In the Information Age people use numerous methods to communicate with others. These methods include phone calls, emails, text messages and even social media posts meant to communicate with a broader group of friends or associates.
The first telephones began to appear in homes nearly 150 years ago. By the early 1880s there were nearly 50,000 telephones installed, while there were purportedly 600,000 telephones by 1900 and 5.8 million by 1910. Believe it or not, one of the first people to have a telephone were doctors and pharmacists. Doctors could call in a prescription or pharmacies could call the doctor with questions.
Probably around 50 years after telephones made their arrived in doctors’ offices physicians stopped using them to communicate with patients. The reason was because health insurance enrollment was growing and third-party payers were not willing to reimburse for phone consultations, while few doctors wanted to work for free. That has been changing over the past few years (the former, not the latter).
Many medical conditions lend themselves to telephone consultations, and even email discussions. This is especially true of follow-up discussions about an earlier visit or to renew a prescription. Doctalker Family Medicine began treating patients in Northern Virginia in 2002, where patients were encouraged to consult with a physician on the phone. Doctalker Family Medicine also has in-office visits, will communicate by email and will even do house calls for patients nearby. Each service comes with a different price and patients are encouraged to first consider phone consultations which cost less than in-person office visits.
The Wall Street Journal reports that more physicians are beginning to answer medical questions by email (or charge for questions by email depending on your perspective). The typical email message charge was $39 in 2021. These email exchanges often provide new information and sometimes save you an office visit. WSJ reports that while some patients are irritated at being billed for what they consider an answer to a simple question, others appreciate a direct response to their question from their physician, rather than being filtered through an office manager or nurse (or ignored).
There are limitations to which emails physicians can bill for. Emails that are billable as a service must require more than 5 minutes of the physician’s time and involve medical decision making. Messages clarifying an earlier consultation or explaining lab results are generally not billable. In other words, your doctor cannot charge for an office visit where blood is drawn for lab work and make you pay again to find out the results.
The volume of emails patients send to their physicians has increased over the past few years. More patients have become comfortable emailing their physicians and more physician offices have configured their information technology to accommodate email systems that are HIPAA compliant. One physician told WSJ on a recent morning she answered 14 emails.
“I do this on my lunch break, I do this in between patients, I do this at night or in the morning before clinic,” she says of responding to patient emails. “It is an amount of work that we need to acknowledge is real.”
The physicians interviewed by WSJ report that they only bill for a small minority of emails they reply to. Those taking more than five minutes or messages involving a minute or two multiple times over the course of a week are billed whereas most that require simple answers are not.
The news that more physicians are billing for emails is both welcome and unwelcome in some situations. It is welcome from the standpoint that a simple email conversation that replaces a more expensive in-office visit is a great way to boost access to care and increase convenience. Email message charges could be less welcome if email follow-ups, that were once taken care of by a nurse, suddenly become services that are billed even if the doctor never sees them.
Overall being able to consult with a doctor over email is a valuable service and the fact you are paying something for that service means your access to a doctor has improved. That is a good thing. Email consultations are a service more cash-based physicians should consider. Imagine sending a PDF file with my lab results to my physician by email, telling her my blood pressure and having her call in a prescription, all for a $50 or $75 email consultation fee. That truly would be liberating compared to scheduling an office visit weeks in advance.