Impact of Insurance and Practice Type on Access to Orthopaedic Sports Medicine

Abstract

Background: The Patient Protection Affordable Care Act has expanded Medicaid eligibility in recent years. However, the provisions of the act have not translated to improved Medicaid payments for specialists such as orthopaedic surgeons. The number of health care practitioners who accept Medicaid is already decreasing, with low reimbursement rates being cited as the primary reason for the trend. Hypothesis: Private practice orthopaedic groups will see patients with Medicaid or Medicare at lower rates than academic orthopaedic practices, and business days until appointment availability will be higher for patients with Medicaid and Medicare than those with private insurance. Study Design: Cross-sectional study. Methods: Researchers made calls to 2 regular-sized orthopaedic practices, 1 small orthopaedic practice, and 1 academic orthopaedic practice in each of the 50 states in the United States. Callers described a scenario of a recent injury resulting in a bucket-handle meniscal tear and an anterior cruciate ligament tear seen on magnetic resonance imaging at an outside emergency department. For a total of 194 practices, 3 separate telephone calls were made, each with a different insurance type. Data regarding insurance acceptance and business days until appointment were tabulated. Student t tests or analysis of variance for continuous data and χ2 or Fisher exact tests for categorical data were utilized. Results: After completing 582 telephone calls, it was determined that 31.4% (n = 59) did not accept Medicaid, compared with 2.2% (n = 4) not accepting Medicare and 1% (n = 1) not accepting private insurance ( P < .001). There was no significant association between type of practice and Medicaid refusal ( P = 0.12). Mean business days until appointment for Medicaid, Medicare, and private insurance were 5.3, 4.1, and 2.9, respectively ( P < .001). Conclusions: Access to care remains a significant burden for the Medicaid population, given a rate of Medicaid refusal of 32.2% across regular-sized orthopaedic practices. If Medicaid is accepted, time until appointment was significantly longer when compared with private insurance.

Health disparities in the management of ACL injuries: How socioeconomic status, insurance, and race influence care

“…This inequity is commonly attributed to the patients' SES, as well as uninsured or noncommercial insurance status. Several studies in this review underscored this: notably by Pierce et al and Shi et al 12,13 When examining this from a broader perspective it is difficult to exclude the possibility that structural racism plays a role in this observation, given that individuals from racial minorities (specifically Black and Hispanic individuals) are the largest group of people insured by Medicaid 25 and are also the lowest household income groups in the United States. 26 However, no studies have explicitly examined the role of structural racism in access to care or health outcomes after ACL injury.…”

“…The patient with Medicaid insurance had a scheduling rate of 14% when contacting those same practices. Most recently, Shi et al 13 conducted a study where group members contacted orthopedic practices in all 50 states, which included small and large private groups as well academic centers about a hypothetical patient with an ACL tear and bucket‐handle meniscal tear that was confirmed on magnetic resonance imaging (MRI). After completing over 500 phone calls, the hypothetical Medicaid patient had only a 68% chance of obtaining an appointment, whereas the Medicare and privately insured patient each had over a 97% chance of obtaining an appointment.…”

Association of Insurance Status With Treatment Delays for Pediatric and Adolescent Patients Undergoing Surgery for Patellar Instability

“…‡ Public or government insurance has been defined as a risk factor for in adult populations with sports-related injuries as well. 21 , 23 , 24 Because this study was performed at a safety-net hospital, we are able to distinguish care delays by insurance status without preferential access to care. In centers where specific health insurance plans are accepted, the findings of the present study may be amplified.…”

Public Insurance Payment Does Not Compensate Hospital Cost for Care of Long-Bone Fractures Requiring Additional Surgery to Promote Union

“…For our health system, these results demonstrate a financial incentive to preferentially provide care to commercially insured fracture patients, as has been shown in other orthopaedic conditions. [30][31][32][33][34][35][36][37][38][39] The majority of our unhealed fracture patients were referred to us as outpatients and are thus vulnerable to any biases against public insurance, as compared with patients who sustain an acute trauma and require inpatient admission. Although one of the missions of a tertiary academic center is to receive and care for more complicated conditions such as fracture nonunion, this rationale should not explain why patients with unhealed fracture and public insurance should be more likely to be referred than those with commercial insurance.…”

“…Future studies should examine whether unhealed fracture patients with public insurance face increased difficulty and longer wait times obtaining orthopaedic trauma clinic appointments compared with those with private insurance, as has been shown in other areas of orthopaedics. 33,35,[37][38][39]43,44 Limitations of this study include the variability in care received before presentation at our institution. Many patients had already undergone one or more unsuccessful previous procedures addressing infection or nonunion of their fractures.…”