Should You Charge Patients to Use Your Patient Portal?

I knew something wasn’t right with my left ear when my plane touched down upon New Orleans for the HIMSS13 Conference two Sundays ago. It felt water-clogged like it used to when I was a little girl and went swimming in the ocean for too long.

Twenty-four hours later, a nurse practitioner at an urgent care center prescribed me medication and told me my ear condition, barotrauma, would likely ease up within a couple of days. But by Wednesday, it hadn’t yet.

Because I didn’t want to pay the urgent care center another $35 to look at my ear again, I thought it would be best to call my primary-care physician back home to ask if I could still fly, given my ear was still in bad shape.

As soon as I called my doctor’s office, the receptionist asked me if I would be willing to enroll in the practice’s patient portal, so I could electronically message my doctor instead.

This is great, I thought at first, recalling two other physician practices I’d connected with via portal to view lab results.

That’s when she hit me with the catch: I’d need to first pay an annual fee of $50 to enroll in the portal. “That way, he’ll get back to you quicker,” she explained.

I was immediately taken aback and I was also surprised. Didn’t I just write an article where physicians trying to achieve Stage 2 of CMS’ meaningful use program were stressed about getting patients to enroll in their patient portals? Wouldn’t charging patients do more to deter them from enrolling?

The idea of paying to use a portal doesn’t always make sense for younger, healthier patients in their 20s and 30s, said Steven Ferguson, patient management officer at Hello Health, a company that offers a free EHR and patient portal to physicians through a revenue-sharing model: Patients each pay a fee of $36 or more annually for portal access, and that money is split between Hello Health and the provider.

But for certain patient populations - such as older patients, who have greater need to access the doctor more frequently to e-mail questions or use telehealth services - charging a nominal fee for portal access makes sense. There’s one caveat to that, however. The portal has to be worth the charge.

“It depends on what the portal is, and how it’s positioned,” Ferguson told Physicians Practice. “Patients have to know that practices are offering an extended service to them. It does serve a need for a lot of the patients. If you have the right business model around that and the right price point it can work.”

Ferguson has a point. A fee of $36-$50, or just a few dollars per month, really is a nominal fee for patients who want secure online access to their primary-care physician, lab results, and an appointment calendar. And for even more valuable services such as e-visits - a term that’s loosely synonymous with episodes of care conducted through secure messaging between physicians and patients - patients will be willing to pay a small fee.

Still, whether to monetize portal use is a hotly debated topic among some physician groups.

Family physician Christopher Tashjian of Western Wisconsin Medical Associates said his practice does not charge patients to use its Cerner patient portal because physicians think the portal is necessary to improve communication. However, Tashjian says he plans to use it for e-visits and then will charge for those.  

“We want people to be engaged and on top of their healthcare and the portal helps,” Tashjian told Physicians Practice. “Have you heard of a bank charging for online banking? I wouldn't go to a bank that charged me for online banking.”

Another Cerner portal user, gynecologist Michael Salesin of Walnut Lake OBGYN in West Bloomfield, Mich., says his portal is a value-add for patients, not a money maker.

“We have upwards of 90 percent of our patients who use it, and they predominantly use it for test results,” Salesin told Physicians Practice. “They also request prescriptions, and from time to time, communicate with us. Some write long letters, some write short letters.”

Though Salesin says he cannot predict whether a higher volume of patients using the portal will eventually cause him to charge for portal use, for now, he sees electronic messages like phone calls.

“We’ve never charged for phone calls, and this is just an extension of the phone calls,” Salesin said. “We also get letters every day from people who thank us for it, and recommend our practice for it. We, therefore, don’t feel we should charge for it.”