Cleveland Clinic is now charging for patient-provider messaging

The news: Cleveland Clinic is now billing for certain messages between patients and providers that take place on the health system’s MyChart portal. Health plans will be on the hook for most of the charges, but uninsured consumers and those with high-deductible plans could be billed up to $50 per message.

What’s Cleveland Clinic billing for? Over the past three years, the number of messages that Cleveland Clinic providers answer on MyChart has doubled. So, as of November 17, some online messages that require a provider’s clinical expertise and take longer than 5 minutes to answer will be billed. Examples include:

• Changes to prescriptions (medication refills will still be a free service).
• New symptoms requiring medical evaluation.
• Changes to or check-ups on a long-term condition.
• Requests to complete medical forms.

Costs for patients will depend on their specific health plan, but even covered members may still be billed for a co-pay. Without insurance, or if a patient’s deductible isn’t met, it can cost the patient up to $50 per message.

Not everything in MyChart will come with a price tag: Other patient portal services such as scheduling appointments, asking questions that lead to a visit, follow-up questions about an appointment that took place in the past week, checking in after a procedure, and general quick updates will remain unbilled.

Zooming out: While most provider organizations do not bill for patient-physician portal messaging, Cleveland Clinic isn’t alone in experimenting with this strategy.

• Last year, the University of California San Francisco (UCSF) rolled out a similar plan. And other hospitals are considering following Cleveland Clinic’s and UCSF’s lead, per Cleveland.com.
• The newly introduced Amazon Clinic only offers messaging-based services—which it charges patients for—in lieu of video or audio chats.

What’s driving the shift? We think there are 2 key factors pushing healthcare providers to find more ways to bill for doctors’ time:

1. Physicians are drained from digital information overload. The number of online messages from patients increased by more than 150% at the onset of the pandemic, per data from electronic health record company Epic.

Expecting doctors to handle this messaging volume without being compensated could lead to higher levels of clinician burnout, which is already a challenge that hospitals are grappling with amidst COVID-19.

2. Health systems need to generate revenue. COVID-19 continues to squeeze hospitals’ operating margins, which remain in the red and below pre-pandemic levels, per Kaufman Hall’s October 2022 National Hospital Flash Report.

When patients message doctors and get the answers they need, a visit may no longer be necessary. And if that message isn’t billed for, it hurts a provider’s bottom line, particularly in a fee-for-service reimbursement environment.

Our take: Health systems are being forced to make difficult decisions in the face of declining revenues. Doctors’ time = money, so charging for online messages between patients and providers seems sensible.

At the same time, services billed for must have transparent pricing and a component of clinical expertise involved that would be covered in a telehealth visit anyway (i.e., not charging for filling out medical forms).

We could see more organizations adopt this approach or even pivot to a subscription-based model where online messages in between visits are included in a flat membership fee.

This article originally appeared in Insider Intelligence's Digital Health Briefing—a daily recap of top stories reshaping the healthcare industry. Subscribe to have more hard-hitting takeaways delivered to your inbox daily.

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