What physicians, patients think of charging for MyChart messages

Cleveland Clinic's plan to charge for MyChart messages requiring clinician time and expertise has been met with mixed reviews from physicians and patients.

Cleveland Clinic began charging for messages requiring clinicians to make clinical assessments, medical decisions or medical history reviews that would take more than five minutes. The charges are often covered by insurers, but patients face up to $50 charges without coverage.

Medicare patients without secondary insurance may see $3 to $8 fees, according to Cleveland Clinic. The new fees went into effect Nov. 17. Some physicians and patients support the charges while others argue it will limit access to care.

"I don't think that it's fair to be charged just for communication, especially with all the other things we already have to pay for," Kya Perry, a Cleveland Clinic patient, told public radio station WKSU. "It sounds silly to me that you would have to be charged to use an app."

Another patient, Brynna Fish, told cleveland.com she was initially annoyed by the charges but then realized she was getting the same information she would get during a billed telehealth visit.

"I'm asking a question related to my health or a medication and the doctor is answering me; it seems to me totally legitimate to bill," she said. "It's actually saving money because I don't have to make an appointment and go in and discuss this certain thing with the doctor."

Patients are informed about the possibility of charges before completing their request and then decide whether to continue the message or schedule an appointment with their provider. Cleveland Clinic is not the only health system making the change; Ohio State University Wexner Medical Center in Columbus also bills for some patient messages, and other health systems are considering the possibility.

The issue of billing for MyChart messages has garnered much discussion between physicians on Twitter as well.

Ralph DeBiasi, MD, a clinical cardiac electrophysiologist at Yale New Haven (Conn.) Health, wrote: "Caring for patients takes time, knowledge and effort. There is nothing wrong with charging for it. My lawyer charges the same rate to answer an email as he does when in a courtroom. I see no problem."

Jocelyn Fitzgerald, MD, assistant professor in the department of obstetrics, gynecology and reproductive sciences at University of Pittsburgh, said in tweet: "I don't disagree with this practice when you consider that female physicians and their staff receive significantly more messages for which they are uncompensated compared to male physicians."

Armine Smith, MD, director of Baltimore-based Johns Hopkins Urologic Oncology at Sibley Memorial Hospital, wrote: "Replying to Epic messages requires a considerable amount of time and expertise. No reason this should not be compensated. It should also discourage unnecessary or multiple messages that can be handled via one telemed or in-person visit."


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