Mayo Clinic's E-Visit Billing Program Shows 8.8% Reduction in Patient Portal Messages
Key Insights
Mayo Clinic's implementation of e-visit billing for patient portal messages led to an 8.8% decrease in message volume over six months compared to the previous year.
The study found no significant difference in emergency department visits or hospitalizations between patients who sent messages after viewing billing disclaimers versus those who did not.
While 80% of providers found e-visit billing acceptable, many expressed concerns about increased documentation burden and insufficient administrative time allocation.
A new study from Mayo Clinic reveals that implementing billing for patient portal messages has resulted in a modest but significant decrease in message volume, while maintaining healthcare utilization patterns. The research, published in the Annals of Internal Medicine (search), comes amid growing concerns about provider burnout from digital communication overload.
The six-month analysis showed an 8.8% reduction (P=0.002) in patient-initiated medical advice message threads compared to the same period in the previous year. This change followed Mayo Clinic's introduction of e-visit billing across all its facilities in August 2023.
Impact on Healthcare Utilization
The study found no adverse effects on acute care utilization. Patients who sent messages after viewing billing disclaimers showed similar rates of 7-day emergency department visits (1.6%) and hospitalizations (1.6-1.7%) compared to those who did not send messages. These findings suggest that the billing initiative did not create barriers to necessary care.
Provider Perspectives and Challenges
A survey of healthcare providers revealed mixed reactions to the new billing system. While 42.6% of providers reported using e-visit billing codes, and approximately 80% found the practice acceptable, significant concerns emerged about implementation challenges:
- 44% of providers reported increased administrative burden
- 40 out of 41 burden-related comments highlighted insufficient time for documentation
- 37 providers noted challenges in determining when to initiate billing
One provider's comment captured the complexity of the situation: "This is a good update, but it needs to come with the plan for more dedicated non-visit care time. Our patients are using this technology more and more, but this is all being completed outside of patient-facing time."
Context of Digital Healthcare Evolution
The initiative responds to a dramatic surge in patient portal communications, with previous studies showing a 157% increase in patient-initiated messages compared to pre-pandemic levels. This increase has contributed significantly to provider workload, with many physicians spending several hours daily responding to messages outside regular clinical hours.
Dr. Shannon Dunlay (search), the study's lead researcher from Mayo Clinic, emphasized the importance of evaluating new healthcare innovations: "As new care models are introduced, such as e-visit billing programs, it is critical to assess their impact on both patients and clinicians."
Study Limitations and Demographics
The researchers acknowledged several limitations in their analysis:
- Inability to track alternative communication methods (such as phone calls)
- A relatively low provider survey response rate of 26.6%
- Limited demographic diversity, with most patients being white and English-speaking
The findings suggest that while e-visit billing may help manage message volume, healthcare systems must carefully balance digital accessibility with provider workload and patient care quality.