The Influence of Insurance Status on Access to and Utilization of a Tertiary Hand Surgery Referral Center

Calfee, Ryan P.; Shah, Chirag; Canham, Colin D.; Wong, Ambrose H.; Gelberman, Richard H.; Goldfarb, Charles A.

doi:10.2106/jbjs.j.01966

Cited by 96 publications

(62 citation statements)

References 9 publications

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“…Lastly, several studies have described the local opportunity cost of providing and sending health-care resources abroad [26][27][28] . The roughly 15% of the United States population that is uninsured (as of 2012) can expect less overall and timely care as compared with those with health coverage, and are less likely to be offered orthopaedic surgery as a treatment option [26][27][28][29] .…”

Section: Discussionmentioning

confidence: 99%

“…The roughly 15% of the United States population that is uninsured (as of 2012) can expect less overall and timely care as compared with those with health coverage, and are less likely to be offered orthopaedic surgery as a treatment option [26][27][28][29] . Volunteer surgeons encounter considerable licensing restrictions, liability concerns, and logistical dilemmas that inhibit providing subsidized care in the United States 26 .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

International Health Electives in Orthopaedic Surgery Residency Training

Shultz¹,

Kamal²,

Daniels³

et al. 2015

The Journal of Bone and Joint Surgery-American Volume

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

International Health Electives in Orthopaedic Surgery Residency Training

Shultz¹,

Kamal²,

Daniels³

et al. 2015

The Journal of Bone and Joint Surgery-American Volume

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show abstract

“…Calfee et al investigated patients with hand and upperextremity conditions and found that patients with Medicaid were traveling farther distances for appointments with specialists than patients with private insurance or Medicare 10 . For patients undergoing total hip arthroplasty, similar results have been seen, as patients with Medicaid were driving farther to obtain care at an academic hospital than patients with private insurance or Medicare 11 .…”

mentioning

confidence: 99%

A Regional Assessment of Medicaid Access to Outpatient Orthopaedic Care: The Influence of Population Density and Proximity to Academic Medical Centers on Patient Access

Patterson

Draeger²,

Olsson³

et al. 2014

The Journal of Bone and Joint Surgery

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“…The authors demonstrated significantly greater barriers in access to surgical care for Medicaid and uninsured patients relative to privately-insured patients. [40] LaPar et al used NIS data for 893,658 hospitalizations and demonstrated that primary payer status adversely affected risk-adjusted mortality following a number of major surgical procedures including hip replacement, gastrectomy, and colectomy. [3] In the spine surgery population, Hacquebord et al reviewed 1,591 patients that underwent spine surgery at a large academic medical center and observed that Medicaid or uninsured primary payer status was independently predictive of postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

Insurance status and reportable quality metrics in the cervical spine fusion population

et al. 2017

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BACKGROUND CONTEXT The incidence of adverse care quality events among patients undergoing cervical fusion surgery is unknown using the definition of care quality employed by the Centers for Medicare and Medicaid Services (CMS). The effect of insurance status on the incidence of these adverse quality events is also unknown. PURPOSE This study determined the incidence of hospital acquired conditions (HAC) and patient safety indicators (PSI) in cervical spine fusion patients and analyzed the association between primary payer status and these adverse events. STUDY DESIGN Retrospective cohort design PATIENT SAMPLE All patients in the Nationwide Inpatient Sample (NIS) aged eighteen and older that underwent cervical spine fusion from 1998–2011 were included. OUTCOME MEASURES Incidence of HAC and PSI from 1998–2011. METHODS We queried the NIS for all hospitalizations that included a cervical fusion during the inpatient episode from 1998–2011. All comparisons were made between privately insured patients and Medicaid/self-pay patients because Medicare enrollment is confounded with age. Incidence of non-traumatic HAC and PSI were determined using publicly available lists of ICD-9-CM diagnosis codes. We built logistic regression models to determine the effect of primary payer status on PSI and non-traumatic HAC. RESULTS We identified 419,424 hospitalizations with cervical fusion performed during an inpatient episode. The estimated national incidences of non-traumatic HAC and PSI were 0.35% and 1.6%, respectively. After adjusting for patient demographics and hospital characteristics, Medicaid/self-pay patients had significantly greater odds of experiencing one or more HAC (OR 1.51 95% CI 1.23–1.84) or PSI (OR 1.52 95% CI 1.37–1.70) relative to the privately-insured cohort. CONCLUSION Among patients undergoing inpatient cervical fusion, primary payer status predicts PSI and HAC (both indicators of adverse healthcare quality used to determine hospital reimbursement by CMS). As the U.S. healthcare system transitions to a value-based payment model, the cause of these disparities must be studied to improve the quality of care delivered to vulnerable patient populations.

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The Influence of Insurance Status on Access to and Utilization of a Tertiary Hand Surgery Referral Center

Cited by 96 publications

References 9 publications

International Health Electives in Orthopaedic Surgery Residency Training

International Health Electives in Orthopaedic Surgery Residency Training

A Regional Assessment of Medicaid Access to Outpatient Orthopaedic Care: The Influence of Population Density and Proximity to Academic Medical Centers on Patient Access

Insurance status and reportable quality metrics in the cervical spine fusion population

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