Evanston RoundTable, Dec. 8, 2022
NorthShore University HealthSystem has adopted a new policy charging for some online medical advice. The move may have been inevitable, many patients concede, but not everyone is on board.
Last month NorthShore – which consists of Evanston, Skokie, Highland Park and Glenbrook hospitals as well as facilities in Chicago, Arlington Heights, Naperville and Elmhurst – announced a change in policy regarding its electronic portal, NorthShore Connect. An email dated Nov. 2 sent to all NorthShore patients with the heading, “Changes to NorthShore Connect medical advice messages,” read: “Beginning Nov. 8, 2022, if a response to your message – when a provider provides their medical expertise and more than a few minutes of their time – we may request that you either schedule a visit with us or we will bill your insurance for providing that medical advice.”
The email gave several examples of medical advice messages “that may result in a charge,” including a new issue or symptom, adjusting or prescribing a new medication, a flare-up or change in an ongoing condition or extensive time reviewing a patient’s medical history.
Fees would be billed through the patient’s insurance, the email said, and patients would have several options, including scheduling an in-person or video visit. Patients could also decline their consent to be charged, if they so chose, though it wasn’t clear how they’d get medical advice in those cases.
In response to RoundTable questions, NorthShore spokesperson Colette Urban said fewer than 1% “of the 47,000 messages our clinicians answer each week have been billed” since the new policy went into effect Nov. 8. “Most of our patients will be unaffected,” she added.
For those who are affected, Medicare fees range from $3 to $10 while self-pay patients would be charged $35.
NorthShore is not the first local health care system to charge for use of its online portal. Northwestern Memorial Hospital put the same policy in place in 2019, said spokesperson Chris King. Lurie Children’s Hospital has also been charging for certain online queries.
Reaction to the NorthShore policy change has been mixed.
“I feel absolutely fine about it, it makes perfect sense to me,” said Evanston resident Ruth Rozen. “I realize that determining the complexity of a medical issue can be subjective, but it surely isn’t right to get free time with and advice from a doctor when others are waiting in line at the clinic or properly scheduling a visit, in-person or online.”
Agreed Evanston resident Siobhan Drummond, “It costs money to create [the online portals] and to maintain and operate them. That’s just a fact.”
Also in favor of the change was Fred Fitzgerald from Wilmette. “I take no issue with their new policy, so long as they don’t attempt to abuse it,” he said. “A simple inquiry that takes only moments to respond to should not be billable. However, online inquires requiring a physician’s time equivalent to responding to their time devoted to a brief physician video or teleconference or an in-office visit should be billable.”
‘Lawyers always have the meter running’
“I agree with the policy if the doctor involved spends more than a few minutes responding,” said John DuBois of Highland Park. “I imagine some patients email their doctors very frequently. I can see where meaningfully responding to these patients could be time consuming. Lawyers always have the meter running – I guess doctors could be the same.”
A NorthShore physician, who asked that his name not be used, said the number of portal questions is “mind blowing…People don’t realize how much time some of them can take.”
But longtime health care consultant and Highland Park resident Michael Millenson took a different view of the new policy. “I thought it was a slap in the face, to be honest,” he said. “They certainly didn’t explain the policy very well, even if they were justified in making the change.”
Millenson added that he understood that doctors “are overwhelmed with portal questions,” but said he felt the issue was whether it was possible to “organize the doctors’ time better to give them more time to answer questions.”
And Reba Meshulam of Glenview said simply, “I was not aware of it. I am not happy about it.”
Another possible issue is the lack of definitive guidelines for charging. “The decision to bill or not is always the decision of the provider providing the care,” said Colette. That means some providers may charge to answer a question while other providers, faced with the same question, may not.