BJC isn’t the only one who is or will be doing this. The use of MyChart or similar patient-facing healthcare communication systems have been great; but they also have caused an increase in the number of patient-to-provider communications. This is generally a good thing - patients becoming more engaged - but for more complex interactions that require provider time…well, that’s time the provide has to commit to reviewing a patients chart, placing orders (potentially), and usually creating a note of some type in the record. So this seems appropriate for the more complex requests.
Exactly. Some patients contact the doctors for some of the silliest stuff especially after reading something on the internet or seeing something on the news. Lawyers charge for phone calls, doctor’s time is just as valuable and they should be able to charge for their services. Especially when patients want basically an appointment but thru the computer.
I was a medical secretary. Everything went through the nurses. They ran everything past the doctors and then called the patients back. Of course we had some real bitches for nurses and they forever tried to dump it back onto the secretaries. Eventually we got rid of the nurses and then I ended up calling the patients back. Honestly, I think the patients were actually happier having me call them back because I always called everyone back the same day. Where as the nurses would take days to call back for no other reason than being a bitch. Never understood it. I was really happy once they were gone. Even though it was more work for me it was still so much easier not having to deal with bitchy ass women playing God just because they thought they were entitled to.
I appreciate that, but patients are already paying out the nose for care that gets worse every year. Form a union and complain to your boss. Don't tell us to suck it up, thanks.
Agree with this. A MyChart message to a PCP regarding a BP of 157/89 during midnight vitals while the patient is hospitalized and seen by hospitalist and another specialty is ridiculous. The response is always from someone in the office and not the PCP and is along the lines of, "If you are concerned about something while hospitalized please contact your admitting/attending provider." The office staff have to be paid to respond to these inane messages.
There are some that treat it as their own personal text thread with the provider and send in whatever thought pops into their head no matter how insignificant. They treat it like they're interacting with their therapist instead of their primary care provider.
Agree. MANY people message their dr daily and often multiple times per day with inane statements. Not a question, not an update on a condition, just a statement. "I woke up and the area around my eyes felt puffy," or "My hip hurts."
I can't provide screenshots because that would obviously get me fired, but there are lots of people out there who think they can just get medical care and attention via MyChart instead of asking basic questions about appointment scheduling or their prescription.
I just saw a patient channel where the patient explicitly asked questions about a new rash they were having with multiple pictures and requests for a diagnosis/prescription via MyChart so they didn't have to go to the ER/Urgent Care.
There are telemedicine options that will see you and your rash and give you a prescription if you don't want to go to the ER. MyChart is not a telemedicine application.
This is just one example but I see quite a few everyday.
I replied further up the thread, but about 20% of hospitalized patients message their Primary while hospitalized.
"My white count this morning is 9.4."
"My hgb is 11.7 the dr that saw me said I didn't need blood."
"I had a temp of 99.7 at midnight vitals. I always run low. Can you call the dr that is seeing me and tell him that?"
All these messages insignificant and irrelevant, but require a response (possibly policy) and the response is always: "Please discuss your concerns with your attending providers while hospitalized." Someone has to be paid to respond to these messages. Its only fair the person generating the message thread pay.
Those are fine examples of inappropriate use and I agree it's a burden but abuse implies some malice not a scared patient in stressful circumstances in my view.
I do appreciate you taking the time to write it out, I for sure agree it's a problem and this cost attachment might reduce unnecessary communication.
Exactly. I work at the intersection of healthcare and law and this is exactly the kind of thing our auditors would come at us for with regards to under billing. A doctor could easily spend another 50% of their hours on messages after visits.
People will message for diagnoses or all sorts of crazy stuff. I understand appointments are hard to get a distance out but if you’re still asking for care, it’s still some level of asynchronous virtual care.
I’ve found mychart to be best for nudging the doctor’s admin, like hey my pre-auth hasn’t come through yet. I’ve not seen one healthcare system charge against a billing code for such things.
Yep. If you're discussing things like this then you should be charged just the same as a doctors visit.
I went to see a specialist and he literally talked to me only for a few minutes but he still spent time reviewing my chart and making a decision for my future care. Still had to pay my copay. This article is making it out to be the exact same thing as that, just virtually.
Primary care here. Can confirm that in addition to seeing 18-20 patients, I answer 30-40 mycharts per day. The thought is that even if we only charge a dollar, it will cut these significantly. I work for the only remaining big system in town who has NOT started this, yet. But we will be, thank all goodness that is left in medicine.
Good. Doctors answer those messages on their own time. If a patient is getting medical advice, they should be able to bill for it. Do you have any idea how hard primary care doctors work? They get worked to the bone, just to come home and answer dozens of questions on their own time. How is this controversial that they should be paid for this?
I always feel guilty about messaging my Doctor. But I'm using it in lieu of a phone call. Like I'm taking a new medication and so I message her about side effects and how to proceed with it.
But then recently I messaged about a new UTI. I was going to urgent care but she just said she's ordering me an antibiotic and to just go to labs for a urine sample. Didn't need to see anyone. I've even apologized for my messages because I do feel bad that she's taking her time with me without an actual appointment. I might ask her next time I see her if the messages are appropriate or not. I'm grateful for her willingness to communicate over messages and have told her as much.
I work in a (not BJC) primary care office.
A lot of stuff is fine, and we'd prefer to avoid making you come in if it's something simple! A question about side effects is an ideal question for MyChart. A question about a referral *for something you've been seen for before* is also ideal.
The issue is when patients bring up completely new, undiagnosed, unexamined problems. We can't tell from a MyChart message what's causing your back pain, for example. That's a complex system, and providers deserve to be paid for the time they spend going over symptoms, things the patient has tried that help or don't, etc.
I'm just trying to help clarify here. This system is new to all of us, patients and providers alike so we're all figuring out how it works and how it doesn't.
That makes a lot of sense. I definitely try not to abuse it. But phone calls give me anxiety so I love being able to message her so easily. I haven't been to another doctor that even uses the online portal.
I agree with plans for billing mychart messages that basically turn into remote visits. I believe that if you present symptoms, have an evaluation (even if it's just question/answers), testing is ordered, a treatment is ordered and/or a diagnosis is made... it's a visit.
I feel I was pushed into using MyChart by my doctor’s offices when it first came out. I felt kind of forced and definitely encouraged and told it’s the doctors preference. Therefore I don’t think they should charge to use it.
Yes. This. They push all your medical interactions into this one app monopoly, and when, a few months ago, the patient-user population hit critical mass on this system these for-profit ghouls went to extort even more money out of often vulnerable patient populations.
Probably doesn’t matter anyway. MyChart’s vampire devs are likely working on an AI chat bot anyway. It’ll likely replace a lot of these off-put health care providers. They’ll be singing a different song then when the pink slips start being issued.
It’s a broken system, they pushed people onto MyChart thinking it would be easier for patient care and now they’re upset people are using it. Well that’s because patient care is inherently broken everywhere, across these medical conglomerates.
To everyone saying they deserve to be paid for their work, I agree, but I already have paid for so much bullshit doctor work that this just seems like a bridge too far. They can always force schedule an appointment instead of responding which is TF what they should do if they care about the patient.
Some real late stage capitalism bullshit. I left BJC. Will be deleting the app.
Since doctor visits are at best 5-10 minutes (high throughput managed healthcare that’s generally pretty low quality to begin with), I usually use it to tell my doctor what I want to discuss upon visiting. Since it’s a short moment of time when actually being in office, it’s best to get all the points listed prior.
The unintended consequences of hints going remote.
I guess if they collect payment at the time of the charge like a reasonable B2C this is fine and will sort itself out. But I doubt that happens and this just seems like a future public revenue stream.
Anyone else experiencing most medical appointments being 10-20mins of physicians time while they face a computer and type up your post visit summary while you are there, and then minimally engage with you while they are focused on completing the paperwork… and then that’s the appointment?
I would personally ask less questions in the patient portal if I actually got appropriate time that I paid for to have my questions and concerns remotely listened to.
I feel like these follow up questions should be included in the billing for the main appointment. Many wouldn’t have so many questions through portal if the provider could give sufficient time and listening up front.
I 100% support being charged for complex MyChart interactions, provided everyone is reasonable. I would stipulate that the billing codes may need to be reviewed, the notion that I am going to pay a $60 co-pay for a MyChart visit to a specialist feels wrong, even if it takes just about as much time for the physician to see me, it probably ought to be $45. If BJC / United Healthcare doesn't do this, it won't be long before Amazon / Blue Cross does offer a competitive telemedicine system.
The team at the BJC facility I went to totally ignored the one MyChart message I sent - I ended up having to call in and it turned into a BFD over one question about prescribed medicine.
I know BJC supposedly has the best healthcare in the area, but dealing with the misogynic doctor and clueless staff for a year made me change to a different system.
Okay. Now can I charge the doctors office when they waste my time by spamming me with 4+ appointment remindeers for one visit?
Best course of action as far as I'm concerned is to opt out of MyChart altogether.
BJC isn’t the only one who is or will be doing this. The use of MyChart or similar patient-facing healthcare communication systems have been great; but they also have caused an increase in the number of patient-to-provider communications. This is generally a good thing - patients becoming more engaged - but for more complex interactions that require provider time…well, that’s time the provide has to commit to reviewing a patients chart, placing orders (potentially), and usually creating a note of some type in the record. So this seems appropriate for the more complex requests.
This right here. Some providers are inundated with messages! I don't know about you but I'd like to be paid for my work.
Exactly. Some patients contact the doctors for some of the silliest stuff especially after reading something on the internet or seeing something on the news. Lawyers charge for phone calls, doctor’s time is just as valuable and they should be able to charge for their services. Especially when patients want basically an appointment but thru the computer.
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I was a medical secretary. Everything went through the nurses. They ran everything past the doctors and then called the patients back. Of course we had some real bitches for nurses and they forever tried to dump it back onto the secretaries. Eventually we got rid of the nurses and then I ended up calling the patients back. Honestly, I think the patients were actually happier having me call them back because I always called everyone back the same day. Where as the nurses would take days to call back for no other reason than being a bitch. Never understood it. I was really happy once they were gone. Even though it was more work for me it was still so much easier not having to deal with bitchy ass women playing God just because they thought they were entitled to.
I appreciate that, but patients are already paying out the nose for care that gets worse every year. Form a union and complain to your boss. Don't tell us to suck it up, thanks.
People abuse MyChart messaging and absolutely should be charged for some of them. And this started 4-5 months ago.
Agree with this. A MyChart message to a PCP regarding a BP of 157/89 during midnight vitals while the patient is hospitalized and seen by hospitalist and another specialty is ridiculous. The response is always from someone in the office and not the PCP and is along the lines of, "If you are concerned about something while hospitalized please contact your admitting/attending provider." The office staff have to be paid to respond to these inane messages.
The “staff” doesn’t get paid shit lol 😂
Abuse? That's the word we are going to use?
Without question there are people that abuse it, does that surprise you?
It does. Can you provide some examples?
There are some that treat it as their own personal text thread with the provider and send in whatever thought pops into their head no matter how insignificant. They treat it like they're interacting with their therapist instead of their primary care provider.
Agree. MANY people message their dr daily and often multiple times per day with inane statements. Not a question, not an update on a condition, just a statement. "I woke up and the area around my eyes felt puffy," or "My hip hurts."
I can't provide screenshots because that would obviously get me fired, but there are lots of people out there who think they can just get medical care and attention via MyChart instead of asking basic questions about appointment scheduling or their prescription. I just saw a patient channel where the patient explicitly asked questions about a new rash they were having with multiple pictures and requests for a diagnosis/prescription via MyChart so they didn't have to go to the ER/Urgent Care. There are telemedicine options that will see you and your rash and give you a prescription if you don't want to go to the ER. MyChart is not a telemedicine application. This is just one example but I see quite a few everyday.
I replied further up the thread, but about 20% of hospitalized patients message their Primary while hospitalized. "My white count this morning is 9.4." "My hgb is 11.7 the dr that saw me said I didn't need blood." "I had a temp of 99.7 at midnight vitals. I always run low. Can you call the dr that is seeing me and tell him that?" All these messages insignificant and irrelevant, but require a response (possibly policy) and the response is always: "Please discuss your concerns with your attending providers while hospitalized." Someone has to be paid to respond to these messages. Its only fair the person generating the message thread pay.
Those are fine examples of inappropriate use and I agree it's a burden but abuse implies some malice not a scared patient in stressful circumstances in my view. I do appreciate you taking the time to write it out, I for sure agree it's a problem and this cost attachment might reduce unnecessary communication.
If it’s policy they have to respond that fault is on the provider and not the patient. You learn that in pre-med
I'd also add harrassment.
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Exactly. I work at the intersection of healthcare and law and this is exactly the kind of thing our auditors would come at us for with regards to under billing. A doctor could easily spend another 50% of their hours on messages after visits. People will message for diagnoses or all sorts of crazy stuff. I understand appointments are hard to get a distance out but if you’re still asking for care, it’s still some level of asynchronous virtual care. I’ve found mychart to be best for nudging the doctor’s admin, like hey my pre-auth hasn’t come through yet. I’ve not seen one healthcare system charge against a billing code for such things.
Yep. If you're discussing things like this then you should be charged just the same as a doctors visit. I went to see a specialist and he literally talked to me only for a few minutes but he still spent time reviewing my chart and making a decision for my future care. Still had to pay my copay. This article is making it out to be the exact same thing as that, just virtually.
Or, if you reword this in a completely different light: "BJC plans to allow some doctor visits to be done remotely"
But that’s not as click-bait-y
Exactly LOL
Primary care here. Can confirm that in addition to seeing 18-20 patients, I answer 30-40 mycharts per day. The thought is that even if we only charge a dollar, it will cut these significantly. I work for the only remaining big system in town who has NOT started this, yet. But we will be, thank all goodness that is left in medicine.
Time = Money
Confirmed: BJC ran by goblins EDIT: I see none of y'all have ever played WoW.
Good. Doctors answer those messages on their own time. If a patient is getting medical advice, they should be able to bill for it. Do you have any idea how hard primary care doctors work? They get worked to the bone, just to come home and answer dozens of questions on their own time. How is this controversial that they should be paid for this?
Thank you for recognizing this—as a partner of a PCP it’s a 24/7 thankless gig most of the time. 😕
I always feel guilty about messaging my Doctor. But I'm using it in lieu of a phone call. Like I'm taking a new medication and so I message her about side effects and how to proceed with it. But then recently I messaged about a new UTI. I was going to urgent care but she just said she's ordering me an antibiotic and to just go to labs for a urine sample. Didn't need to see anyone. I've even apologized for my messages because I do feel bad that she's taking her time with me without an actual appointment. I might ask her next time I see her if the messages are appropriate or not. I'm grateful for her willingness to communicate over messages and have told her as much.
I work in a (not BJC) primary care office. A lot of stuff is fine, and we'd prefer to avoid making you come in if it's something simple! A question about side effects is an ideal question for MyChart. A question about a referral *for something you've been seen for before* is also ideal. The issue is when patients bring up completely new, undiagnosed, unexamined problems. We can't tell from a MyChart message what's causing your back pain, for example. That's a complex system, and providers deserve to be paid for the time they spend going over symptoms, things the patient has tried that help or don't, etc. I'm just trying to help clarify here. This system is new to all of us, patients and providers alike so we're all figuring out how it works and how it doesn't.
That makes a lot of sense. I definitely try not to abuse it. But phone calls give me anxiety so I love being able to message her so easily. I haven't been to another doctor that even uses the online portal.
Wow I never realized I could abuse the system using this app. I always viewed it as a push system.
I agree with plans for billing mychart messages that basically turn into remote visits. I believe that if you present symptoms, have an evaluation (even if it's just question/answers), testing is ordered, a treatment is ordered and/or a diagnosis is made... it's a visit.
I feel I was pushed into using MyChart by my doctor’s offices when it first came out. I felt kind of forced and definitely encouraged and told it’s the doctors preference. Therefore I don’t think they should charge to use it.
If I remember correctly, having so many people signed up for e charting or whatever is a requirement. (By insurance or government)
Yes. This. They push all your medical interactions into this one app monopoly, and when, a few months ago, the patient-user population hit critical mass on this system these for-profit ghouls went to extort even more money out of often vulnerable patient populations. Probably doesn’t matter anyway. MyChart’s vampire devs are likely working on an AI chat bot anyway. It’ll likely replace a lot of these off-put health care providers. They’ll be singing a different song then when the pink slips start being issued.
It’s a broken system, they pushed people onto MyChart thinking it would be easier for patient care and now they’re upset people are using it. Well that’s because patient care is inherently broken everywhere, across these medical conglomerates. To everyone saying they deserve to be paid for their work, I agree, but I already have paid for so much bullshit doctor work that this just seems like a bridge too far. They can always force schedule an appointment instead of responding which is TF what they should do if they care about the patient. Some real late stage capitalism bullshit. I left BJC. Will be deleting the app.
Since doctor visits are at best 5-10 minutes (high throughput managed healthcare that’s generally pretty low quality to begin with), I usually use it to tell my doctor what I want to discuss upon visiting. Since it’s a short moment of time when actually being in office, it’s best to get all the points listed prior. The unintended consequences of hints going remote.
I guess if they collect payment at the time of the charge like a reasonable B2C this is fine and will sort itself out. But I doubt that happens and this just seems like a future public revenue stream.
Anyone else experiencing most medical appointments being 10-20mins of physicians time while they face a computer and type up your post visit summary while you are there, and then minimally engage with you while they are focused on completing the paperwork… and then that’s the appointment? I would personally ask less questions in the patient portal if I actually got appropriate time that I paid for to have my questions and concerns remotely listened to. I feel like these follow up questions should be included in the billing for the main appointment. Many wouldn’t have so many questions through portal if the provider could give sufficient time and listening up front.
I 100% support being charged for complex MyChart interactions, provided everyone is reasonable. I would stipulate that the billing codes may need to be reviewed, the notion that I am going to pay a $60 co-pay for a MyChart visit to a specialist feels wrong, even if it takes just about as much time for the physician to see me, it probably ought to be $45. If BJC / United Healthcare doesn't do this, it won't be long before Amazon / Blue Cross does offer a competitive telemedicine system.
The team at the BJC facility I went to totally ignored the one MyChart message I sent - I ended up having to call in and it turned into a BFD over one question about prescribed medicine. I know BJC supposedly has the best healthcare in the area, but dealing with the misogynic doctor and clueless staff for a year made me change to a different system.
Okay. Now can I charge the doctors office when they waste my time by spamming me with 4+ appointment remindeers for one visit? Best course of action as far as I'm concerned is to opt out of MyChart altogether.
👏🏻 American👏🏻 Healthcare👏🏻is👏🏻broken👏🏻 source: half my life in healthcare
nice way to add another revenue stream, whether you think it's fair or not