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Boden AL, Geller JS, Granger CJ, Summers SH, Kaplan J, Aiyer A. Achilles Injury and Access to Care in South Florida. Foot Ankle Spec 2022; 15:105-112. [PMID: 32703022 DOI: 10.1177/1938640020943711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction. Despite the amount of orthopaedic research evaluating access to care based on insurance status, no study quantifies the effects of insurance status on the care of acute Achilles tendon ruptures. Methods. Using Current Procedural Terminology codes, we identified all patients who underwent surgical management of Achilles tendon rupture between December 31, 2013, and December 31, 2018, and followed-up at either a county hospital-based orthopaedic surgery clinic and/or private university-based clinic. Inclusion criteria included patients who (1) underwent surgical management of an Achilles tendon rupture during this time period and (2) were at least 18 years of age at the time of surgery. A univariate 2-tailed t test was used to compare various groups. Statistical significance was set at P < 0.05. Results. When compared to adequately insured patients (private and Medicare), underinsured patients (uninsured and Medicaid) experienced a significantly greater time from the date of injury to first clinic visit (14.5 days vs 5.2 days, P < .001), first clinic visit to surgery (34.6 days vs 4.8 days, P < .002), injury to surgery date (48.9 days vs 9.8 days, P < .001), initial presentation to when magnetic resonance imaging was obtained (48.1 days vs 1.9 days, P < .002). Conclusions. Disparities in access to care for Achilles tendon ruptures are intimately related to insurance status. Uninsured and Medicaid patients are subject to institutional delays and decreased access to care when compared to patients with private insurance.Levels of Evidence: Level III: Prognostic, retrospective.
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Affiliation(s)
- Allison L Boden
- Department of Orthopaedic Surgery, University of Miami/Jackson Health Systems, Miami, Florida (ALB, SHS, AA).,University of Miami Miller School of Medicine, Miami, Florida (JSG, CJG).,Hoag Orthopedic Institute, Irvine, California (JK)
| | - Joseph S Geller
- Department of Orthopaedic Surgery, University of Miami/Jackson Health Systems, Miami, Florida (ALB, SHS, AA).,University of Miami Miller School of Medicine, Miami, Florida (JSG, CJG).,Hoag Orthopedic Institute, Irvine, California (JK)
| | - Caroline J Granger
- Department of Orthopaedic Surgery, University of Miami/Jackson Health Systems, Miami, Florida (ALB, SHS, AA).,University of Miami Miller School of Medicine, Miami, Florida (JSG, CJG).,Hoag Orthopedic Institute, Irvine, California (JK)
| | - Spencer H Summers
- Department of Orthopaedic Surgery, University of Miami/Jackson Health Systems, Miami, Florida (ALB, SHS, AA).,University of Miami Miller School of Medicine, Miami, Florida (JSG, CJG).,Hoag Orthopedic Institute, Irvine, California (JK)
| | - Jonathan Kaplan
- Department of Orthopaedic Surgery, University of Miami/Jackson Health Systems, Miami, Florida (ALB, SHS, AA).,University of Miami Miller School of Medicine, Miami, Florida (JSG, CJG).,Hoag Orthopedic Institute, Irvine, California (JK)
| | - Amiethab Aiyer
- Department of Orthopaedic Surgery, University of Miami/Jackson Health Systems, Miami, Florida (ALB, SHS, AA).,University of Miami Miller School of Medicine, Miami, Florida (JSG, CJG).,Hoag Orthopedic Institute, Irvine, California (JK)
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Appointment Wait Times in Female Pelvic Medicine and Reconstructive Surgery: A Mystery Caller Study. Female Pelvic Med Reconstr Surg 2021; 27:681-685. [PMID: 34570030 DOI: 10.1097/spv.0000000000001039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the mean appointment wait time for a new patient visit at outpatient female pelvic medicine and reconstructive surgery (FPMRS) offices for U.S. women with the common and nonemergent concern of uterine prolapse. METHODS The American Urogynecologic Society "Find a Provider" tool was used to generate a list of FPMRS offices across the United States. Each of the 427 unique listed offices was called. The caller asked for the soonest appointment available for her mother, in whom uterine prolapse was recently diagnosed. Data for each office were collected, including date of the earliest appointment, FPMRS physician demographics, and office demographics. Mean appointment wait time was calculated. RESULTS Four hundred twenty-seven FPMRS offices were called in 46 states plus the District of Columbia. The mean appointment wait time was 23.1 business days for an appointment (standard deviation, 19 business days). The appointment wait time was 6 days longer when seeing a female FPMRS physician compared with a male FPMRS physician (mean, 26 business days vs 20 business days, P < 0.02). There was no difference in wait time by day of the week called. CONCLUSIONS Wait times are a measure of access to care within the health care system. Shorter wait times are associated with increased patient satisfaction. Typically, a woman with uterine prolapse can expect to wait at least 4 weeks for a new patient appointment with an FPMRS board-certified physician listed on the American Urogynecologic Society website. The first available appointment is more often with a male physician. A patient can expect to wait 6 days longer to see a female FPMRS physician. As mean wait times across outpatient specialties continue to increase, FPMRS offices should strive to keep wait times at a minimum to allow women timely access to care.
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Creadore A, Desai S, Li SJ, Lee KJ, Bui ATN, Villa-Ruiz C, Lo K, Zhou G, Joyce C, Resneck JS, Seiger K, Mostaghimi A. Insurance Acceptance, Appointment Wait Time, and Dermatologist Access Across Practice Types in the US. JAMA Dermatol 2021; 157:181-188. [PMID: 33439219 DOI: 10.1001/jamadermatol.2020.5173] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance In the 15 years since dermatology access was last investigated on a national scale, the practice landscape has changed with the rise of private equity (PE) investment and increased use of nonphysician clinicians (NPCs). Objective To determine appointment success and wait times for patients with various insurance types at clinics with and without PE ownership. Design, Setting, and Participants In this study, PE-owned US clinics were randomly selected and matched with 2 geographically proximate clinics without PE ownership. Researchers called each clinic 3 times over a 5-day period to assess appointment/clinician availability for a fictitious patient with a new and changing mole. The 3 calls differed by insurance type specified, which were Blue Cross Blue Shield (BCBS) preferred provider organization, Medicare, or Medicaid. Main Outcomes and Measures Appointment success and wait times among insurance types and between PE-owned clinics and control clinics. Secondary outcomes were the provision of accurate referrals to other clinics when appointments were denied and clinician and next-day appointment availability. Results A total of 1833 calls were made to 204 PE-owned and 407 control clinics without PE ownership across 28 states. Overall appointment success rates for BCBS, Medicare, and Medicaid were 96%, 94%, and 17%, respectively. Acceptance of BCBS (98.5%; 95% CI, 96%-99%; P = .03) and Medicare (97.5%; 95% CI, 94%-99%; P = .02) were slightly higher at PE-owned clinics (compared with 94.6% [95% CI, 92%-96%] and 92.8% [95% CI, 90%-95%], respectively, at control clinics). Wait times (median days, interquartile range [IQR]) were similar for patients with BCBS (7 days; IQR, 2-22 days) and Medicare (7 days; IQR, 2-25 days; P > .99), whereas Medicaid patients waited significantly longer (13 days; IQR, 4-33 days; P = .002). Clinic ownership did not significantly affect wait times. Private equity-owned clinics were more likely than controls to offer a new patient appointment with an NPC (80% vs 63%; P = .001) and to not have an opening with a dermatologist (16% vs 6%; P < .001). Next-day appointment availability was greater at PE-owned clinics than controls (30% vs 21%; P = .001). Conclusions and Relevance Patients with Medicaid had significantly lower success in obtaining appointments and significantly longer wait times regardless of clinic ownership. Although the use of dermatologists and NPCs was similar regardless of clinic ownership, PE-owned clinics were more likely than controls to offer new patient appointments with NPCs.
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Affiliation(s)
- Andrew Creadore
- Brigham and Women's Hospital, Department of Dermatology, Harvard Medical School, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
| | - Sheena Desai
- Brigham and Women's Hospital, Department of Dermatology, Harvard Medical School, Boston, Massachusetts.,Tufts University School of Medicine, Boston, Massachusetts
| | - Sara J Li
- Brigham and Women's Hospital, Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Karen J Lee
- Brigham and Women's Hospital, Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Ai-Tram N Bui
- Brigham and Women's Hospital, Department of Dermatology, Harvard Medical School, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Camila Villa-Ruiz
- Brigham and Women's Hospital, Department of Dermatology, Harvard Medical School, Boston, Massachusetts.,Ponce Health Sciences University, Ponce, Puerto Rico
| | - Kelly Lo
- Brigham and Women's Hospital, Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Guohai Zhou
- Brigham and Women's Hospital, Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Cara Joyce
- Department of Public Health Sciences, Loyola University, Chicago, Illinois
| | - Jack S Resneck
- Department of Dermatology, University of California School of Medicine, San Francisco
| | - Kira Seiger
- Brigham and Women's Hospital, Department of Dermatology, Harvard Medical School, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Arash Mostaghimi
- Brigham and Women's Hospital, Department of Dermatology, Harvard Medical School, Boston, Massachusetts
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Utilization Patterns of Facet Joint Interventions in Managing Spinal Pain: a Retrospective Cohort Study in the US Fee-for-Service Medicare Population. Curr Pain Headache Rep 2019; 23:73. [DOI: 10.1007/s11916-019-0816-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Hsiang WR, Lukasiewicz A, Gentry M, Kim CY, Leslie MP, Pelker R, Forman HP, Wiznia DH. Medicaid Patients Have Greater Difficulty Scheduling Health Care Appointments Compared With Private Insurance Patients: A Meta-Analysis. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2019; 56:46958019838118. [PMID: 30947608 PMCID: PMC6452575 DOI: 10.1177/0046958019838118] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 02/01/2019] [Accepted: 02/21/2019] [Indexed: 11/16/2022]
Abstract
Medicaid patients are known to have reduced access to care compared with privately insured patients; however, quantifying this disparity with large controlled studies remains a challenge. This meta-analysis evaluates the disparity in health services accessibility of appointments between Medicaid and privately insured patients through audit studies of health care appointments and schedules. Audit studies evaluating different types of outpatient physician practices were selected. Studies were categorized based on the characteristics of the simulated patient scenario. The relative risk of appointment availability was calculated for all different types of audit scenario characteristics. As a secondary analysis, appointment availability was compared pre- versus post-Medicaid expansion. Overall, 34 audit studies were identified, which demonstrated that Medicaid insurance is associated with a 1.6-fold lower likelihood in successfully scheduling a primary care appointment and a 3.3-fold lower likelihood in successfully scheduling a specialty appointment when compared with private insurance. In this first meta-analysis comparing appointment availability between Medicaid and privately insured patients, we demonstrate Medicaid patients have greater difficulty obtaining appointments compared with privately insured patients across a variety of medical scenarios.
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Affiliation(s)
| | | | | | | | | | | | - Howard P. Forman
- Yale School of Medicine, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
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Lee YH, Chen AX, Varadaraj V, Hong GH, Chen Y, Friedman DS, Stein JD, Kourgialis N, Ehrlich JR. Comparison of Access to Eye Care Appointments Between Patients With Medicaid and Those With Private Health Care Insurance. JAMA Ophthalmol 2018; 136:622-629. [PMID: 29710290 PMCID: PMC6007883 DOI: 10.1001/jamaophthalmol.2018.0813] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 02/12/2018] [Indexed: 01/10/2023]
Abstract
Importance Although low-income populations have more eye problems, whether they face greater difficulty obtaining eye care appointments is unknown. Objective To compare rates of obtaining eye care appointments and appointment wait times for those with Medicaid vs those with private insurance. Design, Setting, and Participants In this prospective, cohort study conducted from January 1, 2017, to July 1, 2017, researchers made telephone calls to a randomly selected sample of vision care professionals in Michigan and Maryland stratified by neighborhood (urban vs rural) and professional type (ophthalmologist vs optometrist) to request the first available appointment. Appointments were sought for an adult needing a diabetic eye examination and a child requesting a routine eye examination for a failed vision screening. Researchers called each practice twice, once requesting an appointment for a patient with Medicaid and the other time for a patient with Blue Cross Blue Shield (BCBS) insurance, and asked whether the insurance was accepted and, if so, when the earliest available appointment could be scheduled. Main Outcomes and Measures Rate of successfully made appointments and mean wait time for the first available appointment. Results A total of 603 telephone calls were made to 330 eye care professionals (414 calls [68.7%] to male and 189 calls [31.3%] to female eye care professionals). The sample consisted of ophthalmologists (303 [50.2%]) and optometrists (300 [49.8%]) located in Maryland (322 [53.4%]) and Michigan (281 [46.6%]). The rates of successfully obtaining appointments among callers were 61.5% (95% CI, 56.0%-67.0%) for adults with Medicaid and 79.3% (95% CI, 74.7%-83.9%) for adults with BCBS (P < .001) and 45.4% (95% CI, 39.8%-51.0%) for children with Medicaid and 62.5% (95% CI, 57.1%-68.0%) for children with BCBS (P < .001). Mean wait time did not vary significantly between the BCBS and Medicaid groups for both adults and children. Adults with Medicaid had significantly decreased odds of receiving an appointment compared with those with BCBS (odds ratio [OR], 0.41; 95% CI, 0.28-0.59; P < .001) but had increased odds of obtaining an appointment if they were located in Michigan vs Maryland (OR, 2.40; 95% CI, 1.49-3.87; P < .001) or with an optometrist vs an ophthalmologist (OR, 1.91; 95% CI, 1.31-2.79; P < .001). Children with Medicaid had significantly decreased odds of receiving an appointment compared with those with BCBS (OR, 0.41; 95% CI, 0.28-0.60; P < .001) but had increased odds of obtaining an appointment if they were located in Michigan vs Maryland (OR, 1.68; 95% CI, 1.04-2.73; P = .03) or with an optometrist vs an ophthalmologist (OR, 8.00; 95% CI, 5.37-11.90; P < .001). Conclusions and Relevance Callers were less successful in trying to obtain eye care appointments with Medicaid than with BCBS, suggesting a disparity in access to eye care based on insurance status, although confounding factors may have contributed to this finding. Improving access to eye care professionals for those with Medicaid may improve health outcomes and decrease health care spending in the long term.
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Affiliation(s)
- Yoon H. Lee
- Department of Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland
| | - Andrew X. Chen
- Center for Eye Policy and Innovation, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| | - Varshini Varadaraj
- Department of Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland
| | - Gloria H. Hong
- Department of Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland
| | - Yimin Chen
- Center for Eye Policy and Innovation, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| | - David S. Friedman
- Department of Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland
- Helen Keller International, New York, New York
| | - Joshua D. Stein
- Center for Eye Policy and Innovation, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Health Management and Policy, University of Michigan, Ann Arbor
| | | | - Joshua R. Ehrlich
- Center for Eye Policy and Innovation, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
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