How often Johns Hopkins bills for MyChart messages

Baltimore-based Johns Hopkins Medicine has billed patients for fewer than 1 percent of MyChart messages since a new policy allowing charges for the patient portal interactions, the Baltimore Banner reported Sept. 6.

In the first month after the change went into effect July 18, the health system received 100,000 MyChart messages, only billing in the tenths of a percent, according to the news outlet.

Like about 20 health systems that now charge for MyChart messages, Johns Hopkins aimed to get a handle on the rise in patient portal communications coming out of the pandemic, when patients grew more comfortable with virtual care. The health system said it would charge for messages that take five minutes or more of a provider's time and are for a new medical issue or flare-up, estimating they would cost between $3 and $50 with many insurance plans covering them.

Some advocates — and even hospital executives — have criticized the practice. "While 1 percent sounds slow, 1,000 messages, or patients, a month is a lot of people who need help, but might not be getting it," Anna Palmisano, director of Marylanders for Patient Rights, told the Banner. "That's 12,000 a year."

Other health systems have taken a different tact, funneling the messages to a group of nurses and taking physicians out of the equation altogether, Jay Holmgren, PhD, an assistant professor of medicine at University of California San Francisco, told the news outlet. His research has shown that only a small percentage of patients end up getting charged and the policy hasn't negatively affected already vulnerable patients.

"My fear is that while patients find messaging valuable and doctors don't mind providing care in this way, without some form of payment model, this will become a bigger trend: We simply lose the ability to message physicians at all," he told the Banner.

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