Patients seeking help from their doctors through online portals may soon notice something new: fees for their doctors’ online advice.
A growing number of health systems in the Chicago area and across the country already charge 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 has drawn mixed reactions, with some saying it seems only fair, while others see it as a cash grab.
Locally, NorthShore University HealthSystem began charging for certain types of messages sent through its patient portal, NorthShoreConnect, earlier this month. He joined Northwestern Medicine and Lurie Children’s Hospital in practice. Nationally, the Cleveland Clinic generated headlines this month when it announced it would begin charging for some communications. UCSF Health in California also charges for some messages.
Health system executives say most messages remain free, and they only charge 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’re used to telehealth … we just have different access to our providers now. Health systems are responding in the same way.
However, some consumer advocates criticize the trend as greedy.
“This is again the big business of health care finding ways to profit from every corner of patients,” said Cynthia Fisher, founder and president of Patient Rights Advocate, a Massachusetts-based advocacy group that has been monitoring the trend.
She worries that some people will now hesitate to ask their doctors questions for fear of being accused. “It really disadvantages, disproportionately, and 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 charged for some requests and questions, such as those about new symptoms, medication adjustments, new prescriptions, exacerbations of chronic conditions and others that require extended time to review the patient’s medical history.
Fees will be billed to patients insurance. At NorthShore, 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 copayments similar to those for in-person and video visits, NorthShore spokeswoman Colette Gradsky said. The cost will be $35 for patients paying without insurance.
Patients must first agree to be billed before doctors will answer the questions.
“The COVID-19 pandemic has led to more patients seeking virtual healthcare 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. … Although most online messages are free, there may be times when a physician’s response to a patient requires more complex medical decision-making and deliberation.
Northwestern and Lurie, which already charge for some messages, say very few of their MyChart messages incur fees.
During a three-month period earlier this year, Northwestern charged less than 1 percent of messages on its MyChart portal. Northwestern charges $35 per appointment, spokesman Christopher King said.
Likewise, Lurie billed for about 300 MyChart appointments in the past year, a small fraction of the nearly 300,000 messages it received, 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 inquiries, such as those about scheduling an appointment, following up 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 has come back, a new rash,” he said.
It’s just another 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 it is that 10 years later, we’ve tripled the ways you can get care and hopefully see patients outside of the hospital.”
The trick for health systems may be to find 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 Hargraves, director of strategy for data for the Health Care Cost Institute , a nonprofit organization that studies health care cost trends.
It can be difficult for health systems to set hard parameters around which types of messages should carry fees and which should not, he said.
But he expects the trend to grow.
“I don’t think there’s going back and turning it into 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 chargeable, it is rarely charged.”