Smartphone Application Allowing Physicians to Call Patients Associated with Increased Physician Productivity

Smartphone Application Allowing Physicians to Call Patients Associated with Increased Physician Productivity Christopher M. Whaley, PhD1 , Daniel J. Crespin, PhD2, and Tisamarie B. Sherry, MD, PhD3 1 RAND Corporation, 1776 Main Street, Santa Monica, CA, USA; 2RAND Corporation, Boston, MA, USA; 3RAND Corporation, Washington, DC, USA. BACKGROUND: Telehealth and other technologies that enable remote patient-physician communication technologies have widespread use among physicians and other health care providers, but the impacts of these technologies on physician productivity are not well known. OBJECTIVE: To determine whether a HIPAA-compliant application that allows physicians to call patients from their personal cell phones is associated with an increase in physician productivity. DESIGN, SETTING, AND PARTICIPANTS: We used a 100% sample of Medicare claims and longitudinal physician-level data to examine whether physician use of a smartphone application that enables physicianpatient phone calls is associated with changes in Medicare patient volume and services. We compared early adopters of the application, 31,577 physicians providing Part B services who initiated use of the application between January 2014 and December 2017, with later adopters, 22,988 physicians who initiated use between January 2018 and July 2019. MAIN MEASURES: Physician productivity was measured as total Medicare Part B beneficiaries, total Part B services provided, the number of Part B beneficiaries with any evaluation and management (E&M) service, the total number of E&M services provided, and the average number of E&M services provided per beneficiary. KEY RESULTS: Following application use, there was a 0.52 increase (95% CI: 0.19 to 0.85) in the monthly number of Part B beneficiaries seen. This difference translates to a 0.8% increase in Part B beneficiaries. Similar increases were observed for the number of unique beneficiaries for which the physician provided E&M services—a 0.50 increase (95% CI: 0.27 to 0.73) or 1.2%. There was a 0.43 increase (95% CI: 0.07 to 0.78) in monthly E&M services (0.7% increase). CONCLUSIONS: Physicians who used a freely available smartphone application modestly increased their total Medicare beneficiary volume and total number of E&M services provided, suggesting potential improvements in physician productivity. J Gen Intern Med DOI: 10.1007/s11606-021-06663-2 © Society of General Internal Medicine 2021 INTRODUCTION The use of health communication technologies to support remote health care services has emerged as one method to enhance interaction between physicians and patients.1–4 By adapting the delivery of health care to available technology, these developments allow physicians to reach patients at mutually convenient times to discuss their care when an office visit is burdensome or unnecessary. Advocates believe that these technologies will not only improve care delivery through better patient compliance2 and engagement in decision-making5, 6 but also increase physician productivity.2, 3 At the same time, other studies have noted cost and usage barriers to telemedicine, which may impair productivity. Many health-related technologies speed the flow of information between physicians and patients, which may increase the capacity of physicians to deliver care to new and current patients. However, the impacts of these technologies on physician productivity are not well established. Physicians have noted several implementation barriers of new technologies that may hamper their use, including lacking necessary devices, concerns regarding security and confidentiality, and added workload.7 Understanding the impacts of telehealth applications on productivity is especially relevant given the large increased use of telemedicine during the COVID-19 pandemic.8 This study examines the impact of a smartphone application that allows physicians to communicate with their patients over their personal cell phones.9 The application is HIPAA-compliant and allows physicians to call patients without disclosing their personal cell phone number, thus alleviating both physician and patient privacy concerns. Users of the smartphone application can also specify that calls display the physician’s office phone number, which protects physician privacy and may make patients more likely to answer the call. This paper links physician-level data on use of the application with a 100% sample of Medicare claims data to test whether use of the application is associated with an increase in patients and services. METHODS Doximity Dialer Received July 9, 2020 Accepted February 14, 2021 Doximity is an online professional medical network for physicians and other clinicians that includes, as of 2018, over one Whaley et al.: Use of a Smartphone Application on Physician Productivity million members and over 70% of US physicians.10 In October 2016, Doximity implemented its Dialer application that allows physicians and other health care providers to communicate with patients via their personal cell phone in a HIPAAcompliant environment. Physicians can call patients on their cell phone using the application, but patients see a prespecified number, rather than the physician’s personal number. Physicians can customize the pre-specified number to the main office of their clinic or physician group. Patients do not have to download the application. We obtained physician-level data on the daily volume of calls from October 2016 through December 2019, which we aggregated to the monthly level. For each physician, we identified whether the physician used the application and their total call volume in each month. Specific patient interactions or the contents of the calls are not recorded or tracked, and we are thus unable to examine questions related to specific patient outcomes. For both registered and non-registered physicians, the data combines data from multiple data sources, including data from the Centers for Medicare and Medicaid Services (e.g., the National Plan and Provider Enumeration System (NPPES) National Provider Identifier (NPI) Registry), state licensing boards, specialty societies, and medical schools. Details and validation of the database have been described elsewhere.11–14 From these databases, we obtained information on physician age, sex, specialty, years in practice, and practice location. Medicare Patient Volume Data Our second source of data was a 100% sample of 2014 through 2017 Medicare Fee-for-Service medical claims data. We restricted the sample to Carrier claims for Medicare Part B, which covers clinician office visits. We link these data to the Doximity data using NPIs. Because the Doximity data does not include information on patients, we were unable to link specific patient-physician interactions. For each NPI and month, we identified the number of distinct Medicare beneficiaries with Part B services and the number of Part B services delivered (defined by counts of HCPCS codes) (...truncated)