Emailing your doctor may incur charges

More hospitals and medical practices have started charging for doctors' responses to patient queries, based on the level of medical advice.

For Nina McCollum, the Cleveland Clinic's decision to start charging for certain email correspondence between patients and doctors "was a slap in the face".

She has relied on electronic communications to help care for her ailing 80-year-old mother, Penny Cooke, who needs specialist psychiatric treatment at the clinic. "Every $15 or $20 counts because his money is running out," she said.

Electronic health communications and telemedicine have exploded in recent years, fueled by the coronavirus pandemic and relaxed federal rules on billing for these types of care. In turn, a growing number of healthcare organizations, including some of the nation's major hospital systems like the Cleveland Clinic, medical practices and other groups, have begun charging fees for certain query responses. longer patient lives through secure electronic portals like MyChart. .

Cleveland Clinic said its email volume had doubled since 2019. But it added that since the billing program began in November, fees had been billed for responding to less than 1 percent of the approximately 110,000 emails received per week by its providers. 'a patient supports the necessary decision-making and time commitment of our physicians and other advanced professional providers,' said Angela Smith, clinic spokesperson.

But new research shows that fees, which some institutions say range from a co-payment of as little as $3 to a charge of $35 to $100, can be a deterrent to at least a small percentage patients to seek medical advice by e-mail Some doctors say they are caught in the middle of the fee debate, and others are worried are effects that fees could have on health equity and access to care.

Dr. Eve Rittenberg, a women's health internist at Brigham and Women's Hospital in Boston, examined the effects of medical correspondence with patients in a study that found female practitioners carried a greater communication burden.

< p class="css-at9mc1 evys1bk0">"The volume of messages combined with the expectation of a fast turnaround is very stressful," Dr. Rittenberg said. She recalls a day when she took her teenage daughter to the doctor, but got distracted while responding to patient messages on her phone. She recently reduced her schedule at the clinic - and took a commensurate pay cut - to free up a few hours outside of office visits to deal with other duties like patient messaging.

< p class="css-at9mc1 evys1bk0">U.S. Centers for Medicare and Medicaid Services first introduced Medicare billing codes in 2019 that allowed providers to request reimbursement for writing messages through portals secured. The pandemic has prompted the agency to expand telemedicine coverage, and hospitals have dramatically expanded its overall use.

Federal rules state that a billable message must be in response to a request from a patient and require at least five minutes of time, making it a virtual visit. Private insurers have largely followed Medicare's lead, reimbursing health care practices for doctor emails, and can charge patients a co-pay. For several large hospital systems across the country, rising email costs have opened a new...