The requirements posed by Stage 2 Meaningful Use mean a lot of changes within the offices of eligible providers. But one fact is known – online patient portals are inevitable.
Many healthcare providers have already begun offering online access to information by way of portals, including the North Mississippi Medical Clinic. It launched its portal in 2012 and has seen the benefits first-hand.
"We do everything online, book airline tickets, paying bills," physician Dr. Brad Crosswhite recently told the North Mississippi Daily Journal. "Why not handle medicine the same way?"
It's a logical argument, and it leads to another interesting question being posed by some providers. Should patients pay a subscription fee for access to online medical information?
Why It Could Work
Patient portals are becoming an essential feature of many EHRs, due to the digital interaction requirements of Meaningful Use Stage 2, and greater patient interest in accessing their health records.
78 percent of respondents in a survey conducted by Intuit Health in 2011 said that they would be extremely interested in using a portal and would likely be active users. In our own survey of US patients, we found that just over a quarter (25.3 percent) of patients prefer to schedule appointments online, through such a portal. Among patients 18-24, the rate was over 60 percent.
There is clearly a level of interest, which is likely growing. And it's not out of the norm for information and other online services to have some sort of subscription fee.
Many people are paying for a multitude of subscriptions each month, from cloud storage to record keeping, to online newspaper access. Why shouldn't access to a patient portal be included among those things?
In 2006, before Meaningful Use became a norm in our lexicon, patients at a small primary care practice were surveyed about patient portal access. Of the more than 340 respondents, nearly half said that they would be interested in paying up to $10 per year for access to their medical information online. The study, published in the Oct-Dec 2006 Journal of Medical Internet Research, also showed that patients were interested in three capabilities: emailing their physician directly, viewing medical records and history, and refilling prescriptions.
Dr. Joel Fine, an internal medicine physician in Atlanta, is a believer in the subscription fee.
He partnered with Hello Health to create a patient portal for his office. Patients have the option of multiple subscription tiers to gain access to the portal, the cheapest of which is $36 per year. In addition to other information, patients using the portal typically receive test results in a more timely fashion.
It's a solution that's working for his practice. Forty percent of his patients started using the portal within the first year of its implementation. He anticipates that number will eventually grow to 70 percent. Participation in the portal program, he says, is optional.
"Patients want the efficiencies, access and convenience, sympathize with primary care and are willing to pay the $36," he wrote in a blog post on the Hello Health website. "It's not a cash cow. But instead of negative cash flow, you can break even or make a little bit."
Having a steady, alternate source of cash flow is almost certainly the main incentive for provider's to charge their patients for such access. Simply breaking even, or seeing a small increase in revenue may be enough to tempt some providers to start charging patients.
Why It Probably Won't
So, that all sounds great, right?
Here's the potential downfall of a subscription program.
In order to meet Stage 2 Meaningful Use requirements, eligible providers not only have to provide patients with access to medical information through a patient portal. They also have to get at least five percent of their patients to use the portal. In the future, that rate is likely to substantially increase.
Will adding a subscription fee to a portal be a barrier to accomplishing this? Potentially, yes.
According to a 2009 Gallup survey, the cost of healthcare is the "foremost concern" of Americans. So while a small fee for access to a portal may seem reasonable to you, your patients may feel like you're "nickel-and-diming" them.
Additionally, our research has shown that a plurality of patients still prefer being contacted by phone for general communications and when receiving test results. Online patient portals were a distant third place in order of communication prefer. Given such data, it's hard to see that charging for access to such platforms will encourage adoption.
In 2008, Dr. Kenneth G. Adler implemented a subscription-based patient portal in his practice. The fee was minimal - $15 per year - and a pre-implementation survey of his patients showed interest in the portal as a way of accessing information.
But the reaction to the fee, once it was instated, was mixed at best.
"To my surprise, a couple of patients described it as a 'rip-off,' one wanted to know if we were going to start charging for parking now," he wrote in the journal Family Practice Management. "(O)ne nice 66-year-old lady responded when she heard about the $15 annual charge, 'That's ridiculous.'"
Is a patient portal a potential new source of revenue for your practice? Yes. And several eligible providers such as Dr. Fine have seen it succeed. But carefully consider the implications of adding a subscription fee to your portal. What is your patient demographic? Will your patients be offended by the extra charge? Will enough patients be unable or unwilling to pay, and prevent you from reaching that critical five percent usage threshold?
These are all extremely important questions worth asking before implementing a patient portal fee. Even if you start charging patients for online access to your practice's portal, it's unlikely you'll recoup as much capital as you would from meeting Meaningful Use requirements. Additionally, if charging for access negatively impacts your patients' satisfaction, it could actually end up costing you money. Careful consideration is required, especially as many comprehensive EHRs now provide patient portals at little-to-no additional cost.
Cameron Graham is the managing editor at TechnologyAdvice. He oversees market research for healthcare IT, gamification, business intelligence, and other emerging technology. Connect with him on LinkedIn.
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