‘A race to the bottom’? What hospital execs think about billing for MyChart messages

Giles Bruce – Thursday, July 27th, 2023

Health system leaders have differing opinions on the usefulness of billing patients for MyChart messages, with some telling Becker’s it will relieve burdens on healthcare providers and others saying it will just create another one.

At least 17 health systems now charge patients for certain patient portal interactions after billing codes were released for messages that take five minutes or longer to answer. Those organizations say it’s necessary at a time when MyChart inboxes have filled up dramatically and patients often reach out with new symptoms or a condition that hasn’t been discussed recently.

“Messages received by clinicians can be as simple as a thank you note or as complex as a request for a new diagnosis based on a cascade of vague symptoms. No one should be charged for the former,” said Patrick Woodard, MD, chief healthcare information officer of Rapid City, S.D.-based Monument Health. “For messages that require a clinician to spend substantial time, however, we must acknowledge that this time may detract from the ability of a provider to be in an exam room or otherwise engaged with patient care. With that in mind, it is reasonable to be reimbursed for the latter.”

Milwaukee-based Froedtert Health, however, does not plan to bill for MyChart interactions but is analyzing other solutions to deal with the high volume of messages providers are receiving, according to Bradley Crotty, MD, vice president and chief digital engagement officer.

“We are looking deeper at being able to be more responsive with same-day/next-day telehealth access to resolve needs that are complex or require medical decision-making, for example,” he said. “We are also aware of the perception that charging has on patients at the same time as we are working hard to promote deeper digital patient engagement and health equity.”

University of Rochester (N.Y.) Medical Center went in the other direction when it began billing for certain patient portal messages July 17.

“This recognizes the burden being placed on our providers by the rising volume and complexity of MyChart messages,” said Michael Hasselberg, PhD, RN, the system’s chief digital health officer. “We believe it’s also fair to patients, because most insurance plans cover these ‘medical advice messages’ as a form of telehealth visit. So far, less than 1 percent of messages are being charged.”

Health systems are charging patients anywhere from $3 a message for Medicare beneficiaries to $98 for people without insurance. What patients end up paying likely averages closer to the lower end — Winston-Salem, N.C.-based Novant Health, for instance, reported that the average out-of-pocket cost has been $10.

Christopher Sharp, MD, chief medical information officer of Palo Alto, Calif.-based Stanford Health Care, said he believes determining which messages to charge for just adds another burden on providers when the goal should be to reduce their stressors.

“Given the potential for financial benefit is small, they would rather get home for dinner than be modestly paid,” he said. “Persisting the fee-for-service treadmill down to the level of a message is a race to the bottom. Better solutions that decrease burden, increase access, and support clinician response to patients’ needs are where we should spend our effort.”