Which big health systems do — and don't — bill for MyChart messages

When Cleveland Clinic said in 2022 it would charge patients up to $50 for sending certain MyChart messages to their physicians, many in the healthcare industry took notice. And suddenly hospital leaders had a decision to make.

Would they charge for the patient portal messages, in an effort to get a hold on the expanding number of digital interactions that were increasingly taking up providers' "free" time? Or keep the status quo, instead directing patients to actual appointments — in person or virtual — that they could be billed for?

Becker's reached out to dozens of the largest and most prestigious health systems to ask about their policies on charging for patient portal messages. Of those that responded, only Ann Arbor-based Michigan Medicine said it bills for certain MyChart interactions, adding the health system to the list of nearly 20 that now do.

Michigan Medicine told Becker's that per medical coding changes implemented in 2020, it has been billing for responses that "require clinical expertise and a physician or qualified healthcare professional's time."

"To ensure that patients know there may be a charge associated with the service, they are informed prior to sending a message to their care team," a health system spokesperson said. "Most commercial and governmental health plans now recognize these services as a covered benefit."

The new codes were meant for "patient-initiated digital communications that require a clinical decision that would otherwise have been typically provided in the office" and that take five minutes or more of a provider's time, according to the American Medical Association. The charges can range from $7 to $98 a message, but some insurance plans pick up the full bill.

Other health systems say they are still evaluating whether to make the change.

"At this time, UPMC does not charge for any messaging or interactions using MyUPMC, our patient portal," a spokesperson for the Pittsburgh-based health system told Becker's. "We are continuing to monitor this activity as we focus on expanding patient access to care."

New Hyde Park, N.Y.-based Northwell Health is "currently working on implementation of Epic's MyChart patient portal and is evaluating the decision to bill for certain patient portal messages," a spokesperson said. "No final decision has been made at this time."

Early results on whether billing has tamed the explosion in MyChart messages have been mixed. After San Francisco-based UCSF Health started charging for patient portal interactions in 2021, the volume of threads and messages dropped slightly, researchers there found, saying it "may be attributable to awareness of the possibility of being billed." Plus, health systems say they typically only charge for a small percentage of messages.

Some health systems advertise on their websites that MyChart remains a "free service," including St. Louis-based Ascension and New York City-based NYU Langone Health.

Trinity Health, an 88-hospital system based in Livonia, Mich., doesn't charge for interacting via MyChart "as it plays a key role in communication and care coordination between providers and patients," said Daniel Roth, MD, executive vice president and chief clinical officer.

Nor does Salt Lake City-based Intermountain Health, according to a spokesperson.

"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," a spokesperson for the Oakland, Calif.-based health system told Becker's.

Palo Alto, Calif.-based Stanford HealthCare also recently told Becker's it doesn't bill for the messages. "Persisting the fee-for-service treadmill down to the level of a message is a race to the bottom," said Christopher Sharp, MD, the health system's chief medical information officer.

Systems that bill for some of the messages include Baltimore-based Johns Hopkins Medicine, Renton, Wash.-based Providence, Chicago-based Northwestern Medicine, St. Louis-based BJC Healthcare, Houston Methodist, and UC San Diego Health.

While Cincinnati-based Bon Secours Mercy Health doesn't charge for MyChart interactions, if a patient's message requires an evaluation, diagnosis or treatment, "we are careful to guide individuals to a visit — e-visit, video visit or in-person visit — when it is clinically appropriate," a spokesperson for the 48-hospital system told Becker's. "Patients often have clarifying questions regarding a treatment plan from a prior visit, and we are happy to support those communications without the patient incurring an additional charge."

"None of the Advocate Health care brands — Advocate Health Care, Atrium Health nor Aurora Health Care — charge a messaging fee for communicating with a provider through the patient portal," a spokesperson for the 67-hospital system based in Charlotte, N.C., told Becker's. "If the communication is specific to the care being provided as part of a scheduled virtual visit or e-visit, then charges can be incurred for the care team's time, which is not related to a messaging fee."

Community Health Systems, a 77-hospital system based in Franklin, Tenn., doesn't charge for patient portal messaging and "there are no plans to do so in the future," a spokesperson told Becker's. "Many of our providers encourage outreach through the patient portal because it provides an effective and efficient way for patients to communicate with their providers and keeps them actively involved in their healthcare experience," the spokesperson said.

Michael Restuccia, senior vice president and CIO of Philadelphia-based Penn Medicine, said after evaluating the policy his health system opted to refrain from charging for the messages. But he agreed that something has to change.

"We have heard loud and clear from our provider community that MyChart messages to their inbox are becoming more and more of a challenge," he said. "Our initial approach to address this situation is several-fold, including bringing awareness to our patient community to limit inappropriate messages, centralize and triage provider inbox messages where possible, and explore recently developed artificial intelligence algorithms to automatically respond to common communications."

"We will continue to monitor this situation in order to reduce the burden on our already burdened provider community," he added.

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