Costs for using MyChart? More health systems in the Chicago area are asking for some messages


Patients who seek help from their doctor through online portals may soon notice something new: reimbursements for their doctor’s online advice.

A growing number of health systems in the Chicago area and across the country are now charging for some types of messages sent through online patient portals, such as MyChart, with charges often around $35 or less. It’s a trend that has garnered mixed reactions, with some saying it only seems fair, while others see it as a money grab.

Locally, NorthShore University HealthSystem began billing some types of messages sent through its patient portal, NorthShoreConnect, earlier this month. It joined Northwestern Medicine and Lurie Children’s Hospital in practice. Nationally, the Cleveland Clinic made headlines this month when it announced they would start billing some communications. UCSF Health in California also charges for some messages.

Health system leaders say most messages will remain free, charging only questions that take more than a few minutes of doctor time and would likely have merited an in-person visit in the past.

“Some of those messages have become increasingly complex, replacing what may have been a telephone consultation or an in-person consultation,” said Richard Gundling, vice president of the Healthcare Financial Management Association, a professional group of healthcare financial leaders. “None of us want to sit in waiting rooms after the pandemic. We’re used to telehealth…we just approach our providers differently now. The health systems are responding in kind.”

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However, some consumer advocates criticize the trend as greedy.

“This is once again the healthcare industry’s big business of finding ways to make a profit for patients from every angle,” said Cynthia Fisher, founder and president of Patient Rights Advocate, a Massachusetts-based advocacy group that has been watching the trend. .

She fears that some people are now hesitant to ask their doctors questions for fear they could be sued. “It really, disproportionately, 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 some patient requests and questions may be charged, such as those about new symptoms, medication changes, new prescriptions, flare-ups of chronic conditions and others that require significant time spent reviewing a patient’s medical history.

The costs are charged to the patient’s health insurance. At NorthShore, out-of-pocket costs for people with Medicare will range from about $3 to $10, while patients with private insurance and Medicare Advantage may have a co-payment similar to that for in-person and video visits, said NorthShore spokeswoman Colette Urban. The cost is $35 for patients paying without insurance.

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Patients must first authorize a bill before doctors answer the questions.

“The COVID-19 pandemic has led more patients to seek virtual health care, such as video and phone visits,” Urban said in a statement. “In addition to online visits, messaging a healthcare provider through a secure patient portal offers consumers another way to receive high-quality, convenient and accessible care. … While most online messages are free, there may be times when a doctor’s response to a patient requires more complex medical decision making and discussion.

Northwestern and Lurie, who had already billed a number of messages, say very few of their MyChart messages are charged.

During a three-month period early this year, Northwestern settled less than 1% of posts on its MyChart portal. Northwestern charges $35 per encounter, spokesman Christopher King said.

Similarly, Lurie charged about 300 MyChart encounters in the past year, part of the nearly 300,000 messages it received, said Dr. Ravi Patel, vice president of digital health for Lurie.

“It’s not the intent here to charge for MyChart messages,” Patel said, noting that patients don’t have to pay for quick questions, such as questions about scheduling an appointment, following up on a personal appointment, or refilling of medicines. .

“It’s really for those cases where you have a new problem, a new symptom, a recurring symptom that comes up again, a new rash,” he said.

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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 is now doing video visits as well. “The beauty of this is that 10 years later, we’ve tripled the number of ways you can get care and hopefully see patients outside of the hospital.”

The trick for health systems may be striking a balance between making sure doctors are compensated for their time, and not overpaying patients for messages that don’t require a lot of work or expertise, said John Hargraves, director of data strategy for the Health Care Cost Institute, a non-profit organization that studies healthcare cost trends.

It can be difficult for health systems to establish hard parameters for which types of messages should be charged and which should not, he said.

But he expects the trend to grow.

“I don’t think there’s a way to go back and turn it into a service that no one is charging for,” he said. “Most cases involving care and costs only go one way. When something is known to be billable, it rarely goes unbilled.”

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