Cleveland Clinic recently announced that they will begin charging patients for #MyChart messages. While every health system in the country is probably watching this closely, this move should send shock waves to those concerned about #equity.

I fully support paying providers for their time, and also for protecting their time.  They should not be expected to spend three hours, paid or not, answering messages after seeing their last patient. If responding to messages is part of the job, then the job should be restructured to be completed during the scheduled work day.  Charging for messages doesn’t really fix the fundamental problem of how the work flow is arranged.  Rather, it will just reduce health care that patients obtain.

Things to Consider Before Starting MyChart Message Fees

1) Optimize workflows for responding to patient messages.

The workflow around messaging should enable everyone on the healthcare team to work at the top of their license.  Triage non-medical issues such as appointment scheduling to office staff.  (In my experience as a patient, #clevelandclinic has been exemplary in this regard). Work with your EHR vendor or builder to customize patient options when initiating a MyChart message to direct queries efficiently from the get go.

2) Consider the equity impact of instituting MyChart message charges. People who lack transportation or work flexibility could be more likely to use messaging because of its convenience.  You can assess the equity impact of messaging fees by looking at the volume and types of messages submitted by patients in different demographic groups that are defined along digital equity lines.  Schedule a call with Public Health Innovators to learn more about this strategy.

3) Consider the value proposition of a MyChart message to patients and to health outcomes.  Unless you provide care under a value-based model, patient and provider incentives around messaging may conflict.  To a provider, a message may represent a visit that does not happen.  To a patient, a message may prevent or reduce illness and avert the risk of job loss or foregone income for time needed to go into the clinic.

4)  Plan a communications strategy before launching MyChart Message Fees.  Sorry Cleveland Clinic–announcing on November 14th that charging would start November 17th is–shall we say–not a move likely to enhance the patient experience.  A provider I saw late last week asked me to message her at the end of this week about my response to a medication.  Lacking time to ask my insurer whether they would cover messaging fees, I opted to act quickly before the fee set in, sending her only 4 days of data rather than the week she requested.  She also deserved time to think about how her advice to patients about messaging should change in light of a possible $50 fee.  Maybe she had been given a heads up beforehand, but I doubt it.  She’s been the most conscientious of any provider I’ve ever had about insurance coverage considerations of her treatment and didn’t mention a possible fee.  Patients and providers both need time to digest the news.

5) Consider training to help patients optimize portal use. Beyond teaching the mechanics of portal use, consider offering  patients guidelines on what type of situations are appropriate for messaging.  You might even offer templates for messages about common themes.   Patients with lower levels of health literacy will appreciate them!

I’m currently developing portal training for digital health navigators located in community settings.  Looks like I need to add two items:  How to know whether your message will cross the line into incurring a fee, and how to know whether your insurance will pay for it.

Digital health navigators are the perfect solution for helping patients to understand the new fee structure. 

Check out our new page on Digital Health Navigators!

Public Health Innovators, LLC, helps health systems and community institutions address digital health #equity issues.