Abstract
Objectives:
Medicaid patients with meniscal tears experience delays in care from delayed initial presentation to an orthopaedic surgeon to increased overall time from injury to surgery. While it has been previously established that medicaid patients may have delays in surgery, little is know about how this affects clinical outcomes. The goal of this study was to evaluate the time from injury to surgery and the clinical outcomes of Medicaid compared to commercially insured patient populations undergoing meniscus repair.
Methods:
A retrospective review of patient records with the meniscus repair codes CPT 29882 and 29883 from October 2014 to October 2018 was conducted. Patients over the age of 21 years old, with a fracture, grade 3 or 4 chondromalacia, or Worker’s Compensation payer type were excluded. The remaining patients’ insurance at the date of surgery was categorized as either commercial or Medicaid payer type. Time from initial injury to surgery, pain level, IKDC, Lysholm Knee Score and Tegner Activity Score were compared across the two patient categories. Statistical analysis was performed with 2 sample t-test to compare numerical data between the two groups.
Results:
In total, 98 patients met the final inclusion criteria with 57 patients in the Medicaid group and 41 patients in the commercial group. The average age of the commercial group was 16.9 and the average age of the Medicaid group was 15.1 (p<.001). There was an increase in the average time from injury to surgery from the commercial group to the Medicaid group (p=.04). The average time from injury to surgery was 112 days for the commercial group versus 187 days for the Medicaid patients, an average difference of 75 days or roughly 2.5 months. There was no significant difference in the one-year outcomes between the commercial and Medicaid groups for pain level, IKDC, Lysholm or Tegner level (p=.69, p=.15, p=.09, p=.75, respectively).
Conclusions:
Young Medicaid insured patients with meniscus tears experienced on average 2.5 month longer delays until surgery than their commercially insured counterparts. This result is consistent with previous studies in the literature. When meniscus tears are treated with surgical repair, both young Medicaid insured patients and commercial insured patients had excellent outcomes with no significant difference between the two groups. While this study found no difference in post-operative outcomes, the discrepancy in time from injury to surgery is still an inequality that deserves to be addressed.
Medicaid patients may experience prolonged discomfort and functional limitations during their 2.5- month average longer delays until surgery. Therefore, further work is needed to determine adequate solutions to reducing discrepancies in different payer type patient populations awaiting much needed surgical repair.
