Decreased access to orthopedic surgeons found among pediatric Medicaid patients with fractures

NEW ORLEANS — The number of orthopedic surgeons willing to see a child with a broken arm who is covered under Medicaid is lower than 6 years ago, according to research recently presented at the American Academy of Pediatrics National Conference and Exhibition.

Christopher A. Iobst, MD, and colleagues contacted five orthopedic practices in each state with 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.”

Of 250 offices contacted, the investigators found that 58 (23.2%) were willing to schedule an appointment, according to the study abstract. A similar study published in 2006, noted that 62% of offices would be willing to see such a patient. Iobst and colleagues also discovered that 82% of offices contacted would see the patient if they were covered under a private preferred provider organization (PPO) insurance — down from 92% in 2006.

“Underinsured children continue to have difficulty accessing care for their fractures,” Iobst, an orthopedic surgeon at Miami Children’s Hospital in Miami, stated in an American Academy of Pediatrics press release. He suggested that lower Medicaid reimbursement rates were a likely reason for the increase in patients being turned away.

Of the offices that turned down the request for an appointment, 38% noted they do not accept Medicaid patients. Iobst and colleagues found that states with the lowest Medicaid reimbursement rates offered appointments 6% of the time vs. 44% of the time for the states with the highest reimbursement rates.

Iobst said more patients with private insurance are also being turned away, noting that 46% of offices contacted could not refer families with private insurance to orthopedic surgeons who would see children with fractures.

“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,” Iobst said. While care at these centers is beneficial, he said, “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.”

For more information:

Iobst CA. National access to pediatric care. Presented at: American Academy of Pediatrics National Conference and Exhibition. Oct 20-23, 2012; New Orleans.