Hospitals are charging patients for messages to physicians. Philly health systems aren’t joining the trend.

Health systems across the country are charging patients for messaging their physicians through patient portals. But Philadelphia-area systems are not joining the new trend.

During the COVID-19 pandemic, patients began sending more messages to their physicians, often through portals such as MyChart. Telehealth has remained popular and doctors are finding themselves spending as much as an hour or two a day responding to patient messages — a service that hospitals and physician offices have typically not charged for.

Some health systems have begun charging patients for responses that involve medical advice. The Center for Medicaid and Medicare Services allows providers to count a written reply as a virtual visit if it requires at least five minutes.

Cleveland Clinic, for example, charges people with private insurance a copay of up to $50.

Johns Hopkins, UCSF Health, Oregon Health & Science University, and the University of Washington are among the other large health systems that have joined the trend.

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The Inquirer asked Philadelphia-area health systems if they are charging patients to communicate with their physicians through messaging. Most said that they do not charge: Jefferson Health, Penn Medicine, Tower Health, Prime Healthcare, Cooper University Health Care, Temple Health, Crozer Health, Virtua Health, and Main Line Health.

Children’s Hospital of Philadelphia, Inspira Health Network, and Redeemer Health did not respond.

The Hospital and Healthsystem Association of Pennsylvania said that the industry group hasn’t noticed a trend of billing for messages across the state.

Anna Morgan, a general internal medicine physician at Penn Medicine, has noticed that her patients message her more often.

“It’s a significant part of our daily work as primary care clinicians,” she said.

Being able to answer questions that come up after visits strengthens her relationship with patients. But she struggles to meet the growing demand for virtual correspondence. Since her office doesn’t bill for the service, the time it takes to respond to the growing number of messages is not adequately accounted for in her busy schedule.

“It’s getting increasingly difficult as more and more of these messages are being sent,” Morgan said.

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Still, Morgan said she worries that billing for messages would create an equity issue: patients who can afford an extra co-pay will have more access to their physicians, while those who can’t pay won’t.

She thinks the question of billing for messages should be part of a larger conversation about the use of text communication between visits. What questions are best for a message versus a call to the office? How quickly should patients expect a response? Is the best response a message or a call back?

Some health systems have found that allowing physicians to bill for messages doesn’t mean they do. UCSF established a billing policy in November 2021, but only a small number of eligible messages actually led to a bill. Cleveland Clinic saw similarly low levels of billing, according to reporting in Kaiser Health News.

“I don’t think we’ve entirely figured out as patients or doctors the optimal use of MyChart messages,” Morgan said.