SRFP007: Affording Telemedicine Medication Abortion: Examining A Sliding-Scale Payment Option and Patient’s Ability to Pay

Sajal Sanan; Emily Godfrey, MD, MPH; Rebecca Gomperts, MD, PhD, MPP; Nikeeta Shah, BA, MPH; Anna Fiastro, MPH, MEM

Abstract

Context: Currently, less than 5% of family medicine practices offer first-trimester abortion services, which means that most patients must seek services at specialty family planning facilities. Since abortion is often excluded from insurance coverage, patients pay up to $800 out-of-pocket. Medication abortion via telehealth is much cheaper ($150-$400). Still, many patients cannot afford this amount. To expand affordability, Aid Access – an asynchronous clinician-supported online abortion service - implemented a sliding-scale payment option that allows patients who ask for a discounted rate to choose a payment amount between $0 and $150 or use Medicaid if located in New York (NY). With the availability of telemedicine, more family medicine providers are starting to offer medication abortion services. It is important to understand the financial needs of patients seeking abortion so family physicians can implement payment options that increase access to these essential services. Objective: Analyze percent of patients who utilized sliding scale payment option including Medicaid in NY, along with how much was paid. Study Design: Retrospective chart review. Setting or Dataset: De-identified data from Aid Access patients served by family physicians in Washington (WA), New Jersey (NJ), and NY, including payment information. Population Studied: Patients who received mifepristone, misoprostol medication abortion through Aid Access in WA, NJ, and NY between April and November 2020 (n=504). Main and Secondary Outcome Measures: (1) Percent of patients who used the sliding scale payment option; (2) Percent of patients who paid $0, $1-$30, $31-$60, $61-90, and $91-$120, or used Medicaid. Results: Out of 504 patients, 24% (n=120) paid for their medication abortion use the sliding scale option and 3% (n=17) used Medicaid. Of the 120 patients using the sliding scale: 13% (n=16) paid $0, 11% (n=13) paid $1-$30, 28% (n=34) paid $31-$60, 28% (n=34) paid $61-$90, and 20% (n=24) paid $91-$120. Conclusions: Although most patients paid full price ($150) for their abortion, the sliding scale option including Medicaid was necessary for over 25% of patients. Of those who utilized the sliding scale, most patients paid less than half of the full price. In order to provide medication abortion services to those who need it, it is important to implement payment options such as the sliding-scale method.
Leave a Comment
Debra Stulberg
stulberg@uchicago.edu 11/20/2021

Great poster! Thank you for this work. In future analyses, I'd love to see more about the option to use Medicaid in states where abortion is covered. With more emerging telemedicine abortion providers, I think it's important to assess whether patients whose insurance plans (including Medicaid) cover abortion actually know this and have the option to use their insurance. And of course, many plans still don't cover it, and we should measure the impact of that as well! But in the meantime I am happy to see the use of sliding scale option when people need to pay out of pocket.

Jack Westfall
jwestfall@aafp.org 11/21/2021

This is a great topic and research study. Nice work. Thanks. hope that we can connect with you at the Robert Graham Center to consider some collaborations.

Gillian Bartlett
gillian.bartlett@health.missouri.edu 11/21/2021

This was a very interesting project in an area that is critical to women's health - I really like this notion of a sliding scale option and would love to see more work on how this can be implemented and evaluated more widely. Great job.

William R. Phillips
wphllps@uw.edu 11/21/2021

Is it important that patients pay something/anything? How much revenue is actually produced by these low payments on the sliding scale? How does availability of reduced cost on this sliding scale influence the patients who find their way to this service?Thanks for sharing your work here at NAPCRG. I hope you will continue work in this area.

Emily Godfrey
godfreye@uw.edu 11/22/2021

Great job Sajal! As primary care embarks on novel services like early pregnancy termination via telemed, you are asking questions that many administrators may ask in terms of sustaining a new clinical service.

Diane Harper
harperdi@med.umich.edu 11/22/2021

who offered the sliding scale and how did they afford to offer it? Is it sustainable for the future? Thank you for sharing your work with NAPCRG!

Andy Pasternak
avpiv711@sbcglobal.net 11/26/2021

Well done study with obviously implications.

Louise Acheson
11/29/2021

This is an important idea---one that some practices might apply more widely. I, too, am interested in what it costs to finance such an option.

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