Abstract
Objectives:
Medicaid coverage is associated with longer appointment wait times, poorer health outcomes, and decreased access to care compared to private insurance across multiple medical specialties. Currently, there is a paucity of data assessing the impact of Medicaid coverage on new patient access to care and appointment wait times for orthopaedic sports medicine surgeons. Specifically, data comparing access to hip, knee, and shoulder arthroscopists based on patient insurance status is limited. As a result, the present study aimed to evaluate new patient access to care and appointment wait times for sports medicine-trained orthopaedic surgeons. We sought to assess the impact of insurance status on access to care for patients seeking to schedule an appointment with hip, knee, and shoulder arthroscopists.
Methods:
Sports medicine orthopaedic physicians were identified using the American Academy of Orthopaedic Surgeons patient-facing database, and physicians were categorized by joint specialization (hip, knee, or shoulder) based on a manual review of the surgeon’s websites. Mystery callers–posing as either Medicaid or Blue Cross/Blue Shield (BCBS) insured patients with a textbook presentation of a non-urgent hip, knee, or shoulder injury–contacted physicians to request the next available new patient appointment. The business days until the first available new patient appointment were recorded and analyzed using a linear mixed Poisson regression model. Physicians were included if they were successfully contacted. Physicians were excluded if the caller spent more than 5 minutes on hold or the call was not answered on two repeated call attempts, the physician belonged to a closed medical system, the number contacted did not correspond to the correct office, physician referral was required before scheduling, the call went to a physician’s personal phone number, the physician required a prior visit with their advanced practice provider, or the physician was not accepting new patients.
Results:
A total of 1,043 phone calls were made to 523 unique sports medicine orthopaedic clinics in 48 states. Of the 374 included physicians, 44% (164) did not accept Medicaid. If a clinic did accept Medicaid, Medicaid patients experienced a 20% longer wait for a new patient appointment compared to patients with BCBS (Incidence Rate Ratio (IRR): 1.20; CI: 1.14 - 1.26; p<0.001) with median wait times of 13 days (IQR: 7 - 23) and 12 days (IQR: 6 - 20) respectively (Figure 1). Additionally, patients with Medicaid experienced a 26% decrease in wait time at private practice clinics compared to academic institutions (IRR: 0.74; 0.62 - 0.88; p=0.001). Furthermore, certain geographic regions were associated with a decreased wait time for Medicaid patients (p<0.001). Notably, no significant difference in wait time was identified between hip, knee, and shoulder scenarios (p=0.68) (Figure 2). Our model achieved an R-squared value of 0.93, demonstrating strong explanatory power.
Conclusions:
Patients with Medicaid experience decreased access to care and longer wait times when attempting to schedule an appointment with a sports medicine trained orthopaedic surgeon compared to patients with BCBS insurance. If a clinic accepts Medicaid insurance, patients with Medicaid experience a decrease in wait time at private practices compared to academic institutions. The present study did not assess the underlying reason for the decreased access to care experienced by patients with Medicaid, however it may be due to reimbursement structures that do not cover the full cost of treatment in this population. These findings highlight a critical disparity in care, underscoring the need for additional resources and further research to identify the cause and implement solutions.
