Many health systems are demanding compensation for services doctors provide through patient portals like MyChart, raising questions for payers about the downstream impact on costs.
Ohio’s Cleveland Clinic began charging patients for some MyChart messages with providers this month, such as replies to requests for “medical expertise … that typically take five minutes or more up for your provider to respond.” That includes conversations about changing medications, new symptoms, or checking for chronic illnesses. Last month, NorthShore University Health System of Evanston, Illinois, also began charging for some messages sent through its patient portal, NorthShoreConnect. And University Hospital in Cleveland is considering charging for messages asking clinicians to review patient charts, conduct research, or conduct additional communication.
Physicians have long opposed interacting with patients by phone, email, and other means of communication as an alternative to or in addition to face-to-face visits, largely because they are often unpaid for their time. their time. But emerging technologies, changing patient preferences, and the impact of the COVID-19 pandemic have made electronic messaging more appealing to patients—and a monetization opportunity for providers. service.
As telehealth use grows, doctors say they are inundated with electronic messages from patients seeking additional help beyond their usual appointments. As a result, some health systems are calling on payers to provide reimbursements to maintain contact between provider and patient. Message billing is likely to become more common in the near future, in part due to convenience and growing consumer preference for some virtual health services.
“Someone has to pay the price of time,” said Chip Kahn, president and chief executive officer of the Federation of American Hospitals. “Now we have so many different avenues of communication. Patients and clinicians will want to take advantage of all of those avenues. Letting payers ignore that means ignoring communication, which is really important to patient care.”
growing demand
An important precursor to messaging was the implementation of electronic health records with patient portals, such as Epic Systems’ MyChart, which evolved into messaging platforms. The Centers for Medicare and Medicaid Services have developed billing codes that doctors can use to receive Medicare payments for “virtual enrollment” and “electronic visit.” The CMS limits how often these codes are used and imposes standards on when it must be done. spent answering patient questions and what types of communications are eligible for reimbursement.
Most clinicians did not use these codes before the pandemic because telemedicine was not common. In addition, governments and health insurers are concerned about fraud and abuse of telehealth, said Jennifer Breuer, co-chair of the digital health practice group at law firm Faegre Drinker. “Honestly, CMS’s fear has always been that bored little old ladies will call their doctor too often,” she says.
As the pandemic overwhelmed hospitals and closed other types of healthcare facilities in 2020, telehealth use has exploded. While this partially solves access problems, it also exacerbates physician burnout, especially among women.
A spokeswoman said messaging demand has doubled at the Cleveland Clinic since 2019, and providers spend significant time responding to hundreds of messages each week. The number of UCHealth messages has tripled to about 183,000 per month, said Dr. CT Lin, health information director for the Aurora, Colorado-based health system.
“You would think that the pandemic subsided means the numbers would go down. No. Patients have found a new channel and they love it,” says Lin.
Health systems adopt additional messaging capabilities for a larger shift away from inpatient services. Texting is also an increasingly popular option for patients enrolled in high-deductible plans who are looking to save money by avoiding the office.
unknown implication
A year ago, the University of California, San Francisco Health began charging medical consultations through MyChart. Fees range from nothing for Medicaid beneficiaries to $20 copay for Medicare Advantage members to an average of $75 for those with private insurance. Cleveland Clinic fees range from $3 for Medicare enrollees to $50 for privately insured patients.
Because these sums are small, payment disputes between insurers and service providers are unlikely to trigger full-blown contract wars, Breuer said. However, insurers must conduct regular checks on telehealth use, especially from providers who frequently bill for texting, she said. If providers don’t maintain documentation showing the medical necessity of a service, insurance companies will refuse to pay, she said.
“There is still some anxiety among payers who want to ensure that telemedicine is used judiciously and appropriately,” Breuer said. “It’s a balancing act.”
The health insurance trade group AHIP did not respond to a request for an interview. The Alliance of Public Health Plans, which represents nonprofit insurers, said paying for provider messages was not an issue for its members and declined further comment.
Private health insurers tend to follow CMS’s reimbursement policies. However, it can take years for insurers and providers to establish clear, unified coding rules, says Gary Young, director of the Center for Health and Care Policy Research at the University of California. Northeastern University said.
These new cryptographic and payment protocols can create even more administrative burdens for providers, especially for smaller companies with fewer resources. To stay competitive, health systems must invest in better technology for their patient portals.
Chris George, senior managing director of FTI Consulting, said: “I totally appreciate the origins of my suppliers and I think something needs to be done to get them paid for the effort they put in. out. “You’ll see it mature over time, but what just can’t keep happening is that the patient communicates with the provider and the feedback takes forever, and that’s because [of] … the volume of requests coming through these different channels.”
Health systems say most claims are processed quickly and do not charge premiums. Messages to make an appointment, buy more prescriptions, or answer follow-up questions after the procedure are still free. In some cases, chargeable messages can take the place of scheduled online or virtual appointments.
Message charging can even become a promotional opportunity. For example, an insurance company might advertise that they cover the costs of certain types of interactions that are not borne by their competitors as a way to attract new customers. Health systems can also lose patients because of the messages they bill. “We can actually see some really interesting competitive developments here in terms of how clinicians compete with each other,” says Young. You can see ads on TV and ads on billboards.”
JoAnn Volk, co-director at Georgetown University’s Center for Health Insurance Reform, says it’s difficult to predict the impact this new trend will have on access and costs.
“Hitting patients with bills can deter some people from seeking care,” says Volk. Others may be willing to pay for messages to avoid long waits in urgent care facilities. And the confusion over messaging fees can have legal ramifications. For example, in Washington state, providers must let patients know if they plan to charge for a phone call and get their consent before continuing with the audio visit. Otherwise, they may face fines or other disciplinary action from state regulators.
