“Patients Who Can't Get an Appointment Go to the ER”: Access to Specialty Care for Publicly Insured Children

Rhodes, Karin V.; Bisgaier, Joanna; Lawson, Charlotte C.; Soglin, David F.; Krug, Steven E.; Haitsma, Martha Van

doi:10.1016/j.annemergmed.2012.10.030

Cited by 34 publications

(31 citation statements)

References 19 publications

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“…24,25 Interviews with specialist physicians reveal that economic pressures and direct pressures from their affiliated hospitals motivate their refusal to treat underinsured patients, and the prices charged to these patients up front may represent an attempt to make up the equivalent revenue from care provided to a privately insured patient. 26 Nevertheless, the private market costs are shared by both the patient and the insurer and many insurance payments are significantly delayed from the time of service due to claims processing periods, whereas the uninsured patient must bring the entire cost up front in order to receive care.…”

Section: Discussionmentioning

confidence: 99%

“I Broke My Ankle”: Access to Orthopedic Follow‐up Care by Insurance Status

Medford‐Davis

Lin

Greenstein

et al. 2017

Academic Emergency Medicine

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Objectives: While the Affordable Care Act seeks to reduce emergency department (ED) visits for outpatienttreatable conditions, it remains unclear whether Medicaid patients or the uninsured have adequate access to followup care. The goal of this study was to determine the availability of follow-up orthopedic care by insurance status.Methods: Using simulated patient methodology, all 102 eligible general orthopedic practices in Dallas-Fort Worth, Texas, were contacted twice by a caller requesting follow-up for an ankle fracture diagnosed in a local ED using a standardized script that differed by insurance status. Practices were randomly assigned to paired private and uninsured or Medicaid and uninsured scenarios.Results: We completed 204 calls: 59 private, 43 Medicaid, and 102 uninsured. Appointment success rate was 83.1% for privately insured (95% confidence interval [CI] = 73.2% to 92.9%), 81.4% for uninsured (95% CI = 73.7% to 89.1%), and 14.0% for Medicaid callers (95% CI = 3.2% to 24.7%). Controlling for paired calls to the same practice, an uninsured caller had 5.7 times higher odds (95% CI = 2.74 to 11.71) of receiving an appointment than a Medicaid caller (p < 0.001), but the same odds as a privately insured caller (odds ratio = 1.0, 95% CI = 0.19 to 5.37, p = 1.0). Uninsured patients had to bring a median of $350 (interquartile range = $250 to $400) to their appointment to be seen, and only two uninsured patients were able to obtain an appointment for $100 or less up front. In comparison, typical total payments collected for privately insured patients were $236 and for Medicaid patients $128. When asked where else they could go, 49 (48%) uninsured callers and one Medicaid caller (2%) were directed to local public hospital EDs as alternative sources of care. Of the practices that appeared on Medicaid's published list of orthopedic providers accepting new patients, 15 told callers that they did not accept Medicaid, 11 did not treat ankles, nine listed nonworking phone numbers, and only three actually scheduled an appointment for the Medicaid caller.Conclusions: Less than one in seven Medicaid patients could obtain orthopedic follow-up after an ED visit for a fracture, and prices quoted to the uninsured were 30% higher than typical negotiated rates paid by the privately insured. High up-front costs for uninsured patients and low appointment availability for Medicaid patients may leave these patients with no other option than the ED for necessary care.T he Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that guarantees emergency care to anyone presenting to an emergency department (ED) in the United States that accepts federal funding.1 For a fracture, the standard for emergency care includes reduction and splinting of the fracture. After an ED visit for a fracture, orthopedic follow-up care is important to convert splints to casts, determine the need for surgery, and ensure optimal healing to prevent nonunion or other complications. 2,3However, access to nonemergent care in the out...

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Section: Discussionmentioning

confidence: 99%

“I Broke My Ankle”: Access to Orthopedic Follow‐up Care by Insurance Status

Medford‐Davis

Lin

Greenstein

et al. 2017

Academic Emergency Medicine

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“…9,10 Outpatient access to psychiatric care for children may be limited, especially in certain at-risk socioeconomic groups. 6,[11][12][13][14] While the PECARN study and several Canadian studies have suggested that socioeconomic factors may be associated with high odds of ED psychiatric visits, 3,12,[15][16][17] no study has evaluated these factors using nationally representative United States data. The specific focus of this study was on sociodemographic factors and their effect on odds of ED visits.…”

mentioning

confidence: 99%

Trends in Pediatric Visits to the Emergency Department for Psychiatric Illnesses

Pittsenbarger

Mannix

2013

Academic Emergency Medicine

125

106

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Objectives: While recent studies have demonstrated an overall increase in psychiatric visits in the emergency department (ED), none have focused on a nationally representative pediatric population. Understanding trends in pediatric psychiatric ED visits is important because of limited outpatient availability of pediatric specialists, as well as long wait times for psychiatric appointments. The study aim was to evaluate the trends in ED psychiatric visits for children between 2001 and 2010 with comparison by sociodemographic characteristics.Methods: This was a retrospective, cross-sectional analysis of ED psychiatric visits for children < 18 years of age using the National Hospital Ambulatory Medical Care Survey (NHAMCS). Visits were identified by International Classification of Diseases, Ninth Revision (ICD-9), codes. Outcome measures included frequency of visits for children with psychiatric diagnosis codes and odds and adjusted odds of psychiatric visits controlling for temporal, demographic, and geographic factors.

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“…Finally, research suggests different care preferences for Medicaid populations; patients with low socioeconomic status may preferentially seek hospital-based specialist care over ambulatory care due to perceptions about quality of care. 2 Given that Medicaid patients already have limited access to specialists, 3,4 patients from these populations may also be resistant to efforts shifting them away from specialty care related to historical concerns about denied access and further marginalization. The process of PCMH transformation in practices with high Medicaid rates will need to be sensitive to historical factors shaping patient care utilization preferences when shifting care from specialists where appropriate, and focus efforts on trust-building with at-risk populations.…”

Section: H Eather Klusaritz Phd Mswmentioning

confidence: 99%