By Michelle Crouch
Co-published with Charlotte Ledger
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% 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.”