Patients who seek help from doctors through online portals may soon notice something new: fees for their doctors’ online consultations.
A growing number of health systems in the Chicago area and across the country now charge for certain types of messages sent through online patient portals such as MyChart, with fees often around $35 or less. It’s a trend that has mixed reactions, with some saying it seems fair, while others see it as a cash grab.
Earlier this month, NorthShore University HealthSystem began billing locally for certain types of messages sent through the NorthShoreConnect patient portal. He joined Northwestern Medicine and Lurie Children’s Hospital in practice. Nationally, the Cleveland Clinic made headlines this month when it announced it would begin billing for certain communications. UCSF Health in California also charges for some messages.
Health system executives say most messages remain free, and they bill only for questions that require more than a few minutes of a doctor’s time and that in the past probably merited an in-person visit.
“Some of these messages are becoming more sophisticated and replacing what might have been a phone consultation or an in-person consultation,” said Richard Gundling, vice president of the Healthcare Financial Management Association, a professional group of healthcare finance leaders. “None of us want to sit in waiting rooms anymore after the pandemic. We’ve gotten used to telehealth … we just approach our providers differently. Healthcare systems are responding in the same way.”
Some consumer advocates, however, criticize the trend as greedy.
“It’s once again the big business of health care looking for ways to profit off patients from all sides,” said Cynthia Fisher, founder and chairwoman of Patient Rights Advocate, a Massachusetts-based advocacy group that has been tracking the trend.
She worries that some people will now be hesitant to ask their doctors questions for fear of being blamed. “It really hurts, disproportionately, and it hurts the very people who can least afford it,” she said.
NorthShore announced in an email to patients this month that most messages will remain free, but patients may be billed for some inquiries and questions, such as new symptoms, medication adjustments, new prescriptions, exacerbations of chronic conditions and others that require time. to study the patient’s medical history.
The fee will be billed to the patient’s insurance. At NorthShore, out-of-pocket costs for people on Medicare will range from $3 to $10, while patients with private insurance and Medicare Advantage may have co-pays similar to co-pays for in-person and video visits, NorthShore spokeswoman Colette said. Urban. The cost will be $35 for paying patients without insurance.
Patients must first consent to billing before doctors will answer questions.
“The COVID-19 pandemic has resulted in more patients seeking virtual health care options such as video and phone visits,” Urban said in a statement. “In addition to online visits, messaging a provider through a secure patient portal offers consumers another way to receive quality, convenient and affordable care. … While most online messages are free, there may be times when a physician’s response to a patient requires more complex medical decision-making and discussion.”
Northwestern and Lurie, which already billed for some messages, say very few of their MyChart messages charge a fee.
For three months earlier this year, Northwestern charged less than 1% of messages on its MyChart portal. Northwestern charges $35 per appointment, spokesman Christopher King said.
Likewise, Lurie charged for about 300 MyChart appointments last year, a small fraction of the nearly 300,000 reports it received, said Dr. Ravi Patel, Lurie’s vice president of digital health.
“The intent is not to charge for MyChart messages,” Patel said, noting that patients are not charged for quick inquiries, such as making an appointment, viewing after an in-person appointment or needing a refill.
“It’s really for when you have a new problem, a new symptom, a recurring symptom that’s come back, a new rash,” he said.
It’s another way for patients to access care, he said.
“Ten years ago, you did it in person, that’s all,” Patel said, adding that Lurie now attends by video as well. “The beauty of it is that after 10 years, we’ve tripled the number of ways to get care and hopefully see patients outside of the hospital.”
The trick for health systems may be finding a balance between making sure doctors are compensated for their time while not overcharging patients for messages that don’t require much work or expertise, said John Hargreaves, director of data strategies from the Institute for Health Care Costs, a nonprofit organization that studies trends in health care costs.
He said it can be difficult for health systems to set hard parameters for which types of messages should be charged for and which should not.
But he expects this trend to grow.
“I don’t think you can go back and make it a service that nobody charges for,” he said. “Most things related to health care and costs only go in one direction. When something is known to be payable, it is seldom not exhibited.’