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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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Entertainment

Hollywood writers reach ‘tentative’ deal to end strike over AI and compensation

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Hollywood writers reach 'tentative' deal to end strike over AI and compensation

A “tentative” deal has been reached to end a long-running strike by writers in Hollywood.

The Writers Guild of America (WGA) announced the deal with the Alliance of Motion Picture and Television Producers (AMPTP), the group which represents studios, streaming services and producers in negotiations.

A statement from the WGA said: “We have reached a tentative agreement on a new 2023 MBA, which is to say an agreement in principle on all deal points, subject to drafting final contract language.

“We can say, with great pride, that this deal is exceptional – with meaningful gains and protections for writers in every sector of the membership.”

Most of the writers’ demands have been met

After 146 days on the picket line, Hollywood’s writers are finally ready to put pen to paper and sign an agreement with the studio bosses who pay their wages.

My understanding from speaking to sources on both sides of the standoff, is that most of the writers’ demands have been met with this deal, including greater royalty payments and assurances about the role of Artificial Intelligence in future TV and filmmaking.

If approved by the Writers Guild of America members, which seems all but guaranteed, it will bring an end to the second longest strike in the union’s history. It is also the broadest industry strike in decades, with more than 100,000 actors joining them on the picket.

Hollywood will not fully bounce back. Until actors return to work, filming on shows like the Last Of Us and Stranger Things, which have been on hold for months now, cannot resume. But talk shows like Jimmy Kimmel Live! and Saturday Night Live, which don’t rely on actors, could resume filming as soon as this week.

Speaking to people on the picket line, they framed this strike action as about more than just Hollywood. Some said AI was not just “anti-creative” but that it presented an existential threat not just to their craft but to humankind.

This deal will be seen as a major victory in securing protections over their TV and film credits and payments in the wake of AI.

The three-year contract agreement – settled on after five days of renewed talks by negotiators from the WGA and the AMPTP – must be approved by the guild’s board and members before the strike officially ends.

Read more on Hollywood strikes:
How much of a threat is AI?

The terms of the deal were not immediately announced.

More on Hollywood

The statement added: “To be clear, no one is to return to work until specifically authorised to by the Guild.

“We are still on strike until then. But we are, as of today, suspending WGA picketing. Instead, if you are able, we encourage you to join the SAG-AFTRA picket lines this week.”

The agreement comes just five days before the strike would have become the longest in the guild’s history, and the longest Hollywood strike in decades.

About 11,500 members of the Writers Guild of America walked off the job on 2 May over issues of pay, the size of writing staffs on shows and the use of artificial intelligence (AI) in the creation of scripts.

SAG-AFTRA actors during their ongoing strike, in Los Angeles (file pic)
Image:
SAG-AFTRA actors during their ongoing strike, in Los Angeles (file pic)

In July, the SAG-AFTRA actors’ union started its own walkout which is yet to be resolved.

It said in a statement: “SAG-AFTRA congratulates the WGA on reaching a tentative agreement with the AMPTP after 146 days of incredible strength, resiliency and solidarity on the picket lines.

“While we look forward to reviewing the WGA and AMPTP’s tentative agreement, we remain committed to achieving the necessary terms for our members.

“We remain on strike in our TV/Theatrical contract and continue to urge the studio and streamer CEOs and the AMPTP to return to the table and make the fair deal that our members deserve and demand.”

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Business

Hollywood writers reach ‘tentative’ deal to end strike over AI and compensation

Published

on

By

Hollywood writers reach 'tentative' deal to end strike over AI and compensation

A “tentative” deal has been reached to end a long-running strike by writers in Hollywood.

The Writers Guild of America (WGA) announced the deal with the Alliance of Motion Picture and Television Producers (AMPTP), the group which represents studios, streaming services and producers in negotiations.

A statement from the WGA said: “We have reached a tentative agreement on a new 2023 MBA, which is to say an agreement in principle on all deal points, subject to drafting final contract language.

“We can say, with great pride, that this deal is exceptional – with meaningful gains and protections for writers in every sector of the membership.”

Most of the writers’ demands have been met

After 146 days on the picket line, Hollywood’s writers are finally ready to put pen to paper and sign an agreement with the studio bosses who pay their wages.

My understanding from speaking to sources on both sides of the standoff, is that most of the writers’ demands have been met with this deal, including greater royalty payments and assurances about the role of Artificial Intelligence in future TV and filmmaking.

If approved by the Writers Guild of America members, which seems all but guaranteed, it will bring an end to the second longest strike in the union’s history. It is also the broadest industry strike in decades, with more than 100,000 actors joining them on the picket.

Hollywood will not fully bounce back. Until actors return to work, filming on shows like the Last Of Us and Stranger Things, which have been on hold for months now, cannot resume. But talk shows like Jimmy Kimmel Live! and Saturday Night Live, which don’t rely on actors, could resume filming as soon as this week.

Speaking to people on the picket line, they framed this strike action as about more than just Hollywood. Some said AI was not just “anti-creative” but that it presented an existential threat not just to their craft but to humankind.

This deal will be seen as a major victory in securing protections over their TV and film credits and payments in the wake of AI.

The three-year contract agreement – settled on after five days of renewed talks by negotiators from the WGA and the AMPTP – must be approved by the guild’s board and members before the strike officially ends.

Read more on Hollywood strikes:
How much of a threat is AI?

The terms of the deal were not immediately announced.

More on Hollywood

The statement added: “To be clear, no one is to return to work until specifically authorised to by the Guild.

“We are still on strike until then. But we are, as of today, suspending WGA picketing. Instead, if you are able, we encourage you to join the SAG-AFTRA picket lines this week.”

The agreement comes just five days before the strike would have become the longest in the guild’s history, and the longest Hollywood strike in decades.

About 11,500 members of the Writers Guild of America walked off the job on 2 May over issues of pay, the size of writing staffs on shows and the use of artificial intelligence (AI) in the creation of scripts.

SAG-AFTRA actors during their ongoing strike, in Los Angeles (file pic)
Image:
SAG-AFTRA actors during their ongoing strike, in Los Angeles (file pic)

In July, the SAG-AFTRA actors’ union started its own walkout which is yet to be resolved.

It said in a statement: “SAG-AFTRA congratulates the WGA on reaching a tentative agreement with the AMPTP after 146 days of incredible strength, resiliency and solidarity on the picket lines.

“While we look forward to reviewing the WGA and AMPTP’s tentative agreement, we remain committed to achieving the necessary terms for our members.

“We remain on strike in our TV/Theatrical contract and continue to urge the studio and streamer CEOs and the AMPTP to return to the table and make the fair deal that our members deserve and demand.”

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World

Florida: Woman whose remains were found in alligator’s mouth identified by police

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Florida: Woman whose remains were found in alligator's mouth identified by police

Police have identified a woman whose remains were found in the mouth of a 13ft alligator in Florida.

The body of 41-year-old Sabrina Peckham was pulled from a canal in Largo, about 20 miles west of Tampa, after a witness spotted her in the alligator’s mouth, the Pinellas County Sheriff’s Office said.

The animal was “humanely killed”, the sheriff’s office said, and the coroner’s office will perform a post-mortem examination to determine the official cause of death, but it is suspected Ms Peckham was killed by the alligator.

Sabrina Peckham (left) and her daughter Breauna Dorris
Image:
Sabrina Peckham (L), pictured with her daughter Breauna Dorris, has been identified as the victim

Ms Peckham’s daughter said her mother was homeless and lived near the water, and countered claims her mother had been taunting the animal.

Breauna Dorris wrote on Facebook: “Some details I would like to share is that my mother did not ‘taunt’ the alligator as some are saying in the news outlets comments.

“My mother was a part of the homeless population that lived in the nearby wooded area.

“It is believed that she may have been walking to or from her campsite near the creek in the dark and the alligator attacked from the water.”

She added: “No matter how you put it, no one deserves to die like this.”

A GoFundMe page has been set up for Ms Peckham to raise money for funeral costs, which has raised nearly $6,000 so far.

Witness ‘threw a rock at the alligator’

The alligator was spotted by Jamarcus Bullard, who saw the reptile and a body in the water on Friday afternoon.

“I threw a rock at the gator just to see if it was really a gator,” he told a TV affiliate of NBC News, Sky News’ US partner network.

“It pulled the body, like it was holding on to the lower part of the torso, and pulled it under the water.”

Read more:
Hunters kill record-breaking alligator after all-night battle
Man survives alligator attack by ‘grabbing its teeth, tongue and snout’
Man dies in alligator-filled lake while looking for frisbees

Jamarcus Bullard said he saw the alligator and a body in the water on Friday afternoon Pic: NBC
Image:
Jamarcus Bullard said he saw the alligator and a body in the water. Pic: NBC

Mr Bullard said he started recording on his phone and contacted the authorities.

The discovery has left some locals nervous, with Jennifer Dean telling TV station WFLA that her children frequently walk by the canal.

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