- Patient portals have long been championed as the new and innovative strategy for improving patient engagement and access to quality healthcare. Patients can communicate with their providers about health concerns using secure messaging and become activated in their own health.
However, new research indicates that there could be some adverse effects of patient portal secure messaging, primarily in driving up in-office patient visits.
“While there are a number of plausible arguments for the benefits of e-visits, it is also possible that the adoption of e-visits may increase the consumption of healthcare services since easier access to healthcare providers may generate additional reasons for an office visit without any attendant health benefit,” said the researchers, who hail from the Wharton School at the University of Pennsylvania and the Wisconsin School of Business at University of Wisconsin-Madison.
“Thus, the impact of e-visits on physician utilization and health outcomes is an empirical question, the answer to which is important for understanding whether and how to promote this technology.”
Frequent clinic visits can have a direct impact on clinician caseload and number of clinicians employed, the researchers argued. These factors also have an effect on patient access to healthcare, especially for patients who did not adopt the patient portal or who are new patients at the primary care clinic.
The researchers looked at secure messaging rates and office visit patterns for over 14,000 patients at a large primary care clinic system. The team also looked at how these clinic visits affected patient health and access to care for patients who did not have the clinic’s patient portal.
Overall, secure messaging resulted in six percent more in-office visits and seven percent more phone call visits, the researchers found. There was also a positive correlation between the number of office visits and health outcomes (measured using LDL cholesterol and hbA1c levels). When adjusting for external factors, that correlation became negligible.
Secure messaging removes a clinic “gatekeeper” from patient care access, the researchers pointed out. Patients who secure message with their providers about a concern do not have to go through front-office staff or nurses before accessing their clinician or scheduling an appointment, potentially resulting in an influx of visits, the researchers posited.
The research team also found that visits arising from secure messaging are coming at the cost of patients who are portal non-adopters. Patients who do not have the patient portal have fewer telephone visits monthly, although there was no difference in the number of in-office visits for these patients.
Healthcare professionals should continue to encourage patient portal adoption and use with these patients. Physicians have a regulatory obligation to drive patient portal adoption and they want to ensure all of their patients can equally reap the benefits of the technology.
New patients who had not yet visited the practice also bore the brunt of increased office visits, the researchers said.
“Interestingly, we find that the additional visits appear to come at the sacrifice of new patients: after adopting e-visits, providers see 15 percent fewer new patients each month,” the team found. This means that physicians saw 1.59 fewer new patients each month.
Some clinics may be better suited for accommodating appointment influxes than others, the researchers said.
“The overall impact of e-visits on a health system will depend on the extent to which a system is (a) at capacity, and (b) compensated on a fee-for-service basis,” the team explained. “In particular, the bottom line will improve for health systems which are not at capacity and in which physician compensation is primarily on a fee-for-service basis since e-visits can increase physician utilization.”
However, these results may be bad news for providers working with a value-based or capitated reimbursement model. Clinicians are not reimbursed for the time they spend communicating with patients via the patient portal, nor are they paid a la cart for resultant in-office visits.
Additionally, these results challenge popular sentiment in the healthcare industry. Experts have long praised patient portals for being effective in streamlining patient-provider communication and potentially reducing the number of in-office visits providers must conduct. That may not be the case, the researchers concluded.
“We also show that provider e-visit adoption is linked to about a 15% reduction in the number of new patients each month, challenging notions that e-visits may increase provider capacity by offloading some care to an online channel,” the team said. “Together, our findings highlight the importance of considering patient and physician responses when introducing new models of service delivery in healthcare.”
Clinicians have long feared that patient portals would create more work for them. Responding to surveys about patient access to clinician notes and portal functionality, physicians expressed concern that patients could communicate in any given moment. Some even feared that patients would over-utilize the tools in an effort to receive “free” healthcare.
Going forward, providers will need to exercise good judgment when answering patient queries to determine the best path forward. It may not be wise for primary care clinics to allow in-office visits to become out of hand, but it is also important for providers to take secure messaging requests seriously.
Using both medical expertise and strong communication skills, providers should work to mitigate problems via secure message when possible and appropriately address larger problems as they escalate.