Background Arthroscopic rotator cuff repair is an effective treatment for patients with symptomatic rotator cuff tears. Ensuring timely and appropriate postoperative access to physical therapy (PT) is paramount to the achievement of optimal patient outcomes. Extended immobility due to a lack of formal rehabilitation can lead to decreased range of motion, continued pain, and potential reoperation for stiffness. The purpose of this study is to evaluate national disparities in access to PT services after rotator cuff repair between patients with private vs. Medicaid insurance. This study will further evaluate differences in access to PT services between states that have previously undergone Medicaid expansion as compared with those states which have not. Methods The American Physical Therapy Association Website was used to identify 10 physical therapy practices from the capital city in every state. Each physical therapy practice was contacted using a mock-patient script for a patient with Medicaid insurance or private (Blue Cross Blue Shield) insurance. To maintain anonymity, calls were made by two separate investigators. Univariate analysis included independent sample t-test for differences between the study groups for continuous variables. Chi square or Fisher's exact test assessed differences in discrete variables between the study groups. Results Contact was made with 465 of 510 (91.2%) physical therapy practices. Overall, 52.7% accepted Medicaid insurance, while 94.9% accepted private insurance ( P < .001). Medicaid insurance was more likely to be accepted in a Medicaid expansion state than a nonexpansion state (56.1% vs. 46.3%, P = .05). Private insurance was also more likely to be accepted in a Medicaid expansion state than a nonexpansion state (96.7% vs. 91.3%, P = .01). The time to first appointment varied more in Medicaid expansion states (private range: 0-43 days, Medicaid range: 0-72 days) than in nonexpansion states (private range: 0-11 days, medicaid range: 0-10 days). Conclusion Significantly fewer PT practices accepted Medicaid insurance nationally compared with private insurance, which suggests that patients with Medicaid insurance have greater difficulty accessing PT after rotator cuff repair in the United States compared with patients with private insurance. While Medicaid insurance was more likely to be accepted in a Medicaid expansion state, this finding was only borderline significant, which indicates that patients in Medicaid expansion states are still having difficulty accessing PT, despite efforts to expand government insurance coverage to improve access to care. Orthopedic surgeons should counsel their patients with Medicaid insurance to seek out PT as early as possible in the postoperative period to avoid delays in rehabilitation.

Rotator cuff repair (RCR) is an effective procedure to relieve shoulder pain and dysfunction. Postoperative physical therapy (PT) plays an integral role in the overall success of RCR. Insurance status has been shown to be an important predictor of postoperative PT utilization. This study evaluated the effect of insurance status on access to PT services following RCR. One hundred thirty-eight PT clinics were contacted in the Greater Boston metropolitan area. Clinics were contacted on two separate occasions and presented with a fictitious acutely postoperative RCR patient in need of PT. Insurance status was reported as Medicaid or private insurance. Overall, 133 (96.4%) accepted private insurance, whereas only 71 (51.4%) accepted Medicaid (P=0.019). Medicaid patients were offered a first available appointment at a mean of 8.3 days (95% CI: 7.13-9.38, range: 0-31) versus a mean of 6.3 days (95% CI: 5.3-7.22, range: 0-19, P=0.001) for private patients. Clinic location was not associated with access to PT or time to first appointment. Insurance status affects access to PT services and time to first available appointment in patients following RCR surgery in a major metropolitan area.

Background:In the senior author’s (X.L.) orthopaedic sports medicine clinic in the United States (US), patients appear to have difficulty finding physical therapy (PT) practices that accept Medicaid insurance for postoperative rehabilitation.Purpose:To determine access to PT services for privately insured patients versus those with Medicaid who underwent anterior cruciate ligament (ACL) reconstruction in the largest metropolitan area in the state of Massachusetts, which underwent Medicaid expansion as part of the Affordable Care Act.Study Design:Cross-sectional study.Methods:Locations offering PT services were identified through Google, Yelp, and Yellow Pages internet searches. Each practice was contacted and queried about health insurance type accepted (Medicaid [public] vs Blue Cross Blue Shield [private]) for postoperative ACL reconstruction rehabilitation. Additional data collection points included time to first appointment, reason for not accepting insurance, and ability to refer to a location accepting insurance type. Median income and percentage of households living in poverty were also noted through US Census data for the town in which the practice was located.Results:Of the 157 PT locations identified, contact was made with 139 to achieve a response rate of 88.5%. Overall, 96.4% of practices took private insurance, while 51.8% accepted Medicaid. Among those locations that did not accept Medicaid, only 29% were able to refer to a clinic that would accept it. “No contract” was the most common reason why Medicaid was not accepted (39.4%). Average time to first appointment was 5.8 days for privately insured patients versus 8.4 days for Medicaid patients (P = .0001). There was no significant difference between clinic location (town median income or poverty level) and insurance type accepted.Conclusion:The study results reveal that 43% fewer PT clinics accept Medicaid as compared with private insurance for postoperative ACL reconstruction rehabilitation in a large metropolitan area. Furthermore, Medicaid patients must wait significantly longer for an initial appointment. Access to PT care is still limited despite the expansion of Medicaid insurance coverage to all patients in the state.

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