Published on October 21st, 2012 | by Steven Hodson0
Pediatric Medicaid Patients Being Accepted By Fewer Orthopedic Surgeons
This decline of 39 percentage points is directly attributed to low Medicaid reimbursement rates but one of the other findings in the study showed that additionally even patients with private insurance are also being turned away at an increasing rate. Of the doctor offices contacted by the study found that 46% of them were unable to refer a family to an orthopedist who would be able to take care of the child with a broken bone.
In the study, “National Access to Pediatric Fracture Care,” five general orthopedic practices were identified in each state. Each office was called with a private cellphone using the following script: “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 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 (Connecticut, Illinois, Louisiana, New Jersey, North Carolina, Oklahoma, Rhode Island, South Dakota and Texas).