An interesting piece in yesterday's Seattle Post-Intelligencer -- "The doctor will e-mail you now." The Group Health Cooperative has completed a study on physician-patient email and found that, contrary to the fears of many physicians, email doesn't affect profits and seems to improve patient satisfaction and perhaps even the quality of care. Though emails do reduce the number of patient visits, which reduces revenues to the practice (but benefits patients and health insurers), emails also reduce the number of phone calls, which reduces direct and indirect costs. Seems like the revenue loss was made up for by cost reduction.
GHC also found that email interactions focused more on "prevention and overall health goals", and one physician suggested that as a result his visit mix had changed so that more of his office visits were focused on acute care. Hopefully the study took into account the higher reimbursements per visit that would accompany such a shift -- if not, the move to email might even result in a net profit increase to the practice.
Given that primary care physicians in Massachusetts are already at capacity, I find it hard to believe that emails would reduce their visits -- it would just reduce their backlog. And in the meantime, the GHC study suggests that it would increase profits, quality of care, and patient satisfaction.
This shouldn't be surprising. Since the most scarce resource is the doctor's in-person time, it's optimal to channel as much acute care as possible into that time, since it gives the highest reimbursement to the physician and the greatest satisfaction to the patient. A practice will get higher reimbursement and deliver higher value by using email to siphon off non-acute visits so that the practice can focus office visits on acute care. And the beauty of email is that for a large number of patients, they'll self-select -- if they have a non-urgent question, they'll email it and not take up office time that the practice wants to devote to acute care anyway.
I'm working with some physicians now who used to do email with patients but found it too time-consuming and have now either quit or have started charging patients for it, which has reduced the number of emails dramatically. Judging from the GHC results, these docs might want to take a harder look at the economics of email.