It’s hard not to read an article describing how doctors are drowning in emails and not laugh or feel sad. To be fair, DPC docs get a lot of emails but they know it is part of their job. That is why they only keep 600 patients. Imagine if you had 3000 and had to answer these emails? It would suck. Many of us knew that and saw the future and that is why we jumped to do direct primary care.

Here is how the FFS is trying to deal with it. The article is called For doctors drowning in emails, one health system’s new strategy: pay for replies. Here are some of the highlights:

• And while the University of California, San Francisco, where Byron practices, has seen volumes surge from a few hundred thousand such emails in 2016 to about two million in 2021, she and other clinicians typically haven’t been paid for answering them.
• Since November, doctors, nurse practitioners, physician assistants, and a handful of other UCSF clinicians have been able to bill payers for patient emails that require medical evaluation or more than a few minutes to respond, said Byron, also UCSF’s associate chief medical information officer. UCSF recently expanded the system to all specialties after piloting it for dermatologists.
• It’s still not clear how much of that payment makes it into doctors’ pockets since reimbursement varies depending on the payer and the department they work for, Byron said. But UCSF has seen an average reimbursement of $65 per email consultation, though patients typically pay much less if at all.
• “As nice as it is that these now get paid for, it’s just created another bucket” for billing, said UCSF professor Julia Adler-Milstein, who studies health IT. “It feels a little untenable to keep creating all these buckets, and this feels like kind of a test if this strategy is going to work.”
• Adler-Milstein warned that the patients might be reluctant to hit send on a potential message if they’re notified that they might be billed. “The question at that point is, do they stop? Do they pick up the phone?”
• Byron said patients at UCSF have largely embraced the system, which notifies them when they send messages through the patient portal that they might incur a co-pay, depending on how much time a response requires from their provider. For the vast majority of patients on Medicare and California’s Medicaid program, the new billing system hasn’t led to a co-pay, Byron said.  Patients on some commercial plans have seen co-pays in the $5 to $10 range for a message.

Let me try to summarize this.

1. THE SYSTEM SUCKS!
2. There has been a massive amount of emails coming in.
3. Doctors are not getting the money that they bill for it. Where is it going?
4. It has created more billing and coding work for doctors.
5. They worry patients may not email because they are afraid of being billed.
6. Medicare and Medicaid are not charging patients for it so the money comes from a magical bucket somewhere.

Wouldn’t it be great if there was a different system that would account for patients’ emails? You know, like a membership model where patients can email without the worry of an extra bill?

It’s called DIRECT PRIMARY CARE.

Now, spread the word as you pity those still stuck doing this other crap.