Saturday, June 3, 2023

Want to email your doctor? You may be charged for this

WASHINGTON (AP) — The next time you text your doctor to ask about a pesky cough or itchy rash, you might want to check your bank account first — you’ll get a bill for the question. Can get it.

Hospital systems across the country are charging fees for some of the messages patients send to physicians, who they say are spending more and more time online with questions, some so complex they require a level of medical expertise. Which is usually given during an office visit. ,

However, patient advocates worry that these new fees may deter people from accessing their doctors and that they add another layer of complexity to the US health care system’s already opaque billing process.

Cynthia Fisher, founder of Massachusetts-based Patient Rights Advocates, said, “It’s a barrier that denies access and will result in patients with lower quality care and outcomes because they will hesitate or fear to communicate and potentially harm them. ” Nonprofit that emphasizes hospital price transparency.

The explosion of telehealth over the past three years — driven by the COVID-19 outbreak and relaxed federal regulations for online care — has prompted many doctors to adopt more robust teleworking with their patients. Consultations that once took place in the office have been transformed into computer or smart phone visits. Jack Resneck Jr., president of the American Medical Association, told The Associated Press that health care systems invited patients to use the new online portal to message their doctors with a question at any time.

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“When people realized it was good and could improve care, you saw hospitals and practice groups saying to patients, Welcome to your portal … Ping your doctor with questions if you like.” Can,” Resneck said. “We found ourselves getting dozens and dozens a day as physicians and not making the time to do all that work.”

Fees vary for each patient and hospital system, with the cost of messages ranging from as little as $3 for Medicare patients to as much as $160 for uninsured patients. In some cases, the final bill depends on how long the doctor takes to respond.

Several health systems that have introduced these new policies in recent months say they automatically alert patients that they may be charged when they message their doctor through an online portal. Such as MyChart, an online system that many organizations now use to schedule or issue appointments. test results to patients.

Under new billing rules designed during the pandemic, doctors are allowed to bill Medicare for 5 minutes of time spent on online messaging over a seven-day period, according to the Centers for Medicaid and Medicare.

University of Chicago health economist Katherine Backer said doctors need to be paid for the time they spend giving expert medical advice – even over messages. But it’s also important that hospital systems be transparent about what patients can expect to pay as they implement these new charges.

“Co-pays accomplish nothing when they are not clear to patients ahead of time,” Backer said.

According to system spokesman Jess Berthold, physicians at University of California San Francisco Health field about 900,000 email threads—3 million total messages—in a year.

After seeing a spike during the pandemic, the hospital announced in November 2021 that it would begin charging for some of those messages. During the one-year period, 1.4% of email threads, or approximately 13,000, turned out to be bills.

Only certain messages trigger the charge. Patients will not be charged, for example, for prescription refills, to schedule an appointment, to ask follow-up questions about an office visit within the past seven days, or if their doctor recommends that they Should schedule a visit in response.

What type of messages will the bill indicate? Sending your doctor a picture of a new rash, asking to fill out a form, or requesting a change in medication.

Navigating how much you might owe can be complicated.

At UCSF, Medicaid patients who message their doctor will incur no out-of-pocket costs, and may pay as much as $3 to $6 over traditional Medicare. Patients on private insurance will be billed a co-pay – usually around $20 – as will patients on Medicare Advantage, the private insurance plan for Medicare.

The Cleveland Clinic in Ohio, the latest major hospital system to announce fees for online messages, rolled out similar guidelines late last month, capping the cost of the messages at $50 for those with private insurance. And at Northwestern Medicine in Chicago, which charges $35 for some messages, less than 1% of those correspondences resulted in a bill, said spokesman Christopher King.

All those systems use the online portal MyChart. Epic, the privately owned software company that runs MyChart, does not track which health systems charge patients for messages, spokeswoman Barb Hernandez said in an email. The company did not respond to questions about whether it gets a share of the fees from those charges.

The hospital system argues that offering advice to patients online could save the patient time or money in the long run. If the doctor can answer the patient’s question over email, the patient can reduce the wait time for an appointment and avoid having to take time off from work to go to the doctor’s office.

Also, some patients simply prefer the convenience of getting quick answers from a doctor on the app, UCSF’s Berthold said.

“If patients can have access to a doctor when questions or concerns arise, they can get care more quickly and get treated more quickly,” Berthold said.

But Fischer argues that this could have the opposite effect, with patients thinking twice before sending a message to a doctor. Instead, some people may turn to free, unreliable advice online.

“It becomes a slippery slope, and that slippery slope is not in the patient’s favor,” she said.

Copyright 2022 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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