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Meg Bakewell, who has cancer and cancer-related heart disease, sometimes emails her primary care physician, oncologist, and cardiologist asking them for medical advice when she experiences urgent symptoms such as pain or shortness of breath.

This story also ran on The Sacramento Bee. It can be republished for free.

But she was a little surprised when, for the first time, she got a bill a $13 copay for an emailed consultation she had with her primary care doctor at University of Michigan Health. The health system had begun charging in 2020 for e-visits through its MyChart portal. Even though her out-of-pocket cost on the $37 charge was small, now shes worried about how much shell have to pay for future e-visits, which help her decide whether she needs to see one of her doctors in person. Her standard copay for an office visit is $25.

If I send a message to all three doctors, that could be three copays, or $75, said Bakewell, a University of Michigan teaching consultant who lives in Ypsilanti, Michigan, and is on long-term disability leave. Its the vagueness of the whole thing. You dont know if youll get into a copay or not. It just makes me hesitate.

Spurred by the sharp rise in email messaging during the covid pandemic, a growing number of health systems around the country have started charging patients when physicians and other clinicians send replies to their messages. Health systems that have adopted billing for some e-visits include a number of the nations premier medical institutions: Cleveland Clinic, Mayo Clinic, San Francisco-based UCSF Health, Vanderbilt Health, St. Louis-based BJC HealthCare, Chicago-based Northwestern Medicine, and the U.S. Department of Veterans Affairs.

Billing for e-visits, however, raises knotty questions about the balance between fairly compensating providers for their time and enhancing patients access to care. Physicians and patient advocates fret particularly about the potential financial impact on lower-income people and those whose health conditions make it hard for them to see providers in person or talk to them on the phone or through video.

A large part of the motivation for the billing is to reduce the messaging. Soon after the pandemic hit, health systems saw a 50% increase in emails from patients, with primary care physicians facing the biggest burden, said A Jay Holmgren, an assistant professor of health informatics at UCSF, the University of California-San Francisco. System executives sought to compensate doctors and other providers for the extensive time they were spending answering emails, while prodding patients to think more carefully about whether an in-person visit might be more appropriate than a lengthy message. Email Sign-Up

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After UCSF started charging in November 2021, the rate of patient messaging dipped slightly, by about 2%, Holmgren and his colleagues found.

Like UCSF, many other health systems now charge fees when doctors or other clinicians respond to patient messages that take five minutes or more of the providers time over a seven-day period and require medical expertise. They use three billing codes for e-visits, implemented in 2020 by the federal Centers for Medicare & Medicaid Services.

E-visits that are eligible for billing include those relating to changes in medication, new symptoms, changes or checkups related to a long-term condition, and requests to complete medical forms. Theres no charge for messages about appointment scheduling, prescription refills, or other routine matters that dont require medical expertise.

So far, UCSF patients are being billed for only 2% to 3% of eligible e-visits, at least partly because it takes clinicians extra time and effort to figure out whether an email encounter qualifies for billing, Holmgren said.

At Cleveland Clinic, only 1.8% of eligible email visits are being billed to patients, said Eric Boose, the systems associate chief medical information officer. There are three billing rates based on the time the clinician takes to prepare the message five to 10 minutes, 11 to 20 minutes, and 21 minutes or more. He said patients havent complained about the new billing policy, which started last November, and that theyve become a little smarter and more succinct in their messages, rather than sending multiple messages a week.

The doctors at Cleveland Clinic, like those at most health systems that bill for e-visits, dont personally pocket the payments. Instead, they get productivity credits, which theoretically enables them to reduce their hours seeing patients in the office.

Most of our physicians said its about time were getting compensated for our time in messaging, Boose said. Were hoping this helps them feel less stressed and burned out, and that they can get home to their families earlier.

Its been a frustration for many physicians for many years that we werent reimbursed for our pajama-time work, said Sterling Ransone, the chair of the American Academy of Family Physicians Board of Directors. Ransones employer, Riverside Health System in Virginia, started billing for e-visits in 2020. We do it because its the right thing for patients. But rarely do you see other professions do all this online work for free, he said.

We see physicians working two to four hours every evening on their patient emails after their shift is over, and thats not sustainable, said CT Lin, the chief medical information officer at University of Colorado Health, which has not yet adopted billing for email visits. But we worry that patients with complex disease will stop messaging us entirely because of this copay risk.

Many health care professionals share the fear that billing for messages will adversely affect medically and socially vulnerable patients. Even a relatively small copay could discourage patients from emailing their clinicians for medical advice in appropriate situations, said Caitlin Donovan, a senior director at the National Patient Advocate Foundation, citing studies showing the dramatic negative impact of copays on medication adherence.

Holmgren said that while patients with minor acute conditions may not mind paying for an email visit rather than coming into the office, the new billing policies could dissuade patients with serious chronic conditions from messaging their doctors. We dont know who is negatively affected, he said. Are we discouraging high-value messages that produce a lot of health gains? That is a serious concern.

Due to this worry, Lin said, University of Colorado Health is experimenting with an alternative way of easing the time burden of e-visits on physicians. Working with Epic, the dominant electronic health record vendor, it will have an artificial intelligence chatbot draft email replies to patient messages. The chatbots draft message will then be edited by the provider. Several other health systems are already using the tool.

There also are questions about price transparency whether patients can know when and how much theyll have to pay for an email visit, especially since much depends on their health plans deductibles and copays.

While Medicare, Medicaid, and most private health plans cover email visits, not all do, experts say. Coverage may depend on the contract between a health system and an insurer. Ransone said Elevance Health, a Blue Cross Blue Shield carrier, recently told his health system it would no longer pay for email or telephonic visits in its commercial or Medicaid plans in Virginia. An Elevance spokesperson declined to comment.

Another price concern is that patients who are uninsured or have high-deductible plans may face the full cost of an email visit, which could run as high as $160.

At University of Michigan Health, where Bakewell receives her care, patients receive a portal alert prior to sending a message that there may be a charge; they must click a box indicating they understand, said spokesperson Mary Masson.

But Donovan said that leaves a lot of roo for uncertainty. How is the patient supposed to know whether something will take five minutes? Donovan said. And knowing what youll be charged is impossible because of health plan design. Just saying patients could be charged is not providing transparency.

Harris Meyer: @Meyer_HM Related Topics Health Care Costs Health Industry Insurance Colorado Copayments Doctors Health IT Michigan Ohio Contact Us Submit a Story Tip

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Sir Keir Starmer ‘absolutely’ wants Angela Rayner back in cabinet

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Sir Keir Starmer 'absolutely' wants Angela Rayner back in cabinet

Sir Keir Starmer has said he “absolutely” wants Angela Rayner back in his cabinet after she resigned for failing to pay the correct amount of stamp duty.

Speaking from the G20 Summit in South Africa, the prime minister told broadcasters his former deputy is “the best example ever” of social mobility and he is still in touch with her.

Asked if she could make a comeback this side of a general election, Sir Keir said: “I’ve always said I want Angela back. Even back in September at the time I said she is going to be a big voice in the Labour movement.

“Do I want Angela back at some stage? Yes absolutely.

“I think she is the best example ever in the United Kingdom of social mobility – going from a pretty challenging childhood to being deputy prime minister of the United Kingdom. She is the story of social mobility above all other stories.”

Asked if he missed having her around, Sir Keir said: “I’m friends with Angie and I like Angie a lot and we talk a lot. We still do.

“It’s always good to have Angela.”

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Ms Rayner’s meteoric rise to the top of Labour came after she left school aged 16, pregnant and with no qualifications.

She was elected deputy Labour leader by the membership in 2020, and was made deputy prime minister then housing secretary by Sir Keir.

She resigned from all of those positions in September, after it emerged she had not paid the higher rate of stamp duty on a second home she bought in Hove, East Sussex, saving her about £40k.

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Rayner admits she didn’t pay enough tax

It followed a tearful interview with Sky’s political editor Beth Rigby about the “complex living arrangement” regarding her first home, which was sold to a trust following her divorce to provide stability for her teenage son, who has lifelong disabilities and is the sole beneficiary of the trust.

An investigation by the prime minister ethic’s watchdog found she breached the ministerial code by failing to get correct tax advice, but that she acted “with integrity”.

Ms Rayner is still a backbench MP and recently did not rule out a return to the front bench herself – telling the Daily Mirror during a visit to a care centre in her constituency that she had “not gone away”.

Other cabinet ministers have also supported her return.

During the Labour Party Conference a few weeks after she resigned, Health Secretary Wes Streeting paid tribute to her work on the Employment Rights Bill and said Labour “wants her back and needs her back”.

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Technology

Americans are holding onto devices longer than ever and it’s costing economy

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Americans are holding onto devices longer than ever and it's costing economy

If you are holding onto your aging printer or cracked smartphone longer than you had planned, you are not alone.

Heather Mitchell, 69, retired and living in Tucson, Arizona, is content with her phone even though it is old by smartphone standards.

“My Samsung Galaxy A71 is six-years-old. It’s hanging in there surprisingly well for a jalopy. I’ve had issues with it, and still do, but they are minor,” said Mitchell. “I love Samsung phones, but can not afford a new one right now. A new phone would be a luxury.”

The average American now holds onto their smartphone for 29 months, according to a recent survey by Reviews.org, and that cycle is getting longer. The average was around 22 months in 2016.

While squeezing as much life out of your device as possible may save money in the short run, especially amid widespread fears about the strength of the consumer and job market, it might cost the economy in the long run, especially when device hoarding occurs at the level of corporations.

Research released by the Federal Reserve last month concludes that each additional year companies delay upgrading equipment results in a productivity decline of about one-third of a percent, with investment patterns accounting for approximately 55% of productivity gaps between advanced economies. The good news: businesses in the U.S. are generally quicker to reinvest in replacing aging equipment. The Federal Reserve report shows that if European productivity had matched U.S. investment patterns starting in 2000, the productivity gap between the U.S and European economic heavyweights would have been reduced by 29 percent for the U.K., 35 percent for France, and 101% for Germany.

Experts agree lost productivity and inefficiency are the unintended consequences of people and businesses clinging to aging technology.

“Think about how much internet speeds have changed in the past decade or more. In the 2010s, 100MB speeds were considered high speed and very good. A short 10 years later and we’re operating at 1GB speeds, which is roughly 10 times faster,” said Cassandra Cummings, CEO of New Jersey-based electronics design company Thomas Instrumentation. Operating at higher GB speeds requires different electronic hardware, and a lot of the older technology can’t handle it.

“Those devices were engineered when no one could fathom speeds that much faster would be mainstream,” Cummings said.

That can be a drain on nationwide networks as well.

“Both the cellular and internet infrastructure has to operate to be backwards compatible in order to support the older, slower devices. Networks often have to throttle back their speeds in order to accommodate the slowest device,” Cummings said. “Often entire sections of networks or company internal networks are running slower than they would if all devices were up to the newer standards,” she added.

Cummings doesn’t deny that staying up to date with new devices and hardware is expensive.

“Many companies, especially small businesses, and individual people can’t afford to constantly upgrade to the latest and greatest devices,” she said.

To ease the transition to new technologies, she says there should be designs that are repairable or modular rather than the constant purge and replace cycles. “So perhaps future devices can have a partial upgrade in say ethernet communications rather than forcing someone to purchase an entirely new computer or device,” Cummings said. “I’m not a fan of the throw-away culture we have these days. It may help the economy to spend more and force upgrades, but does it really help people who are already struggling to pay bills?” she said.

Indeed, entrepreneurs in the device resale market see the longer-lived tech as a success story that can be improved upon. Steven Athwal, CEO of the UK-based The Big Phone Store — which specializes in refurbished phones — says devices longevity is not the problem. “The issue is the lag. Businesses and individuals are trying to squeeze modern workloads out of old hardware, heavy processing, rendering, generation, and admin, and that creates a productivity drag. Things like slow processors, outdated software, and degraded batteries on older tech waste energy and morale,” Athwal said.

He adds that when people hold onto their phones or laptops for five or six years, the repair and refurbishment market becomes an active part of the economy. But right now, in both European, American, and global markets, too much of that happens in the shadows.

“It’s unregulated, underreported, and underutilized. If governments and big tech supported refurbishment properly, aging devices could become part of a sustainable circular economy,” Athwal said, improving the second-hand cycle by extending software support, improving access to parts, and treating repair as infrastructure.

“That’s how you disable constant replacement. No need to constantly push upgrades, which financially strains both small and large businesses alike,” Athwal said.

Still, some device manufacturers have found ways to entice consumers to ditch their older phones for newer ones. For instance, Apple just had one of its most successful new launches with the iPhone 17, and artificial intelligence could be a game-changer.

Najiba Benabess, dean of the business school at Neumann University, says rising prices and sustainability concerns are among reasons “America’s gadgets are aging out,” but the market should be focused on slowing productivity, increasing repair and maintenance expenses, and limited access to software updates and efficiency gains.

“Small businesses, in particular, lose valuable hours each year due to lagging systems, creating what economists call a ‘productivity drag,'” Benabess said. On a national scale, this translates to billions of dollars in lost output and reduced innovation. “While keeping devices longer may seem financially or environmentally responsible, the hidden cost is a quieter erosion of economic dynamism and competitiveness,” she added.

Most people still want the newest and most up-to-date phones and tablets, according to Jason Kornweiss, senior vice president of advisory services at Diversified, a global technology solutions provider, but research does show a widening gap between businesses and individuals when it comes to aging devices.

“Corporations with hundreds or thousands of people are not investing at the same rate,” Kornweiss said, adding that technology is changing so fast IT departments can’t keep up with the pace and that bloated corporations need to vet the newest technology, which takes time, and by the time they do the vetting, something new has arrived anyway. The result: businesses with increasingly long-in-the-tooth technology.

“Businesses establish shelf-life that is multi-year. Employees look at replacing devices within an organization as too tedious and people cringe when the IT department comes with a new device,” Kornweiss said, even when it is a meaningful upgrade, he added.

The price to the organization is then paid in lack of productivity, inability to multitask and innovate, and needless, additional hours of work that stack up. Workplace research conducted by Diversified last year found that 24% of employees work late or overtime due to aging technology issues, while 88% of employees report that inadequate workplace technology stifles innovation. Kornweiss says he doesn’t expect there’s been any improvement in those numbers over the past year.

There’s a disconnect between the numbers and behavior. Many workers report that aging devices stifle productivity, but like a favorite pair of shoes or an old sweater, they don’t want to give them up to learn the intricacies of a new device (which they’ll learn and then have to replace with another). Familiarity can trump productivity for many workers. But the result of that IT clinginess is felt in the bottom line.

“Productivity is hampered and it all has a tangible impact on the economics,” Kornweiss said.

The biggest commodity a worker has is time, he says, and older devices gobble that up. Bring-your-own-device (BYOD) policies can be a savior for businesses slow to upgrade, with individuals using their own more functional devices easily able to integrate into most workplace systems these days, Kornweiss said. Another option for companies that don’t want to buy a bunch of quickly dated devices is to lease.

Kornweiss sees a future where technology continues to advance at warp speed and companies will continue to have trouble keeping up. And individuals like Heather Mitchell will continue to hang on to their devices.

“I tend to hang onto my phone until I have no choice in the matter. In 26 years, this is only my fifth phone,” Mitchell said.

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More companies are shifting workers to passwordless authentication

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More companies are shifting workers to passwordless authentication

It’s safe to say that no one is crazy about passwords. For chief information security officers, there’s the nightmare of employees leaving lists of passwords on their desks or putting them on Post-it notes on their computers. For workers, there’s the inconvenience of having to enter multiple passwords to gain access to various devices and resources.

Passwordless authentication technology is designed to address these issues, and use of these tools is on the rise. A recent survey of 200 CISOs by Wakefield Research, sponsored by security vendor Portnox, showed that a significant majority (92%) of the security leaders said their organizations had implemented or were planning to implement passwordless authentication. That’s up from 70% in 2024. CISOs cited improved employee productivity and enhanced user experience as the top benefits.

Passwordless authentication verifies user identity without the need for traditional passwords, through alternative methods such as hardware tokens, biometrics, or mobile push notifications. It offers potential benefits such as enhanced security and improved user experience.

Training services provider Universal Technical Institute has begun using a passwordless platform from Microsoft, “and as we expand adoption, the benefits show up quickly, with fewer password resets, fewer service desk tickets, and a faster start to the day,” said Adrienne DeTray, senior vice president and CIO at the company.

“The bigger impact is cultural,” DeTray said. “It shows that we’re serious about making technology feel lighter and more human again. Over the years, we’ve added so many systems and logins that the weight of technology has become part of the work. This is one of those steps that helps remove that administrative drag and makes the ecosystem feel more seamless and connected.”

It’s not just about security, DeTray said, but user experience as well. “Every password reset or lockout slows people down and chips away at their focus,” she said. “Passwordless takes that friction out of the day and gives people time back. It’s part of designing a connected ecosystem where security and usability work hand in hand.”

MFA losing status as ‘gold standard’ cybersecurity

R Systems International, a provider of digital product engineering services, is in the midst of a phased migration to a passwordless environment, said CTO Srikara Rao. “For us, this isn’t about chasing a trend, it’s a direct response to the fact that our previous gold standard, multi-factor authentication, is showing its age,” Rao said. “The threat landscape has evolved past what traditional MFA can handle.”

R Systems’ decision to make the move is driven by both security and business enablement factors. “Credential-based attacks remain the top threat vector, with a significant rise in phishing attempts and several near-miss incidents underscoring the urgency to act,” Rao said. “We want to promote solutions within our organization that are phishing resistant.”

On the operational side, password resets have become quite expensive, Rao said. Resets can be costly due to direct labor expenses and significant indirect costs such as lost employee productivity and IT resource drain. Research firm Forrester estimates that a single password reset can cost $70, and this can add up quickly for large enterprises.

In addition, it’s critical that the company adhere to compliance requirements such as PCI 4.0, which mandates that users reauthenticate everything they restart or access. “Passwordless authentication will make it seamless,” Rao said. “And finally, as we compete for top tech and cybersecurity talent, being a passwordless enterprise signals that we’re a forward-thinking, security-first organization.”

Bring-your-own-device policies are a factor

Health-care services provider Diversus Health is also moving to passwordless authentication, using the technology in the form of certificate-based network access control.

“Due to recently adopting a bring-your-own-device policy, our internal annual HIPAA compliance audit detected lack of network access control as one of our high-risk threats,” said Neil Ford, IT security administrator. “So, we began looking into solutions that could be used to mitigate the threat.”

Diversus Health earlier this year deployed a system from Portnox that uses certificate-based authentication to verify the identity of devices. “We deploy the certificate through a cloud-based endpoint management solution, so verification with Portnox is transparent to staff,” Ford said.

The solution has effectively mitigated the threat of unknown devices connecting to the company’s network and being able to access internal resources, Ford said.

One of the keys to a successful adoption of passwordless authentication is to effectively communicate the security change with staffers. “Employees are overcoming decades of password muscle memory and addressing legitimate user anxiety about ‘what if I lose my device?’ is critical,” Rao said. “We learned quickly that we had to sell the ‘why’ to our employees.”

Enterprises need to frame passwordless authentication not as another security mandate, but as a direct benefit to employees through less frustration, faster logins, and the elimination of password resets, Rao said. Before making the shift, R Systems ran small, interactive training sessions to get people comfortable with access tools such as fingerprint identification on their phones.

“I cannot stress enough the importance of organizations providing user education,” Rao. “It’s a significant difference between a successful deployment and a shelfware investment.”

R Systems passwordless strategy isn’t tied to a single vendor, but built on FIDO2 and WebAuthn open standards, “giving us flexibility to choose the right tool for each risk profile,” Rao said. “Privileged users such as administrators, developers, and executives use FIDO2 hardware security keys, while the broader workforce relies on passkeys integrated with device biometrics like Windows Hello and Face ID.”

The company is still evaluating the results of the transition to passwordless authentication and working to ensure that it works best for everyone.

“We’ve seen our employee experience improve dramatically, with faster logins and a significant reduction in password-related help desk tickets,” Rao said. “Most importantly, passwordless authentication has become a cornerstone of our zero-trust architecture, giving us a stronger, high-assurance identity layer that enables secure access regardless of user or device location.”

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