Fewer Orthopedic Surgeons Willing to Treat Kids on Medicaid

According to a recent study titled “National Access to Pediatric Fracture Care,” presented at the American Academy of Pediatrics National Conference and Exhibition in New Orleans, La., fewer orthopedic surgeons are accepting pediatric Medicaid patients compared to six years ago. Between 2006 and now, the number of orthopedic surgeons willing to see a child with a broken bone covered by Medicaid has dropped by 39 percentage points—but even children with private insurance are facing obstacles in getting a timely appointment.

The study identified five general orthopedic practices in each U.S. state. Each office was called with a private cellphone, and a message was left saying the following: “My 10-year-old son broke his arm while out of the country last week. He was splinted and told to see an orthopedic surgeon within one week. His fracture does not involve the growth plate.” Only 23.2 percent (58 out of 250) of the practices across the country agreed to schedule an appointment for a pediatric fracture patient with Medicaid. Of the offices that declined an appointment request, 38 percent said that they do not accept Medicaid patients. The 10 states with the lowest Medicaid reimbursement rates offered an appointment 6 percent of the time; the 10 states with the highest level of reimbursement, 44 percent. The same group of 10 lowest Medicaid reimbursement states offered an appointment to a preferred provider organization (PPO) patient 88 percent of the time, and the 10 best Medicaid reimbursement states, 82 percent of the time. Eighty-two percent of the offices nationwide agreed to see a patient with private PPO insurance. Nine states were identified where all five offices refused the Medicaid patient, but all five accepted the PPO patient. The states were Connecticut, Illinois, Louisiana, New Jersey, North Carolina, Oklahoma, Rhode Island, South Dakota and Texas.

Data published in 2006 showed that the number of offices willing to see a child with private insurance was 92 percent. In 2012, it is 82 percent. When it comes to children with Medicaid insurance, the numbers are 62 percent in 2006, and just 23 percent today.

“Underinsured children continue to have difficulty accessing care for their fractures,” said author of the study Christopher Iobst, M.D., who cited low Medicaid reimbursement rates as the most likely reason for practices refusing to see patients. As for those with private insurance, Iobst cites a variety of reasons:

46 percent of the offices contacted in the study were unable to refer the family to an orthopedist who would take care of the child. “This paradigm shift has resulted in a greater number of children getting referred to pediatric tertiary care centers (hospitals) for their care, even for routine injuries,” he said. While receiving care at these centers is beneficial, “many patients are forced to drive long distances to receive care for routine injuries. This places an unnecessary burden on families that often have limited resources.”

Photo courtesy of yourchildhealthy.blogspot.com.