Paying for privileges

The opinion is likely to get divided. I was alerted to this link from an excellent substack newsletter. More on that later. However, this first:

MyChart Messaging | Cleveland Clinic

Staying connected is important, and your provider is committed to responding to your needs in a timely way — within three business days. Most of these messages are free. However, starting November 17, 2022, MyChart responses that require your provider’s clinical time and expertise to answer may be billed to your insurance. There may be a co-pay based on your insurance company’s guidelines. This will allow us to continue to provide the high level of care you have come to expect from Cleveland Clinic.

Here’s from the link:

But what kinds of messages could get billed? Messages about:

  • Changes to your medications.
  • New symptoms.
  • Changes to a long-term condition.
  • Check-ups on your long-term condition care.
  • Requests to complete medical forms.

The provider looking at your message might be reviewing the information you sent over and changing part of your treatment plan, or recommending you get a test to learn more. They might need to look at your medical history and do an in-depth review of your records to make sure they give you the best possible advice.

What’s the cost of the retrieval? Zilch. What is the cost of the time for “review”? That’s something which can’t be calculated.

I have seen my colleagues working closely with their patients through WhatsApp. WhatsApp serves as an informal extension of the hospital, but also allows them to develop “close associations”. WhatsApp, however, has no significant privacy controls. It has a terrible caching system and almost zero automation (barring the option for “business account”). Phone number privacy (and notification systems) are even worst trade-offs. While my colleagues may prefer direct relationships- if they can get their options in place, so be it.

As an enterprise messaging option (I assume a specific gateway and people can “review” private messages), it will be difficult to put a price on time. This hospital extends the concept of “virtual clinic” and aims to “respond within three business days”. This is nothing but a de-facto industrialisation of medicine and opening up a new revenue stream. A simple way to side-step this is to shift to Telegram by handing just the username.

Here’s more from Dr Brian (who’s shifted to his substack). I had reached out to him to consider Telegram, but there has been no response. Either he’s busy/ignored/”telegram is Russian” excuse or he’s not interested. Nevertheless, he’s got a good insight here:

Should Hospitals Charge for MyChart Messages?

As we think about this it’s important to start with a universal truth about technology: Whenever a tool is released we never know what the end user is going to do with it. This truth has played itself out from mobile apps to social media platforms.

In this case, health systems never really anticipated the way MyChart messaging would be used by patients.

So when given the unrestrained opportunity to touch base with their clinics, some patients definitely seize the day. In pediatrics, this can take the shape of 3,000 word messages — sometimes several times a day. These may be follow-up concerns from the day’s visit, or questions. Other times it represents a new, acute issue. As a pediatric gastroenterologist, my inbox is like Instagram for dirty diapers. Which is fine.

This is though a flawed assumption that everyone wants to send the messages at the outgo. We should learn to use technology tools at our disposal first. How many of you set up email rules to automatically sort out the messages and then slot them accordingly? My Telegram is slotted in folders, for example. Extremely high volume messages are archived, and I look at them only if I want. My contacts are graded in order of priority (for me). Each folder (and contact) has specific notification settings that allow me to respond accordingly. I have drilled this even further. Telegram allows widgets on the home screen, and after Android 13 update (Samsung UI 5), I only have to check the most frequent contacts. If there’s an update, I open the application; else I ignore and focus more on work.

Technology can work if you spend time understanding its limitations.

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