This story was first published by the Charlotte Ledger, North Carolina Health News. Story by Michelle Crouch.
For patients, being able to drop a message to your doctor for some quick medical advice is one of the best things about electronic patient portals.
But if your doctor is at one of the 15 Novant hospitals or dozens of clinics in the system, you may have to pay for that.
Novant Health has become one of a growing number of health care systems across the country to start billing for some patient-physician message exchanges.
Hospitals say they are being flooded with messages and doctors spend hours responding, contributing to burnout.
“We have seen a more than 50% increase in the usage of the MyChart messaging feature over the past four years,” Novant Health said in a statement when asked about the billing practice. “While growth was perpetuated by the pandemic, the steady increase continues into 2023.”
Other N.C. health care systems contacted by The Ledger, including Atrium Health, Tryon Medical Partners, Cone Health, WakeMed, Duke Health and UNC Health, said they do not charge for patient messages.
Most messages are free
Charging for messages became possible after the federal Centers for Medicare & Medicaid Services created new billing codes in 2019 that allowed providers to get paid for responding to patient queries, according to a recent New York Times story about the trend. To be billable, the doctor must spend at least five minutes of time, the Times said – effectively making it a virtual visit.
Novant said that since its billing program began in July 2022, it has billed for less than 1 percent of all MyChart messages its providers have received.
The fees apply only when patients request advice on a new medical complaint or on an issue that hasn’t been recently discussed, Novant said. It’s still free for a patient to ask a follow-up question after an appointment, to send a prescription refill request or discuss lab results.
The amount you may be asked to pay depends on your insurance plan, how much it covers and whether you have met your deductible. Novant said its average charge is $10.
UNC Health takes a different approach
Dr. Matthew Ewend, chief clinical officer of UNC Health and President of UNC Physicians, said his system evaluated the pros and cons of charging for messages and decided against it, even though the volume of messages had become overwhelming.
“We believe that charging new fees wouldn’t significantly reduce virtual messaging, won’t help physicians manage the requests for information more efficiently, and will likely make patients unhappy,” Ewend said in an emailed statement.
Instead, UNC Health made changes to reduce the burden on physicians, he said, such as prompting patients to be more specific in online requests and directing messages for scheduling and medication refills to non-physician staff members.
“Those efforts have resulted in a 35 percent reduction in messages for physicians,” Ewend said. “That’s about 100,000 messages per month.”
He said UNC is still exploring other ways to reduce message volume, “including a process to encourage patients with complex, time-consuming messages to arrange virtual or in-person visits.”
A surprise for some patients
Novant includes a disclaimer to patients who are messaging a provider, letting them know that they may be billed if they bring up a new issue or ask for medical advice.
“By clicking next, you are acknowledging that we may file a new medical request to your insurance and consent that you may be responsible for a portion of the bill,” the disclaimer says, in part.
Still, the change in policy has taken some patients by surprise.
One 42-year-old Charlotte woman who did not want to be named said she was annoyed when she messaged her doctor about a symptom she thought was a reaction to medication, and he said he would have to bill her to address her concerns through the portal.
“He said he would have to charge me for the emails if I didn’t make an appointment to talk about it,” she said. “I was a little offended. I even called and spoke to the front desk. … they said it was an across-the-board thing.”
North Carolina Health News is an independent, non-partisan, not-for-profit, statewide news organization dedicated to covering all things health care in North Carolina. Visit NCHN at northcarolinahealthnews.org.
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The part that is offensive about this is not physicians being paid for their time, but that the secondary conversations are often necessary because of the very short time patients spend with their doctor and the frequency of having to see another provider when a primary care doctor doesn’t have available slots. Novant, and other hospital systems, would do well to acknowledge that 15 minutes isn’t a reasonable time for a patient to explain new complaints, the doctor to complete an exam, come up with a course of action, discuss the potential benefits and possible side effects of any treatment, and make chart notes for all of this, along with ordering medications and/or referrals. The problem stems from organizations that are always trying to do more with less, and load too many patients and appointments on their doctors. I think most people have been through the experience of having a new doctor who seems really great and attentive to detail at first, until they have become completely booked up and get overwhelmed. Not having the time for a thorough conversation initially leads to worse outcomes, and more messages and visits. Personally I have stopped using MyChart since it was discovered Novant had been sending information to Meta and only contacted us about the HIPAA violations months after the news broke, and with very little information.