movement toward a system that rewards for quality over quantity but it may take years to fully transition. Email is currently not a service physicians are reimbursed for. While it may seem simple for the consumer, a physician sees hundreds of patients and adding all the time spent on a non-reimbursable service adds up. There is simply no incentive for a physician to change the way they do business, despite the convenience and ease of email and other telehealth services.
- Definition of telehealth: Unfortunately, there is no clear definition of telehealth or digital health due to the evolving landscape and new innovations coming to market daily. The lack of definition creates confusion and limitations around reimbursement. For example, under Medicare telehealth is limited to real-time and audio-video telecommunications and doesn’t allow for “store-and-forward” technology, which includes email, preventing email consultations to get reimbursed.
- Confusing policies: Additionally, several states have enacted their own policies around telehealth, creating conflicting laws. There are also different views on what role the Health Insurance Portability and Accountability Act plays, creating resistance to making communication more open. State licensing issues also produce barriers for physicians to practice across states.
While there are a number of issues with digital health, there is consensus that it can help move us towards more open and faster communication between patients and physicians. As communicators, it will be important that we continue to raise awareness on this topic to ensure both patients and doctors recognize what demands and needs exist. For example, raising awareness around shared decision making or helping our clients discover new digital ways to communicate with patients. On the policy side, the most important step will be creating a definition of telehealth to ensure relevant services are included and therefore reimbursed. It will be important for patients to take advantage of all the resources available, such as online portals and trackers. While it may seem like we are just one click away from modernizing the way we interact, there is still a long road ahead before we enter a digital health care future.