Access to Orthopedic Care post Medicaid Expansion Through the Affordable Care Act

Abstract

BackgroundAs of January 2017, 32 states have decided to expand Medicaid through the Patient Protection and Affordable Care Act. The uninsured rate in the United States has decreased, but does the increased coverage translate to increased access to outpatient orthopedic care? Through a simulated patient telephone survey, this study aims to evaluate access to orthopedic surgeons for Medicaid patients in Louisiana. MethodsA comprehensive list of potentially eligible orthopedic surgeons in the state of Louisiana was obtained from an online public database managed by the Louisiana Medicaid website (lamedicaid.com). This list represented all orthopedic surgeons that received a Medicaid payment within the six months prior to February 1st, 2017 (August 1st, 2016–January 31st, 2017). Using an internet search, we found that 309 orthopedic surgeons listed met the inclusion criteria and were practicing in 93 different clinical practices. Because several orthopedists practiced in the same group practice, and some practiced in multiple practices, we sampled unique clinical practices as opposed to individual providers. One telephone call was made to each practice in an attempt to secure an appointment for a simulated Medicaid patient. The average number of orthopedic surgeons per practice was 3.4, with the majority of practices (60%) being private practices with only one surgeon. ResultsOf the 93 practices in the study, only 17 (18.3%) offered an appointment. The 17 practices represented 41 orthopedic surgeons (13.3%) that were willing to accept new Medicaid patients. That number decreased to 22 (7.1%) if you remove the orthopedic surgeons practicing at safety-net facilities. ConclusionThe results suggest that although Medicaid expansion has decreased the uninsured rate, access to outpatient orthopedic care for Medicaid patients in Louisiana is still significantly limited.