Medicaid Status Impacts Access to Care for Pediatric Patients With ACL Injuries

SAN FRANCISCO — Adolescent patients who sustained ACL injuries and
had private insurance had significantly greater odds of securing an appointment
at orthopedic practices than those with Medicaid, according to a recently
presented study.

“Access to orthopedic care for children on Medicaid continues to be
a problem in the United States,” Tiffanie R. Pierce, CNP, and
colleagues wrote in their study. Pierce presented the results at the American
Academy of Orthopaedic Surgeons 2012 Annual Meeting.

Government vs. private insurance

To determine whether insurance status played a role in gaining access to
care for adolescent patients with ACL injuries, Pierce and colleagues searched
for orthopedic offices within a 25-mile radius of a Cincinnati-area zip code.
They eliminated from their study centers that did not treat children, those
that failed to answer phone calls, those with retired surgeons and nonsurgical
orthopedic offices. The researchers pinpointed 42 practices for the study with
69 orthopedic surgeons.

The investigators telephoned the orthopedic practices using the
following script: “My 14-year-old son was on the soccer field last
Saturday. He fell and was taken to the emergency room. The MRI said he had an
ACL tear, and the ER doctor told me he had to see you within 2 weeks.”

Pierce and colleagues called each practice twice. During the first phone
call, researchers would say they had state medical insurance for Ohio, Indiana
or Kentucky. In the second phone call placed 2 weeks to 4 weeks later, the
callers reported they had private insurance.

Potential economic motives

Of the 42 offices contacted, Pierce said that 36 centers would not
accept government insurance regardless of whether the practice was in the same
state as the patient’s insurance. Of the six offices that accepted
Medicaid, all offered appointments to patients within the 2-week time limit.

“The offices that were expecting the private insurance gave
appointments 100% of the time within the 2 weeks, and four of the offices
appointments did go outside the appointment limit of 2 weeks,” Pierce

When Pierce and her colleagues investigated the reimbursement rates for
state vs. private insurance, she noted that her institution billed $4,325 on
average for each ACL surgery performed in 2010. Private insurance typically
reimbursed $3,882.33 for each procedure. Medicaid insurance for the state of
Kentucky reimbursed $922.23, Indiana paid out $986 and Ohio dispensed $802.

“Economic motivation seemed to be a big issue,” Pierce said.
by Renee Blisard

For more information:

Pierce T, Mehlman CT, Tamai J, Skaggs DL. Access to anterior cruciate
ligament care for children with Medicaid vs. private insurance. Paper #690.
Presented at the American Academy of Orthopaedic Surgeons Annual Meeting. Feb.
7-11. San Francisco.

Disclosure: Pierce has no relevant financial disclosures.

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