Patients who ask for their doctors' help through online portals might soon notice something new: fees for their physicians' online advice.
A growing number of health systems across the country are now charging for some types of messages sent through online patient portals, such as MyChart, with fees often around $35 or less. It's a trend that's sparking mixed reactions, with some saying it seems only fair, while others see it as a cash grab.
In the Chicago area, NorthShore University HealthSystem began billing for some types of messages sent over its patient portal, NorthShoreConnect, earlier this month. It joined Northwestern Medicine and Lurie Children's Hospital in the practice. Nationally, the Cleveland Clinic generated headlines this month when it announced it would start billing for some communications. UCSF Health in California also charges for some messages.
Health system leaders say most messages remain free, and they're only billing for questions that require more than a few minutes of a doctor's time and that, in the past, would likely have merited an in-person visit.
"Some of those messages have become increasingly complex and are replacing what may have been a phone consultation or an in-person consultation," said Richard Gundling, vice president at the Healthcare Financial Management Association, a professional group of health care finance leaders. "None of us wants to sit in waiting rooms anymore after the pandemic. We're used to telehealth ... we're just accessing our providers differently now. The health systems are responding in kind."
Some consumer advocates, however, criticize the trend as greedy.
"This is yet again the big business of health care finding ways to profit at every angle on patients," said Cynthia Fisher, founder and chairman of Patient Rights Advocate, a Massachusetts-based advocacy group that's been watching the trend.
She worries some people will now be hesitant to ask their doctors questions, out of fear they could be charged. "It really disadvantages, disproportionately, and harms the very people who can afford it the least," she said.
NorthShore announced in an email to patients this month that most messages will remain free, but patients might be billed for some requests and questions, such as those about new symptoms, medication adjustments, new prescriptions, flare-ups of chronic conditions and others that require extensive time reviewing a patient's medical history.
The fees will be billed to patients' insurance. At NorthShore, the out-of-pocket costs for people on Medicare will range from about $3 to $10, while patients with private insurance and Medicare Advantage may have co-payments similar to those for in-person and video visits, said NorthShore spokeswoman Colette Urban. The cost will be $35 for patients who pay without insurance.
Patients must first consent to being billed before doctors answer the 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 via a secure patient portal offers consumers another way to receive quality, convenient and accessible care. ... While most online messages are at no cost, there may be times when a physician response to a patient requires more complex medical decision-making and discussion."
Northwestern and Lurie, which had already been billing for some messages, say very few of their MyChart messages incur charges.
During a three-month period at the beginning of this year, Northwestern charged for fewer than 1% of messages on its MyChart portal. Northwestern charges $35 per encounter, said spokesman Christopher King.
Similarly, Lurie has charged for about 300 MyChart encounters in the last year, a sliver of the nearly 300,000 messages it's received, said Dr. Ravi Patel, vice president of digital health for Lurie.
"The intent here is not to be charging for MyChart messages," Patel said, noting that patients aren't charged for quick queries, such as those about scheduling an appointment, following up after an in-person appointment, or needing a medication refill.
"It's really for those cases where you've got a new problem, a new symptom, a recurring symptom that came up again, a new rash," he said.
It's just one more way for patients to access care, he said.
"Ten years ago, you did it in-person, that was it," Patel said, adding that Lurie now also does video visits. "The beauty of this is, 10 years later, we've now tripled the ways in which you can get care and hopefully see patients outside 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 take much work or expertise, said John Hargraves, director of data strategy for the Health Care Cost Institute, a nonprofit organization that studies trends in health care costs.
It may be difficult for health systems to set hard parameters around which types of messages should incur charges and which should not, he said.
But he expects the trend to grow.
"I don't think there's any going back and making it a service that no one charges for," he said. "Most things with health care and costs only move in one direction. When something is known to be billable, it's rarely not billed."