At least eight health systems have said they will charge for some patient portal services like Epic’s MyChart, signaling a possible new expense for consumers and health plan sponsors.
The development drew national attention in November when the Cleveland Clinic began charging for certain types of messages, mostly those that involve clinical evaluations or medical history reviews that take more than five minutes. Other MyChart services will remain free, according to media reports, including scheduling appointments, filling prescriptions, and most questions about appointments and recent visits.
According to Becker’s Health IT, seven other health systems currently bill for some patient portal services. They include Northshore University Health System in Evanston, Illinois, Northwestern Medicine in Chicago, Chicago-based Lurie’s Children’s Hospital, San Francisco-based UCSF Health, Renton, Washington-based Providence and UW Medicine and Fred Hutch Cancer Center, both based in Seattle. .
Change in consumer habits
The Cleveland Clinic’s decision appears to be based on the growing popularity of online and virtual care options, according to information released by the clinic. On its website, the health system notes that shortly before the COVID-19 pandemic, the use of online services skyrocketed.
“Over the past few years, virtual options have played a bigger role in our lives,” the website says. “And since 2019, the number of messages that providers respond to has doubled.”
According to Patient Engagement HIT, patient portals have been around for a while but have often been lightly used by users. “In 2019, the Office of the National Coordinator for Health IT reported that although most hospitals offer access to a patient portal, very few patients take advantage of it,” according to a story on the website. “Sixty-two percent [of hospitals] said that less than a quarter of their patients had registered with the patient portal. Only about a third of hospitals said less than 10% of their patients had adopted the tool, while less than 10% of hospitals said most of their patients had adopted the patient portal.”
Then came the pandemic and consumers as well as healthcare providers needed a remote solution. There has been a huge increase in virtual visits and according to industry insiders, as users have become more comfortable with online interactions, the ease of use and relatively quick responses provided by the portals have created a whole new situation.
“We’ve seen a big increase in adoption, both in terms of the number of patients using MyChart and the depth of use by those patients,” Sean Bina, vice president of patient experience at Epic Systems, said in September. 2020 “People are now increasingly using it to really manage their clinical care. Everything from doing a symptom check on MyChart to being able to do a telehealth visit and also being able to self-manage your COVID symptoms.”
A controversial decision
There is a possibility that patients may question being charged for something that was provided free of charge in the past.
Some doctors support the idea, saying that answering questions on MyChart takes time, just like in-person service does. “Responding to Epic messages requires considerable time and expertise. There’s no reason it shouldn’t be compensated,” Armaine Smith, MD, director of Baltimore-based Johns Hopkins Urologic Oncology at Sibley Memorial Hospital, said in a tweet. “It should also discourage unnecessary or multiple communications that can be handled by a single telemedia or in-person visit.”
However, some consumer rights groups see the idea of charging for MyChart-type services as a money grab from health systems. With many consumers unsure what services they will be charged for, the prospect of new charges for online communications has sparked a backlash. “I don’t think it’s fair to be charged just for communication, especially with all the other things we already have to pay for,” Cleveland Clinic patient Kya Perry said in a WKSU report. “Sounds silly to me that you would have to be charged to use an app.”
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But as online services increasingly replace in-person appointments, it’s likely that healthcare providers will feel the need to monetize these services. In the Patient Engagement HIT article, one provider says patient management will likely never be the same once people get comfortable with online portals. “What we’re seeing is just like in other industries, healthcare organizations are striving to provide a seamless digital experience for patients. Instead of digital being secondary, people are creating and making it a primary way for patients to do everything from scheduling, checking in and accessing all their clinical information.”