The proliferation of email communications between patients and healthcare providers during the COVID-19 pandemic has prompted an increasing number of health systems across the United States to implement fees for patients seeking medical advice through electronic channels. This shift towards billing for e-visits has stirred a complex debate on the equitable compensation of healthcare professionals for their time while ensuring continued access to care for patients. Physicians and patient advocates express concerns, particularly regarding the potential financial burden on lower-income individuals and those with health conditions that limit in-person or telephonic interactions.
Meg Bakewell, who battles cancer and cancer-related heart disease, has become accustomed to seeking medical advice from her primary care physician, oncologist, and cardiologist via email when faced with urgent symptoms. However, she was taken aback when she received her first bill, a $13 copay, for an email consultation with her primary care doctor at the University of Michigan Health system. The institution began charging for “e-visits” in 2020 through its MyChart portal. Although her out-of-pocket cost was modest, Bakewell now worries about the potential cumulative expense of future e-visits, with her standard office visit copay standing at $25.
The surge in email messaging during the pandemic prompted many healthcare systems to address the growing burden on healthcare providers. Patients’ emails increased by 50%, with primary care physicians experiencing the most significant influx. Health systems like the Cleveland Clinic, Mayo Clinic, UCSF Health, Vanderbilt Health, BJC HealthCare, Northwestern Medicine, and the U.S. Department of Veterans Affairs have followed suit in implementing fees for e-visits.
The primary objective behind this fee structure is to curtail the volume of electronic messages. Health system executives aimed to remunerate doctors and other healthcare professionals for the considerable time spent responding to emails, all while encouraging patients to assess whether an in-person visit might be more suitable than a lengthy digital exchange.
The introduction of fees for e-visits poses challenging questions regarding the delicate balance between compensating providers fairly and ensuring patients’ access to quality healthcare. As this trend unfolds, its potential implications on patients’ healthcare affordability and accessibility will be closely monitored.
