Should Doctors Charge Patients to use the Patient Portal?

My employer,  a rather large and well known medical behemoth based in Cleveland, recently announced that patients may be charged for medical advice solicited on the patient electronic portal.  This has generated an array of opinions ranging from accusations of corporate greed to defending physicians’ right to be compensated for practicing medicine.

Implementing this new program violates the following reality of human nature.

Folks will not support losing an established benefit. 

Consider how organized labor reacts when management aims to reduce worker benefits.  How would any of us feel if our employer cut back our vacation allowance?   How might homeowners feel if their mortgage interest is no longer tax deductible? 

You get my point.  Over the past few decades, I have provided thousands of hours of free medical care on the phone and electronically.  I never felt that I was being ripped off since this was the only system I knew and I accepted it.  Similarly, patients never felt they were stealing my time since for them this was simply how the system always operated.  It never entered their minds that these interactions were compensable.

But is it fair to ask a physician to dispense medical advice without being paid for it?  If a reader maintains that medical advice offered electronically should be gratis, then kindly explain why.   Legal clients are well aware that many law firms invoice every phone call or e-mail exchanged.  Indeed, we joke about hearing a ticking clock when we phone our attorney.

'You mean water isn't free anymore?

The proposal will not charge patients for mundane issues including medication refills or setting up appointments.  But, if the communication involves a specified level of medical complexity, then a charge may be issued.   If patient sees me in the office for my advice on stomach pain, of course, I will put a charge through.  If another patient wants the same advice through the electronic portal, shouldn’t a charge also be issued?  

Keep in mind that when I give free advice, I am still medically liable and can be sued for this.  Doesn’t basic fairness dictate that if I am legally responsible for a medical recommendation, that I should be compensated for it?  If not, then why not?

Is the aim here to create a new revenue stream for medical establishments and doctors?  Or was the objective to decrease the deluge of patient electronic requests that have become an increasing daily burden for physicians?  (Ask you own doctor how much time he or she spends on these electronic communications each week.)  My suspicion is that charging for advice on the portal will be uncommon events.  In my case, for example, if a patient sends me an electronic message that has medical complexity, then I am likely to respond that an office visit is necessary.  The electronic portal is not a vehicle to conduct ‘office visits’.  Yet, I typically receive messages from patients I haven't seen in over a year asking my advice on abdominal pain and vomiting.

This new program does not apply to phone calls, an activity that takes up hours of my time each week.  Might this be the next target for billers? Should it be?

No one likes to pay for anything that used to be free. I still can’t believe that I now have to pay for a bottle of water.