Hospitals begin charging fees for online portal messages

Doctors are spending more time reviewing online messages, but patient advocates worry the new charges will prevent people from reaching out.

WASHINGTON — Next time you text your doctor about a nasty cough or itchy rash, you might want to check your bank account first — you might get a bill for that question.

Hospital systems around the country are rolling out charging for some messages patients send to doctors, who they say are spending more and more time reviewing online queries , some are so complex that they require medical expertise that is usually provided in an in-office visit.

However, patient advocates worry these new fees could deter people from contacting their doctors and add another layer of complexity to the care system’s already opaque billing process. US health care.

“This is a barrier to access and will lead to hesitation or fear of communication and potential,” says Cynthia Fisher, founder of Patient Rights Advosacy, based in Massachusetts. harm patients with a lower quality of care and, as a result, much higher costs.” Non-profit organization promoting transparency in hospital pricing.

The boom in telehealth over the past three years — driven by the COVID-19 outbreak and loosened federal regulations for online care — has spurred many physicians to adopt the service. stronger telecommunications with their patients. Consultations that used to take place in the office have been converted into computer or smartphone visits. And healthcare systems have invited patients to use new online portals to submit questions to their doctors at any time, said American Medical Association president Jack Resneck Jr. told the Associated Press.

“As people realize that this is great and can improve care, you have seen hospitals and practice groups saying to patients, welcome to your portal,” says Resneck. .. you can ask your doctor questions if you want,” says Resneck. “We find ourselves as doctors who get dozens and dozens of these things every day and don’t have the time to do the work.”

Fees vary for each patient and hospital system, with messages costing from $3 for Medicare patients to $160 for the uninsured. In some cases, the final bill depends on how long the doctor takes to respond.

Health systems that have rolled out these new policies, many in recent months, say they automatically warn patients they may be charged when they text their doctors through online portals such as MyChart, an online system many organizations now use to schedule appointments or releases. test results for the patient.

Under the new billing rules, doctors are allowed to bill Medicare as little as 5 minutes spent on an online message over a seven-day period, according to the Centers for Medicaid and Medicare.

Health economist Katherine Baicker of the University of Chicago says doctors need to be paid for the time they take to give expert medical advice – even via text message. But it’s also important for hospital systems to be transparent about what patients may have to pay when they introduce these new charges, she added.

“Copays don’t accomplish anything when they are not obvious to the patient ahead of time,” says Baicker.

According to Jess Berthold, a spokesperson for the system, doctors at the University of California San Francisco Health field about 900,000 email threads — 3 million messages in total — in a year.

In November 2021, the hospital announced that it would begin charging for some of those messages, after noticing a spike during the pandemic. Over a one-year period, 1.4% of email chains, or about 13,000, resulted in an invoice.

Only certain messages will trigger charging. Patients will not be charged for, for example, refilling a prescription, making an appointment, asking a follow-up question about an office visit within the last seven days, or if their doctor recommends that they schedule an appointment for a follow-up visit. reply.

What kind of message will prompt an invoice? Send your doctor pictures of the new rash, ask to fill out a form, or request a change in medication.

Navigating how much money you will likely owe can be trickier.

At UCSF, patients with Medicaid texting their doctor won’t have to pay any out-of-pocket costs, and patients with traditional Medicare can expect to pay $3 to $6. Patients with private insurance will be billed a copay – usually around $20 – as well as patients with Medicare Advantage, Medicare’s private insurance plan.

The Cleveland Clinic in Ohio, the latest major hospital system to announce charging for online messages, launched similar guidelines late last month, with messages costing up to $50 for people have private insurance. And at Northwestern Medicine in Chicago, which charges $35 for some messages, less than 1% of those correspondence lead to a bill, said spokesman Christopher King.

All of those systems use the online portal MyChart. Epic, the private software company that runs MyChart, does not track which health systems charge patients for text messages, spokeswoman Barb Herandez said in an email. The company did not respond to questions about whether it received a portion of those fees.

The hospital system argues that giving patients advice online can save patients time or money in the long run. If a doctor can answer a patient’s questions via email, the patient can cut down on waiting times for an appointment and avoid taking time off work to get to the doctor’s office.

Plus, some patients simply enjoy the convenience of getting quick answers from their doctors on an app, UCSF’s Berthold adds.

“If patients can reach a doctor right away with questions or concerns, they can seek care faster and get treatment faster,” says Berthold.

But Fisher argues that it could have the opposite effect of making patients think twice before texting a doctor. Some people may turn to free, unreliable online advice instead.

“It becomes a slippery slope and that slippery slope is not beneficial to the patient,” she said. Hospitals begin charging fees for online portal messages

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