A fee for chatting with your doctor online? It’s happening some places. What about WA?

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Some medical systems across the nation have begun charging patients a fee for talking to doctors and other treatment providers through online portals.

In Washington, some aren’t for now, but others have quietly introduced fees for certain portal messages, invoicing them as a billable service.

Fee-based use of Epic Systems’ MyChart, a popular patient portal used by many health systems, has grown as health systems look for ways to offset financial losses from the pandemic.

John Hargraves, director of data strategy for the nonprofit Health Care Cost Institute, told the Chicago Tribune in November it was unlikely the fee trend would go away.

“I don’t think there’s any going back and making it a service that no one charges for. .... When something is known to be billable, it’s rarely not billed,” Hargraves said.

Patient portal services such as MyChart allow patients access to medical records, including test results. It also allows patients to schedule appointments and send messages online to doctors and staff with medical questions between in-person visits, among other features.

Such features have, up until recently, been free for patients to help expand access to medical staff.

Billable codes added before the start of the COVID-19 pandemic, though, introduced specific options for medical offices nationwide to charge in some situations.

Growing trend

Sites operating in the Cleveland Clinic network, Chicago-based Northwestern Medicine and Lurie Children’s Hospital, Evanston, Illinois-based NorthShore University HealthSystem, and San Francisco-based UCSF Health are among those reported to now charge for some patient portal messages to medical staff.

Closer to home, Providence health system, which includes Pacific, Swedish and Kadlec medical centers, shows billable messaging charges possible through MyChart in its online FAQ.

“While most messages are free, some messages sent to your care team will qualify as a billable medical service,” it notes. “Your provider will determine whether a message exchange should be billed to insurance. If that is the case, we will bill your insurance on your behalf.”

“Examples of messages that may result in a charge include: making a clinical assessment, ordering tests or medications, extensive time spent reviewing your medical history.”

Providence noted, “Many messages sent through MyChart are never billed to insurance. However, those that require time and expertise are a form of virtual care and are treated as such — alongside other types of care.”

UW Medicine/Fred Hutch Cancer Center’s MyChart FAQ lists that possible charges in some cases are up to the physician’s and patient’s discretion.

“There is no charge for access to this service at this time. In some situations, your provider may offer you the choice between paying a fee to receive medical advice via MyChart, or coming into the office for a visit for that advice. You will be notified in advance if your provider will charge you for a MyChart encounter,” it says.

A media representative for the health system told The News Tribune on Friday, “At this time, we do not have any information to share on this topic.”

Elsewhere in the Pacific Northwest, Portland-based Oregon Health & Science University charges for certain messages. According to its website, “If your medical question needs an in-depth answer (involves medical decision-making and takes your provider more than 5 minutes to respond), we may bill you or your insurance.”

“Simple” questions, or “follow-up question based on a recent visit, procedure or lab result,” are not charged, the health system says.

Also not billed are situations where “You message your provider with a question, and they say you should have a visit,” the website states.

OHSU MyChart fees can range from $25-$77, depending on insurance co-pay and Medicare.

Medicaid/Oregon Health Plan recipients are not charged.

Inquiries from The News Tribune this week to representatives for Virginia Mason Franciscan Health, MultiCare and Kaiser Permanente came back with responses indicating that at least for now, messaging remains free.

“There is no cost for Kaiser Permanente members to access their electronic health record or to message the physicians and clinicians on their care team, nor any plan to change that for our members at this time,” Linnae Riesen, media representative for Kaiser, told The News Tribune via email.

“Patients who have questions about their care and coverage can contact Kaiser Permanente member services at 888-901-4636,” she added.

In a statement Monday, VMFH division director of communications Susan Callahan said: “There are no plans for a fee-based system at this time.”

MultiCare media representative Scott Thompson said via email that the health system “currently has no plans to implement a fee-based system for MyChart use to message our physicians.”

Financial pressures add up

Washington health systems, specifically hospitals, have faced a tough financial outlook as pandemic relief from the federal government wound down and labor costs rose to retain an already stretched work pool. Add to that low Medicaid reimbursements and high demand for emergency care persisting past earlier waves of COVID and now with rising cases of flu and RSV.

While fees in patient messaging portals are not considered a significant source of revenue for medical networks, they are a newly created way to monetize staff time spent with a patient’s file.

Becker’s Hospital Review, an online medical news site that has covered the fee roll-out, noted that the ability to charge came with new coding introduced Jan. 1, 2020, just before the nation was swept up in the COVID-19 pandemic.

“The Current Procedural Terminology, or CPT, codes released that year gave providers a way to bill for patient portal messages,” it said in a Nov. 30, 2022, article, citing a January 2020 American Medical Association posting.

The AMA article said that providers can charge for work done cumulatively over a seven-day time frame that takes five minutes or longer. It noted, “If the work takes under five minutes, it is not reported. Time worked cannot be counted twice or billed for under another, separate code.”

Also, “While the code is intended for an established patient, the problem being addressed can be new,” AMA noted.

Previous coding for online medical evaluations was too general, it added.

“The need for these new codes, which are intended to advance adoption of digital health tools, were first identified by the AMA-convened Digital Medicine Payment Advisory Group, which has helped clarify payment complexities connected to the use of remote monitoring and other technologies,” the article stated.