A growing number of health systems are starting to charge patients for asking for their physicians' advice through online patient portals, such as MyChart, which is sparking mixed reactions from patient advocates and providers, The Chicago Tribune reported Nov. 25.
Earlier this month, Evanston, Ill.-based NorthShore University HealthSystem started billing patients for some types of messages sent over its patient portal, 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.
According to the health system, the fees will be billed to patients' insurance, with the out-of-pocket costs for people on Medicare ranging from about $3 to $10. The cost for patients without insurance will be $35.
NorthShore also said patients must consent to being billed before physicians answer their questions.
The health system isn't the only one making this move: Chicago-based Northwestern Medicine and Lurie Children's Hospital and San Francisco-based UCSF Health have already begun doing so, according to the report.
Northwestern and Lurie 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 percent of messages on its MyChart portal.
Similarly, Lurie has charged for about 300 MyChart encounters in the last year, a sliver of the nearly 300,000 messages it's received, according to Ravi Patel, MD, vice president of digital health for Lurie.
"The intent here is not to be charging for MyChart messages," said Dr. Patel. "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."
Cleveland Clinic also made headlines when it announced it would charge for messages requiring clinicians to make clinical assessments, medical decisions or medical history reviews that take more than five minutes.
These charges are often covered by insurers, but patients could face up to $50 charges without coverage.
The move has been criticized by consumer advocates, however, who view the trend as greedy.
"This is yet again the big business of healthcare finding ways to profit at every angle on patients," said Cynthia Fisher, founder and chair of Patient Rights Advocate.
Ms. Fisher said she worries some people will now be hesitant to ask their physicians 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.
But John Hargraves, director of data strategy for the Health Care Cost Institute, a nonprofit organization that studies trends in healthcare costs, said he expects this trend to grow as health systems try to balance between making sure physicians are compensated for their time while not overcharging patients for messages that don't take much work or expertise.
"I don't think there's any going back and making it a service that no one charges for," said Mr. Hargraves. "Most things with healthcare and costs only move in one direction. When something is known to be billable, it's rarely not billed."