Patients in Johns Hopkins medical offices may soon have to decide if the questions they type out to their doctors about their health are worth the potential costs.

Johns Hopkins Medicine is joining a national trend this month when it begins charging a fee to send some messages through its online patient portal, MyChart, much like it does for in-person or telehealth visits, according to a memo to staff obtained by The Baltimore Banner.

The system will begin notifying patients Wednesday of the change, which goes into effect July 18.

The memo to staff emphasizes that most MyChart messages will not be billed and they don’t want to put off regular communications with patients. In a response to questions from The Banner, the system added it’s consistent with billing in other medical systems and permitted by insurers for services that have become increasingly popular since the coronavirus pandemic.

The Baltimore Banner thanks its sponsors. Become one.

“Johns Hopkins Medicine recognizes the vital role virtual options such as MyChart messages play in health care and we are committed to ensuring patients and clinicians have access to these important resources,” said spokeswoman Vanessa Wasta in a statement.

“Insurance companies now recognize some MyChart medical advice messages as a billable service,” she said. “As a result of our routine review of policies and careful consideration, starting July 18, 2023, clinician responses to some nonurgent MyChart messages may be billed to insurance.”

Asked if the change could nonetheless have a chilling effect on communications with patients who are used to messaging their providers, Wasta said the system will be closely monitoring the effects on patient care.

It’s unclear if other doctor offices in Maryland will follow Hopkins’ lead or already are charging.

Two major systems said they did not plan to charge, including the University of Maryland Medical System and LifeBridge Health.

The Baltimore Banner thanks its sponsors. Become one.

“We want, and encourage, patients to message providers via the MyPortfolio portal since many basic questions can be answered using this format,” said Michael Schwartzberg, a UMMS spokesman. “For questions that are more complex, we encourage patients to either utilize the appointment request functionality within the platform to request a telehealth visit or schedule an in-person visit if the nature of the questions involve issues that are best addressed in a traditional clinical setting.”

LifeBridge’s online patient portal isn’t configured to allow charging, said Sharon Boston, a spokeswoman. She said system leaders “are aware of other health systems discussing charges for this type of physician interaction but have not had any discussions on its potential use at this point.”

Around the country, at least 14 major health care systems are charging for patient portal messages as of January, according to the industry publication Becker’s Hospital Review. They included systems in Chicago, Cleveland, Seattle, Houston, San Francisco, San Diego and Washington, D.C., as well as several smaller markets.

Electronic interactions are rising fast between patients and clinicians and are something to closely watch, said Jonathan P. Weiner, professor of health policy and management in the Johns Hopkins University Bloomberg School of Public Health. This includes telehealth visits, but also email, telephone, text and web portal communications.

“Unless a doctor is paid for their services via a flat fee, as they are in some HMOs, it is now increasingly common for providers to charge a fee for these other types of services,” he said. “How these new types of e-visits add to better access and better care, while not unduly increasing costs or leading to lower quality, will be something that will be important for providers, insurers and government agencies to monitor over the coming years.”

The Baltimore Banner thanks its sponsors. Become one.

In a note to be sent to patients, Hopkins officials suggested they were seeking to balance the need for the convenient and necessary messaging service and being paid when the effort amounts to substantial work.

The note said messages that would be billed to insurance would be those that are non-urgent and take “more time for review and response.” That means they take more than five minutes and require clinical judgment.

According to information from Hopkins, examples include messages that ask about a new issue or symptom requiring medical assessment or referral, adjusting medications, chronic disease check-in and management, or flare-up or change in a chronic condition. Other health systems that charge for messaging use similar standards.

Examples of services that will not be billed to insurance include prescription refill requests, scheduling appointments, or follow-up care linked to recent surgery. Also not charged will be messages about an issue addressed during a visit in the last seven days or lead to a visit in the next seven days, those that do not require a response or those that take less than five minutes to answer.

Patients using the portal will be asked to agree to payment terms when they select “ask a medical question.”

The Baltimore Banner thanks its sponsors. Become one.

The change comes as doctors’ offices and health care in general face a labor shortage while many people are trying to catch up on routine and more urgent health needs. While that has made in-person appointments harder to come by in some cases, and severely backed up emergency rooms, it’s also added to the workload and stress for many clinicians.

Telehealth services, via video and phone, as well as messaging portals, have aimed to ease the burden for everyone.

Some offices also are testing artificial intelligence to respond to the ever-increasing pile of messages in their inboxes. A recent Hopkins study found that the machines did a better job in some ways than the humans.

Policy and legal changes at the state and federal levels have allowed more insurance billing for virtual services to compensate for real, time-consuming medical services.

Hopkins patients with private insurance will pay $10 to $50 depending on how much time is billed and whether the patient’s plan covers the service. Those with Medicare, the program for seniors, will pay $3 to $10.

The Baltimore Banner thanks its sponsors. Become one.

Patients with Medicaid, the health program for low-income residents, will not be charged, nor will patients at Baltimore Medical System sites or Esperanza Center Health Services.

While some patients may understand they are paying for a service, others may feel nickel-and-dimed.

Anna Palmisano, director of the advocacy group Marylanders for Patient Rights, called it a “prime example” of hospital systems “squeezing every last cent out of patients.”

She added, “It would absolutely discourage patients from asking important questions regarding their own health. It sends a clear message to patients: Don’t bother us — your health isn’t important.”

She said it would be more patient-centric to identify those few patients they feel are over-messaging “and have a word with them.”

More From The Banner