Patients who turn to their doctors for help through online portals may soon notice something new: online doctor fees.

A growing number of healthcare systems in the Chicago area and across the country now charge for certain types of messages sent via online patient portals such as MyChart, with fees often around $35 or less. This is a trend that is getting mixed reactions, with some saying it seems 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. In practice, he joined Northwestern Medicine and Lurie Children’s Hospital. Nationwide, the Cleveland Clinic made headlines this month when it announced it would start charging for certain communications. UCSF Health in California also charges for some messages.

Health system leaders say most messages remain free and only pay 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 complex and replacing what could 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 post-pandemic waiting rooms anymore. We’re used to telehealth… now we just access our providers differently. Health systems respond in nature.”

However, some consumer advocates criticize this trend as greedy.

“This is another big healthcare business looking to monetize patients from all angles,” said Cynthia Fisher, founder and chair of Patient Rights Advocate, a Massachusetts-based advocacy group that is watching the trend.

He worries that some people will now be hesitant to ask doctors questions for fear of being prosecuted. “It really hurts, disproportionately, and it hurts the same people who can least afford it,” she said.

NorthShore announced in an email to patients earlier this month that most messages will remain free, but patients may be charged for certain requests and questions, such as those relating to new symptoms, medication adjustments, new prescriptions, exacerbations of chronic conditions, and more. require a long time of reviewing the patient’s medical history.

Fees will be charged to patients’ insurance. At NorthShore, out-of-pocket costs for Medicare recipients will range from about $3 to $10, while privately insured and Medicare Advantage patients may have co-payments similar to those for in-person and video visits, NorthShore spokeswoman Colette Municipal said. The cost will be $35 for patients who pay without insurance.

Patients must first consent to billing before doctors can answer questions.

“The COVID-19 pandemic has resulted in 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 another way for consumers to receive high-quality, convenient and accessible care. … While most online news is free, there may be times when a doctor’s response to a patient requires more complex medical decision-making and discussion.”

Northwestern and Lurie, which already charged for some messages, say very few of their MyChart messages involve fees.

In a three-month period earlier this year, Northwestern charged less than 1% of the messages on its MyChart portal. Northwestern charges $35 per appointment, spokesman Christopher King said.

Similarly, Lurie charges for about 300 MyChart appointments over the past year, a fraction of the nearly 300,000 messages it receives, said Dr. Ravi Patel, Lurie’s vice president of digital healthcare.

“The idea is not to charge for MyChart messages,” Patel said, noting that patients are not charged for quick inquiries such as scheduling an appointment, follow-up after an in-person meeting, or needing to refill medication.

“It’s really about those cases where you have a new problem, a new symptom, a recurring symptom that has reappeared, a new rash,” he said.

He said it was just one more way for patients to access care.

“Ten years ago you were doing it in person, that was it,” Patel said, adding that Lurie now also does video visits. “The beautiful thing about it is that 10 years later, we’ve tripled the ways you can get care and hopefully see patients outside the hospital.”

The trick for healthcare systems may be to strike a balance between making sure doctors are paid for their time, while not overcharging patients for messages that don’t require a lot of work or knowledge, said John Hargraves, director of data strategy at the Health Care Cost Institute, a non-profit organization that studies health care cost trends.

He said it can be difficult for health systems to set hard parameters around which types of messages should incur charges and which should not.

However, the trend is expected to increase.

“I don’t think you can go back and make it a service that nobody charges for,” he said. “Most healthcare and cost issues only move in one direction. When something is known to be accountable, it is rarely accounted for.”

lschencker@chicagotribune.com

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