Musculoskeletal Urgent Care Centers Restrict Access for Patients with Medicaid Insurance Based on Policy and Location

• Published in: Clinical orthopaedics and related research 2021-11, Vol.479 (11), p.2447-2453
• Main Authors: Yousman, Laurie C., Hsiang, Walter R., Jin, Grace, Najem, Michael, Mosier-Mills, Alison, Khunte, Akshay, Jain, Siddharth, Forman, Howard, Wiznia, Daniel H.
• Format: Article
• Language: English
• Subjects: Ambulatory Care - economics; Ambulatory Care - organization & administration; Ambulatory Care Facilities - economics; Ambulatory Care Facilities - organization & administration; Ankle; Clinical Research; Cross-Sectional Studies; Geography; Health Services Accessibility - economics; Health Services Accessibility - organization & administration; Humans; Medicaid; Medicaid - statistics & numerical data; Medical referrals; Musculoskeletal Diseases - economics; Musculoskeletal Diseases - therapy; Orthopedics; Orthopedics - economics; Orthopedics - methods; Patients; Policy; Primary care; United States
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1097/CORR.0000000000001825

As the urgent care landscape evolves, specialized musculoskeletal urgent care centers (MUCCs) are becoming more prevalent. MUCCs have been offered as a convenient, cost-effective option for timely acute orthopaedic care. However, a recent "secret-shopper" study on patient access to MUCCs in Connecticut demonstrated that patients with Medicaid had limited access to these orthopaedic-specific urgent care centers. To investigate how generalizable these regional findings are to the United States, we conducted a nationwide secret-shopper study of MUCCs to identify determinants of patient access. (1) What proportion of MUCCs in the United States provide access for patients with Medicaid insurance? (2) What factors are associated with MUCCs providing access for patients with Medicaid insurance? (3) What barriers exist for patients seeking care at MUCCs? An online search of all MUCCs across the United States was conducted in this cross-sectional study. Three separate search modalities were used to gather a complete list. Of the 565 identified, 558 were contacted by phone with investigators posing over the telephone as simulated patients seeking treatment for a sprained ankle. Thirty-nine percent (216 of 558) of centers were located in the South, 13% (71 of 558) in the West, 25% (138 of 558) in the Midwest, and 24% (133 of 558) in New England. This study was given an exemption waiver by our institution's IRB. MUCCs were contacted using a standardized script to assess acceptance of Medicaid insurance and identify barriers to care. Question 1 was answered through determining the percentage of MUCCs that accepted Medicaid insurance. Question 2 considered whether there was an association between Medicaid acceptance and factors such as Medicaid physician reimbursements or MUCC center type. Question 3 sought to characterize the prevalence of any other means of limiting access for Medicaid patients, including requiring a referral for a visit and disallowing continuity of care at that MUCC. Of the MUCCs contacted, 58% (323 of 558) accepted Medicaid insurance. In 16 states, the proportion of MUCCs that accepted Medicaid was equal to or less than 50%. In 22 states, all MUCCs surveyed accepted Medicaid insurance. Academic-affiliated MUCCs accepted Medicaid patients at a higher proportion than centers owned by private practices (odds ratio 14 [95% CI 4.2 to 44]; p < 0.001). States with higher Medicaid physician reimbursements saw proportional increases in the percentage of MUC