Who Handles Portal Messages? 71% of Groups Assign Someone

Seven in 10 medical groups (71%) have someone designated to handle portal messages for other providers, according to an MGMA Stat poll of 238 applicable responses on October 27, 2026. Another 24% have no one in that role, 1% were unsure, and 4% reported no portal.

The question matters because the message load keeps growing and falls unevenly. The sections below cover the volume data, who carries the load, who does the work, and how billing rules apply.

Portal message volume rose again in 2024

An MGMA Stat poll on January 28, 2025, with 223 applicable responses, found that 70% of medical groups saw more patient portal messages in 2024. Another 29% said volume was about the same, and 1% reported a decrease.

Epic data show the same trend over a longer span. A JAMA study by Long and colleagues, published online in June 2026, found that patient-authored portal messages rose 153% from 2020 to 2025. Physicians Practice reported on September 1, 2026 that the study covered roughly 8 billion encounters.

Physicians Practice also reported that office visits rose 17% over the same years while telephone calls fell 6%. The added messages arrived on top of in-person care. The same article said 30% of active Epic patients, about 42 million people, sent at least one message in the first quarter of 2025 alone.

Portal access is common. MGMA's ten-year retrospective (September 30, 2026) reports that 90% of groups offered a patient portal in its census-style polls of 2018 and 2019, and a July 2018 portal question drew 1,785 responses, the most of any MGMA Stat poll. MGMA does not state the base for the 90%.

A small share of patients and physicians carry most of the load

A Health Affairs study by Holmgren, Apathy, Mehrotra, and Chernew (August 2026) used data on 487,442 patients at UCSF Health and national EHR metadata from 224,068 ambulatory care physicians. The top 5% of UCSF Health patients accounted for 52.8% of all messages.

By simple arithmetic, 5% of 487,442 is about 24,000 patients who sent more than half the messages.

The physician side is just as uneven. Primary care physicians nationally received a median of 9.6 messages per week, and the top quartile received 53.3. That is 5.6 times the median.

Measure	Figure	Base
Share of all messages from the top 5% of patients	52.8%	487,442 UCSF Health patients
Median primary care messages per physician per week	9.6	224,068 U.S. ambulatory physicians
Top-quartile primary care messages per physician per week	53.3	224,068 U.S. ambulatory physicians

Source: Holmgren AJ, Apathy NC, Mehrotra A, Chernew ME, Health Affairs, 2026;45(8):862-870.

A group-wide average hides this spread. One physician can carry five times the median load while the group average looks normal. The study also found that physicians with higher visit volume received fewer messages per visit.

Which roles take the inbox

MGMA asked groups whether anyone is designated to handle portal or inbox messages for other providers. The poll ran on October 27, 2026.

Answer	Share of 238 responses
Yes, someone is designated	71%
No one is designated	24%
Unsure	1%
No portal	4%

Source: MGMA Stat, October 28, 2026.

In count terms, 71% of 238 responses is about 169 groups with a designated person, and 24% is about 57 without one.

Among "yes" respondents who named a role, nearly two-thirds cited medical assistants, nurses, or both. About one in 10 named advanced practice providers. Roughly one in eight described physicians and APPs covering each other's inboxes. MGMA does not state the count behind these shares.

Time and pay for inbox work

About 71% of "yes" respondents who addressed time or pay reported no separate schedule time and no added pay for the inbox role. This 71% uses a different base from the 71% who said yes, and MGMA does not state that base.

Among the 24% with no designated person, about six in 10 said the treating provider handles their own messages. That group is roughly 14% of all 238 responses. One practice quoted by MGMA allots 30 minutes daily during work hours for inbox tasks.

A JAMA Network Open cohort study (Kanaparthy and colleagues, December 2025) tested one protected appointment slot per half-day for asynchronous EHR work by internal medicine physicians. MGMA describes the slot as 20 to 30 minutes and summarizes the result as only a small decrease in wRVU productivity. PubMed lists no abstract for the paper, so the exact change is not available there.

Triage tools and e-visit billing rules

Kaiser Permanente's Southern California group put an automated triage tool on its portal. Permanente Medicine reported on February 13, 2026 that the tool reached 81% classification accuracy, against 44% for the legacy system. Time for clinicians to read a high-acuity message fell from 22 hours to 5, a cut of 17 hours.

Some portal messages can be billed. MGMA states that patient-initiated messages from established patients may qualify as e-visits (CPT 99421 to 99423) when they involve clinical evaluation and at least five minutes of cumulative physician or other qualified health professional time over seven days. MA and nursing time does not count toward the five minutes.

MGMA's January 2025 guidance says billing should cover a small percentage of total messages, often less than 1%. Billing applies to a thin slice of the inbox, and the rest is unpaid work. A Mayo Clinic study that MGMA cites found an 8.8% decrease in portal message threads over six months of billing, compared with the same period the year before.

Sources

Talk to us

Fifteen minutes about your practice and the systems you run.

Book a demo