From the 2024 HVPA National Conference
Sara Alturky BS (Oregon Health and Science University), Suryaa Gupta BS, Anne Smeraglio MD, Jeff Gold MD
Background
Amidst the COVID-19 pandemic, physicians turned to technology to conduct virtual visits and increased communication with patients via MyChart messaging. This improved accessibility, but providers were mostly not compensated for time spent responding to patient messages. In 2022, Oregon Health & Science University began a rollout of billing for MyChart messages in order to protect and compensate provider time. While this is an important step for physician time management, there is little data on patient impact. We aimed to determine if initiating billing for MyChart messages disproportionately impacts MyChart use amongst vulnerable populations such as patients > 65 years of age and those in racial minority groups. This is particularly crucial in primary care settings as it sheds light on the potential for new disparities that could exacerbate already existing gaps and inequalities in vulnerable populations.
Objective:
This study aimed to examine how introducing a new billing practice influences patient usage of MyChart and whether this new billing system disproportionately impacts minority groups.
Methods
An alert was sent to all OHSU MyChart patients on 2/27/2023 announcing the initiation of bills for MyChart messages. Data regarding MyChart message frequency and billing status pre- and post-this announcement were sorted by various demographics (e.g., age, race, ethnicity, RUCA status, etc.).
Utilizing an XmR (individual and moving range) control chart template, analysis was completed to demonstrate stability and variability across various data points, illustrating trends over time, pre- and post-billing implementation.
Results
The announcement that billing would occur did not change patient behavior. Rates of patient MyChart messaging remained unchanged. Before the billing rollout, 23% of the senior population utilized MyChart messaging, which insignificantly rose to 26% following. Interestingly, providers also issued very few bills despite having this option, with less than 0.3% of MyChart messages being billed monthly.
Conclusion
Despite the implementation of a MyChart billing system, vulnerable patients were not dissuaded from utilizing the service. While this is encouraging news that billing for MyChart does not change accessibility, further studies should investigate if receipt of a bill changes patient behavior or creates disproportionate barriers to the vulnerable.
Clinical Implication
The initiation of billing for MyChart messages at OHSU did not significantly alter patient behavior, with rates remaining stable pre- and post-implementation. Despite concerns, vulnerable patients were not dissuaded from utilizing MyChart messaging, and thus, further research is needed to assess whether receiving a bill alters future patient behavior in these groups. Additionally, exploring factors that contribute to a provider’s decision to bill or not bill a patient is crucial to understanding the future implications of this initiative.