Does Medicaid Insurance Confer Adequate Access to Adult Orthopaedic Care in the Era of the Patient Protection and Affordable Care Act?

• Published in: Clinical orthopaedics and related research 2017-06, Vol.475 (6), p.1527-1536
• Main Authors: Labrum, Joseph T., Paziuk, Taylor, Rihn, Theresa C., Hilibrand, Alan S., Vaccaro, Alexander R., Maltenfort, Mitchell G., Rihn, Jeffrey A.
• Format: Article
• Language: English
• Subjects: Adult; Clinical Research; Conservative Orthopedics; Delaware; Health Services Accessibility - statistics & numerical data; Humans; Insurance Coverage - legislation & jurisprudence; Insurance Coverage - statistics & numerical data; Male; Maryland; Medicaid - legislation & jurisprudence; Medicaid - statistics & numerical data; Medicine; Medicine & Public Health; New Jersey; Orthopedics; Orthopedics - legislation & jurisprudence; Orthopedics - statistics & numerical data; Patient Protection and Affordable Care Act; Patient Simulation; Pennsylvania; Sports Medicine; Surgery; Surgical Orthopedics; United States
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-017-5263-3

Background A current appraisal of access to orthopaedic care for the adult patient receiving Medicaid is important, since Medicaid expansion was written into law by the Patient Protection and Affordable Care Act (PPACA). Questions/Purposes (1) Do orthopaedic practices provide varying access to orthopaedic care for simulated patients with Medicaid insurance versus private insurance in a blinded survey? (2) What are the surveyed state-by-state Medicaid acceptance rates for adult orthopaedic practices in the current era of Medicaid expansion set forth by the PPACA? (3) Do surveyed rates of access to orthopaedic care in the adult patient population vary across practice setting (private vs academic) or vary with different Medicaid physician reimbursement rates? (4) Are there differences in the surveyed Medicaid acceptance rates for adult orthopaedic practices in states that have expanded Medicaid coverage versus states that have foregone expansion? Methods Simulated Patient Survey: We performed a telephone survey study of orthopaedic offices in four states with Medicaid expansion. In the survey, the caller assumed a fictitious identity as a 38-year-old male who experienced an ankle fracture 1 day before calling, and attempted to secure an appointment within 2 weeks. During initial contact, the fictitious patient reported Medicaid insurance status. One month later, the fictitious patient contacted the same orthopaedic practice and reported private insurance coverage status. National Orthopaedic Survey: Private and academic orthopaedic practices operating in each state in the United States were called and asked to complete a survey assessing their practice model of Medicaid insurance acceptance. State reimbursement rates for three different Current Procedural Terminology (CPT ®) codes were collected from state Medicaid agencies. Results Simulated Patient Survey: Offices were less likely to accept Medicaid than commercial insurance (30 of 64 [47%] versus 62 of 64 [97%]; odds ratio [OR], 0.0145; 95% CI, 0.00088–0.23639; p