Five minutes of a doctor’s time could cost patients $50

One of the nation’s largest hospital systems has begun charging for some electronic messages its doctors send to patients.

On November 17 the Cleveland Clinic began billing patients’ insurers for messages that typically take more than five minutes to answer and require a doctor’s “medical expertise,” according to an announcement on the Clinic’s website. Among these are:

• Changes to a patient’s medication,
• questions about new symptoms,
• changes to a long-term condition,
• check-ups on care for long-term conditions, and
• requests to complete medical forms

Message charges will be billed to patients’ insurers. For Medicare beneficiaries, that could result in an out-of-pocket charge of between$3 and $8. Most commercial insurers cover these messages at little or no cost to the patient, the Clinic says. However, patients with plans that don’t cover messages could see charges anywhere between $33 and $50.

“The provider looking at your message might be reviewing the information you sent over and changing part of your treatment plan, or recommending you get a test to learn more. They might need to look at your medical history and do an in-depth review of your records to make sure they give you the best possible advice,” according to the announcement.

The Clinic uses the MyChart electronic health record for its messaging system.

Providers aren’t billing for:

1. appointment scheduling,
2. prescription refills,
3. questions that lead to an appointment,
4. questions about an issue for which the patient was seen within the past seven days,
5. check-ins that are part of follow-up care after a procedure, or
6. quick updates from patients

The Clinic’s announcement comes at a time of financial stress for hospitals and hospitals. The median year-to-date operating margin index for hospitals was -0.1% in September, for a ninth straight month of negative actual operating margins, according to findings in the latest National Hospital Flash Report.

Primary care doctors seemingly endorse getting reimbursed for electronic messaging. In a recent Physicians Foundation survey, 86% said reimbursement for responding to queries through emails, texts, or phone calls was an important tool for enhancing access to care and improving outcomes.

But PatientRightsAdvocate.org, a nonprofit organization advocating price transparency, takes a different view. In an article on cleveland.com, founder and chairman Cynthia A. Fisher calls the practice “egregious.”

“Billing them [patients] for electronic messages to their providers is just the latest attempt to wring even more blood from the stone,” she said.

This article was published by our sister publication Medical Economics.