The impact of insurance coverage on access to orthopedic spine care

Segal, Dale N; Grabel, Zachary J.; Shi, Weilong J.; Gottschalk, Michael B.; Boden, Scott D.

doi:10.21037/jss.2018.05.22

Cited by 42 publications

(48 citation statements)

References 16 publications

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“…However, it is also well known that Medicaid patients have poor odds of accessing direct orthopaedic care. 17,23,26 Our results demonstrate that this comes at a significant cost to the healthcare system, as accessing care through the ED added $4587 to the total cost of care.…”

Section: Discussionmentioning

confidence: 83%

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Increased Total Cost and Lack of Diagnostic Utility for Emergency Department Visits After ACL Injury

Chuck

Bokshan

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Patients are commonly evaluated at the emergency department (ED) with acute anterior cruciate ligament (ACL) tears, but providers without orthopaedics training may struggle to correctly diagnose these injuries. Hypothesis: It was hypothesized that few patients would be diagnosed with an ACL tear while in the ED and that these patients would be of lower socioeconomic status and more likely to have public insurance. Study Design: Cohort study; Level of evidence, 3. Methods: The 2017 State Ambulatory Surgery and Services Database (SASD) and State Emergency Department Database (SEDD) from the state of Florida were utilized in this study. Cases with Current Procedural Terminology code 29888 (arthroscopically aided ACL reconstruction [ACLR]) were selected from the SASD, and data from the SEDD were matched to patients who had an ED visit for a knee injury within 120 days before ACLR. Chi-square analysis was used to test for differences in patient and surgical variables between the ED visit and nonvisit patient groups. A generalized linear model was created to model the effect of ED visit on total cost for an ACL injury. Results: While controlling for differences in patient characteristics and concomitant procedure usage, a visit to the ED added $4587 in total cost ( P < .001). The ED visit cohort contained a greater proportion of patients with Medicaid (20.2% vs 9.1%), patients who were Black (18.4% vs 10.3%), and patients in the lowest income quartile (34.4% vs 25.0%) ( P < .001 for all). In the ED visit cohort, 14.4% of patients received an allograft versus 10.1% in the non-ED visit cohort ( P = .001) despite having a similar mean age. An ACL sprain was diagnosed in only 29 of the 645 (4.5%) patients who visited the ED. Conclusion: Utilizing the ED for care after an ACL injury was expensive, averaging a $4587 increase in total cost associated with ACLR. However, patients rarely left with a definitive diagnosis, with only 4.5% of patients who underwent ACLR being correctly diagnosed with an ACL tear in the ED. This additional cost was levied disproportionately on patients of low socioeconomic status and patients with Medicaid.

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Section: Discussionmentioning

confidence: 83%

“…In particular, patients who have Medicaid have been shown to have poor access to orthopaedic care. 17,23,26 Areas that have a higher density of Medicaid enrollees could thus benefit from expanded provider coverage. This could include primary care sports medicine physicians or advanced practice providers at urgent care orthopaedic clinics.…”

Section: Discussionmentioning

confidence: 99%

Increased Total Cost and Lack of Diagnostic Utility for Emergency Department Visits After ACL Injury

Chuck

Bokshan

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…Access to care in orthopaedics, especially after the PPACA, has been a popular topic of discussion in orthopaedic research. 13,18,29 This study sought to examine access to orthopaedic care for urgent sports medicine patients based on the insurance they possessed. In the literature, there was a similar study published in 2017 looking at access to care based on insurance.…”

Section: Discussionmentioning

confidence: 99%

“…35 In a similar study conducted with regard to access to orthopaedic spine surgeons, patients with Medicare were unable to book appointments. 29 Studies have shown that patients with low socioeconomic status have a negative disparity in their health. 7,27 The purpose of Medicaid is to provide low-income patients with insurance, 33 and while expanding Medicaid may provide some patients with insurance that they would otherwise lack, it fails to grant them equal access to care when compared to patients with other insurance types.…”

Section: Discussionmentioning

confidence: 99%

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

Shi

Anastasio

Guissé

et al. 2020

Orthopaedic Journal of Sports Medicine

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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.

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Acceptance of Simulated Adult Patients With Medicaid Insurance Seeking Care in a Cancer Hospital for a New Cancer Diagnosis

et al. 2022

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Key Points Question Can individuals insured by Medicaid access cancer care services at high-performing cancer-designated hospitals? Findings In this cross-sectional study of 334 facilities recognized for cancer care, 95.5% accepted new patients with Medicaid for breast cancer, 90.4% for colorectal cancer, 86.8% for kidney cancer, and 79.6% for skin cancer (melanoma) care. Medicaid was accepted for all 4 surveyed cancers at 67.7% of facilities. Meaning Despite increases in the number of US residents insured through Medicaid, these findings suggest that barriers to accessing cancer care exist at high-quality centers.

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The impact of insurance coverage on access to orthopedic spine care

Cited by 42 publications

References 16 publications

Increased Total Cost and Lack of Diagnostic Utility for Emergency Department Visits After ACL Injury

Increased Total Cost and Lack of Diagnostic Utility for Emergency Department Visits After ACL Injury

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

Acceptance of Simulated Adult Patients With Medicaid Insurance Seeking Care in a Cancer Hospital for a New Cancer Diagnosis

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