Survey of Patient Insurance Status on Access to Specialty Foot and Ankle Care Under the Affordable Care Act

Kim, Chang-Yeon; Wiznia, Daniel H.; Roth, Alexander S.; Walls, Raymond J.; Pelker, Richard R.

doi:10.1177/1071100716642015

Cited by 31 publications

(40 citation statements)

References 14 publications

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“…Although studies have stressed the importance of increased reimbursements on physician participation, these results are consistent with previous studies on patient access to orthopaedic surgery specialty care. 15,16 …”

Section: Discussionmentioning

confidence: 99%

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The Influence of Medical Insurance on Patient Access to Orthopaedic Surgery Sports Medicine Appointments Under the Affordable Care Act

Wiznia

Nwachuku

Roth

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:The goal of the Patient Protection and Affordable Care Act (PPACA) was to expand patient access to health care. Since the rollout of the PPACA, Medicaid patients have demonstrated difficulty obtaining appointments in some specialty care settings.Purpose:To assess the effect of insurance type (Medicaid and private) on patient access to orthopaedic surgery sports medicine specialists for a semiurgent evaluation of a likely operative bucket-handle meniscus tear. The study was designed to determine whether disparities in access exist since the PPACA rollout.Study Design:Cohort study; Level of evidence, 2.Methods:The design was to call 180 orthopaedic surgery sports medicine specialists in 6 representative states (California, Ohio, New York, Florida, Texas, and North Carolina) between June 2015 and December 2015. An appointment was requested for the caller’s fictitious 25-year-old-brother who had suffered a bucket-handle meniscus tear. Each office was called twice to assess the ease of obtaining an appointment: once for patients with Medicaid and once for patients with private insurance. For each call, data pertaining to whether an appointment was given, wait times, and barriers to receiving an appointment were recorded.Results:A total of 177 surgeons were called within the study period. Overall, 27.1% of offices scheduled an appointment for a patient with Medicaid, compared with 91.2% (P < .0001) for a patient with private insurance. Medicaid patients were significantly more likely to be denied an appointment due to lack of referral compared with private patients (40.2% vs 3.7%, P < .0001), and Medicaid patients were more likely to experience longer wait times for an appointment (15 vs 12 days, P < .029). No significant differences were found in patients’ access to orthopaedic surgery sports medicine specialists between Medicaid-expanded and -nonexpanded states. Medicaid reimbursement for knee arthroscopy with meniscus repair was not significantly correlated with appointment success rate or patient waiting periods.Conclusion:Despite the passage of the PPACA, patients with Medicaid have reduced access to care. In addition, patients with Medicaid confront more barriers to receiving appointments than patients with private insurance and wait longer for an appointment.

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Section: Discussionmentioning

confidence: 99%

“…In addition, the majority of practices in these states reported that they simply do not accept Medicaid as an insurance policy, not that they required a referral, which is consistent with results from previous studies. 14–16 …”

Section: Discussionmentioning

confidence: 99%

The Influence of Medical Insurance on Patient Access to Orthopaedic Surgery Sports Medicine Appointments Under the Affordable Care Act

Wiznia

Nwachuku

Roth

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…Although studies have stressed the importance of reimbursements on physician participation, this result is consistent with previous works on patient access to carpal tunnel release and total ankle replacement. 22 , 23 Long 18 suggested that although reimbursements may help, additional strategies for promoting Medicaid acceptance may be needed, such as lowering the costs of participating in Medicaid by simplifying administrative processes, speeding up reimbursement, and reducing the costs associated with caring for those patients.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Insurance Type on Fragility Fracture Patient Access to Endocrinology Under the Affordable Care Act

Wiznia

Ndon

Kim

et al. 2016

Geriatr Orthop Surg Rehabil

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Objectives:To assess the effect of insurance type (Medicaid, Medicare, and private insurance) on fragility fracture patients’ access to endocrinology specialists in the postoperative period.Materials and Methods:The research team called 247 board-certified endocrinologists in 8 representative states. The caller requested an appointment for her fictitious mother to be evaluated for osteoporosis after suffering a hip fracture that required surgery. The caller stated that her mother had an abnormal level of parathyroid hormone and her mother’s orthopedic surgeon believed she needed to see an endocrinologist. Each office was called 3 times to assess the responses for each insurance type. For each call, we documented whether the patient was able to receive an appointment and the barriers the patient confronted to receiving an appointment.Results:About 15.8% of offices scheduled an appointment for a patient with Medicaid, compared to 48.6% for Medicare and 54.3% for BlueCross (P < .0001). Medicaid patients confronted more barriers to receiving appointments. There was no statistically significant difference in access for Medicaid patients in states that had expanded Medicaid versus states that had not expanded Medicaid. Medicaid reimbursement for a new level 3 patient visit did not significantly correlate with appointment success rates or wait times.Conclusion:Despite the passage of the Affordable Care Act, Medicaid patients have reduced access to endocrinologists and more complex barriers to receiving appointments. A more robust strategy for increasing access to care for Medicaid patients would be more equitable.

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“…7 Only 19% of Medicaid patients could schedule an orthopedic office evaluation for an ankle replacement across eight states. 8 Less is known about access to orthopedic care for the uninsured, and Texas has the highest uninsured rate in the nation. [9][10][11] A public ED in Texas reported that 20% of their orthopedic patient population is seeking follow-up care after visiting another ED, suggesting possible barriers to orthopedic care access in this area.…”

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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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Survey of Patient Insurance Status on Access to Specialty Foot and Ankle Care Under the Affordable Care Act

Abstract: Level II, prognostic study.

Cited by 31 publications

References 14 publications

The Influence of Medical Insurance on Patient Access to Orthopaedic Surgery Sports Medicine Appointments Under the Affordable Care Act

The Influence of Medical Insurance on Patient Access to Orthopaedic Surgery Sports Medicine Appointments Under the Affordable Care Act

The Effect of Insurance Type on Fragility Fracture Patient Access to Endocrinology Under the Affordable Care Act

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

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