Every department in a health system has a good reason to send a patient one more message. Scheduling needs a confirmation. Billing wants a payment. Marketing has flu shots and open enrollment, and the foundation has its year-end appeal. Nobody adds up what the patient receives.
The patient’s phone already does. Gmail ranks senders by how often they write and unsubscribes with one tap. iPhones can file texts from unknown numbers in a folder with no alert and make unknown callers explain themselves before the phone rings. Scammers have made it worse, sending fake MyChart messages good enough to fool people. Patients have learned to ignore what they don’t recognize, and calls from their own doctors are among the ones they miss most.
Inside the health system, the senders keep multiplying. One large academic system lists three separate texting platforms on its own website, and that’s before the portal, the CRM, agencies running campaigns, an outsourced billing vendor and the foundation. Each answers to its own scorecard and its own rules. Automated care reminders carry a federal frequency limit. Promotional messages carry none. One careless campaign can push patients to opt out of the reminders they actually wanted.
Chris Boyer and Reed Smith put the choice on the table. Coverage notices, care gap reminders and clear billing all need reach. Every low-value message makes those easier to ignore. Sending less only works when someone inside the organization can rank what goes out, sort messages so a patient can opt out of one kind without losing the rest and measure the cost to the patient instead of the open rate.
If a patient could get only one message from you this week, would your organization agree on which one?
MENTIONS FROM THE SHOW
- Healthcare’s Long Walk Toward the Patient, the free eBook marking 500 episodes, plugged in the open: https://www.touchpointpodcastbook.com
- Mailchimp and Ascend2 survey of 6,000 consumers in the US, UK, Canada, Australia and New Zealand, published 2026: https://www.marketingprofs.com/charts/2026/54295/how-many-marketing-emails-and-texts-is-too-many
- Dotdigital’s 2026 benchmark (brands sent 57.2% more texts than the year before) and EZ Texting’s 2026 survey (40% opt out over frequency): https://www.inc.com/ali-donaldson/brands-sent-57-percent-more-texts-last-year-heres-the-reason-founders-keep-hitting-send/91405127
- Google, Gmail “Manage subscriptions,” July 8 2025: https://blog.google/products/gmail/new-manage-subscriptions-unsubscribe/
- Gmail and Yahoo bulk sender requirements: https://www.warmy.io/guides/google-yahoo-sender-requirements/
- Apple iOS 26 “Screen Unknown Senders” for texts, September 2025: https://www.bandwidth.com/blog/apple-ios26-inbox-update/
- Apple iOS 26 Call Screening: https://www.techradar.com/phones/iphone/call-screening-in-ios-26-has-finally-ended-my-spam-call-nightmare-heres-how-to-set-it-up
- CMSWire on how Apple Mail Privacy Protection preloads email and inflates open rates, October 27 2026: https://www.cmswire.com/digital-marketing/did-apple-and-gmail-break-email-measurement-or-just-expose-it/
- Cloaked, The Trust Cost of Spam Calls and Texts: https://www.cloaked.com/research-hub/cost-of-spam-calls-and-texts
- Healthcare Dive, Health systems warn patients of MyChart phishing scam: https://www.healthcaredive.com/news/health-systems-warn-patients-of-mychart-phishing-scam/828597/
- Healthcare Finance News, Epic, AHA warn of phishing schemes in MyChart: https://www.healthcarefinancenews.com/news/epic-aha-warn-phishing-schemes-mychart
- Tebra, “The scamdemic,” 500 adults and 500 health workers, updated January 15 2026: https://www.tebra.com/theintake/healthcare-reports/the-scandemic-fake-healthcare-messages
- JAMA, Long et al., “Trends in patient portal messages, office visits, and telephone encounters,” June 22 2026: https://www.ajmc.com/view/patient-portal-messages-outpace-office-visits
- Mass General Brigham’s text message terms, which name three texting platforms: https://www.massgeneralbrigham.org/en/notices/text-message-terms-conditions
- FCC 2015 healthcare exemption for automated calls and texts to patients’ cell phones: https://www.kutakrock.com/newspublications/publications/2015/08/fcc-clarifies-tcpa-robocalls-rules-for-health-care
- FCC declaratory ruling, February 2024, that AI-generated voices are artificial voices under the federal robocall law: https://www.mayerbrown.com/en/insights/publications/2024/02/fcc-declares-authority-and-intent-to-regulate-ai-generated-calls-under-the-tcpa
- HIPAA fundraising rule, 45 CFR 164.514(f). Permits use of department of service, treating physician and outcome information, with an opt-out in every fundraising message: https://www.bricker.com/insights/resources/key/HIPAA-Privacy-Regulations-Other-Requirements-Relating-to-Uses-and-Disclosures-of-PHI-Fundraising-164-514-f
- The Permanente Journal, Duckro et al., “Developing Patient-Centered Communication Ecosystems in Integrated Health Care Delivery Organizations,” September 2023: https://pmc.ncbi.nlm.nih.gov/articles/PMC10723088/
- FCC order narrowing opt-out rules, adopted September 30 2026, published in the Federal Register October 26 and effective November 25 2026: https://www.womblebonddickinson.com/us/node/21530
- US military hospital guidance on missed hospital calls, April 23 2026: https://irwin.tricare.mil/News-Gallery/Article-Display/Article/4468117/missing-hospital-calls
- American Hospital Association, “Improving the Patient Billing Experience,” 2021. The source for consolidating statements by episode of care and offering one point of contact for billing questions: https://www.aha.org/system/files/media/file/2021/10/Improving-Patient-Billing-Experience_IB_Final_10-22-21.pdf
- TP511, “Live from HCIC26: Who Let the Agents In?”, recorded at the 30th Healthcare Interactive Conference: https://touchpoint.health/podcast/tp511-live-from-hcic26-who-let-the-agents-in/
- TP508, “Marketing Beyond the Megaphone,” on coverage outreach: https://touchpoint.health/podcast/tp508-marketing-beyond-the-megaphone/
- Reed Smith on LinkedIn: https://www.linkedin.com/in/reedtsmith/
- Chris Boyer on LinkedIn: https://www.linkedin.com/in/chrisboyer/
- Chris Boyer website: http://www.christopherboyer.com/
- Chris Boyer on BlueSky: https://bsky.app/profile/chrisboyer.bsky.social
- Reed Smith on BlueSky: https://bsky.app/profile/reedsmith.bsky.social
Recommendations from this episode:
- Chris: the original metal Slinky: https://www.pbs.org/wgbh/americanexperience/features/slinky
- Reed: Pappyland: A Story of Family, Fine Bourbon, and the Things That Last by Wright Thompson (Penguin Press, 2020): https://www.publishersweekly.com/9780735221253
