Patients seeking help from their doctors through online portals may soon be in for something new: charges for online consultations with their physicians.
A growing number of health systems in the Chicago area and across the country are now charging fees for certain types of messages sent through online patient portals such as MyChart, with fees often starting at $35 or less. It’s a trend that’s garnering mixed reactions, with some saying it only seems fair, while others see it as a cash grab.
Locally, NorthShore University HealthSystem began billing earlier this month for certain types of messages sent on its patient portal, NorthShoreConnect. It 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 some communications. UCSF Health in California also charges for some messages.
Health system leaders say most messages remain free, and they are billing only for questions that require more than a few minutes of a doctor’s time and that, in the past, would have required in-person visits. There was a possibility of
“Some of those messages have become increasingly complex and are taking the place of a phone consultation or in-person consultation,” said Richard Gundling, vice president of the Healthcare Financial Management Association, a professional group of health care finance leaders. “None of us want to sit in the waiting room anymore after the pandemic. We’ve grown accustomed to telehealth…we’re just accessing our providers differently. Health systems are responding in a variety of ways. ,
Some consumer advocates, however, criticize the trend as greedy.
“It’s again the big business of health care finding ways to profit from every angle on patients,” said Cynthia Fischer, founder and president of the Massachusetts-based advocacy group Patient Rights Advocates, which is watching the trend.
He worries that some people will now hesitate to ask their doctors questions, for fear they could be accused. “It really hurts, disproportionately, and hurts the 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 certain requests and questions, such as reports of new symptoms, medication adjustments, new prescriptions, flare-ups of chronic conditions, and more. is required. Extensive time spent reviewing a patient’s medical history.
The fee will be billed to the patient’s insurance. In NorthShore, out-of-pocket costs for people on Medicare will range from about $3 to $10, while in-person and video visits may have similar co-pays for patients with private insurance and Medicare Advantage, said NorthShore spokeswoman Colette Said Urban. The cost will be $35 for paying patients without insurance.
Patients must first consent to billing before doctors can answer questions.
“The COVID-19 pandemic has resulted in more patients seeking virtual health care options, such as video and telephone visits,” Urban said in a statement. “In addition to online visits, messaging a provider through a secure patient portal provides another way for consumers to receive quality, convenient and accessible care. … While most online messages are at no cost, there may be times when a physician’s response to a patient requires more complex medical decision-making and discussion.
Northwestern and Lurie, which were already billing for some messages, say very few of their MyChart messages are charged.
During a three-month period earlier this year, Northwestern charged for less than 1% of messages on its MyChart portal. Spokesman Christopher King said Northwestern charges $35 per encounter.
Similarly, Lurie charged for about 300 MyChart encounters last year, which yielded about 300,000 messages, said Dr. Ravi Patel, vice president of digital health for Lurie.
“The intent here is not to charge for MyChart messages,” Patel said, noting that patients are not charged for quick questions, such as about scheduling an appointment, to follow up after an in-person appointment. About needing to top up or refill the drug.
“It’s really for those cases where you have a new problem, a new symptom, a recurring symptom that reappeared, a new rash,” he said.
It is just another way to take care of patients, he added.
“Ten years ago, you did it in person, that’s all,” Patel said, adding that Lurie now also does video visits. “The beauty of it is that 10 years later, we’ve now tripled the number of ways you can get care and see patients outside of the hospital.”
John Hargreaves, director of data strategy for the Health Care Cost Institute, said there may be a balance for health systems to find between making sure doctors are compensated for their time while not overcharging patients for messages. which do not take much work or expertise. , a non-profit organization that studies trends in health care costs.
He said it could be difficult for health systems to set hard criteria for which types of messages should be charged and which should not.
But he expects this trend to grow.
“I don’t think anybody is going to go back and make this a service that nobody charges for,” he said. “Most things with health care and costs only move in one direction. When something is known to be billable, it is rarely billed.”