Medicaid Insurance and Access to Orthopaedic Sports Medicine Care: A National “Mystery Caller” Study in the United States

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Abstract
Background: Medicaid coverage is associated with longer appointment wait times, poorer health outcomes, and decreased access to care compared with private insurance across multiple medical specialties. Currently, there is a paucity of data assessing the effect of Medicaid coverage on new patient access to care and appointment wait times for orthopaedic sports medicine surgeons. Purpose: To assess the effect of insurance status on patient access to care and appointment wait times for sports medicine–trained orthopaedic surgeons specializing in hip, knee, and shoulder arthroscopy. Study Design: Cross-sectional study. Methods: Sports medicine–trained orthopaedic surgeons were identified using the American Academy of Orthopaedic Surgeons patient-facing database, and physicians were categorized by joint specialization (hip, knee, or shoulder). Mystery callers posing as either Medicaid or Blue Cross/Blue Shield (BCBS) insured patients with a textbook presentation of a nonurgent hip, knee, or shoulder injury contacted physicians to request the next available new patient appointment. The number of business days until the first available new patient appointment was recorded and analyzed using a linear mixed model of Poisson regression. Results: A total of 1046 telephone calls were made to 523 unique orthopaedic sports medicine clinics in 48 states. Of the 385 included physicians, 129 (34%) did not accept Medicaid. Patients with Medicaid experienced a 20% longer wait time for a new patient appointment compared with patients with BCBS (incidence rate ratio [IRR], 1.20 [95% CI, 1.14-1.26]; P < .001), with median wait times of 13 days (IQR, 7-23 days) and 12 days (IQR, 6-20 days), respectively. Additionally, patients with Medicaid experienced increased wait times in specific geographic locations ( P < .05) and a greater increase in wait times at academic institutions compared with private practices (IRR, 1.36 [95% CI, 1.13-1.62]; P = .001), with median wait times of 19 days (IQR, 15-22 days) and 14 days (IQR, 12-15 days), respectively. No significant difference in access to care or wait time was identified between hip, knee, and shoulder arthroscopic surgeons ( P = .68). Our model achieved an R 2 value of 0.93, demonstrating strong explanatory power. Conclusion: Patients with Medicaid experienced decreased access to care, with 34% of sports medicine–trained orthopaedic surgeons declining to accept Medicaid insurance. Among surgeons who accepted Medicaid, patients with Medicaid experienced slightly longer wait times for a new patient appointment compared with patients with private (BCBS) insurance. Additionally, patients with Medicaid experienced significantly longer wait times at academic institutions and in specific geographic locations. The present findings highlight a critical disparity in care, further underscoring the need for additional research to identify the cause and implement solutions.
Funding Information
  • National Center for Advancing Translational Sciences (UL1 TR002535)

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