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National Access to Pediatric Fracture Care

Sunday, October 21, 2012: 10:55 AM
Melrose (Hilton Riverside)
Christopher A. Iobst, MD1, Dillon Arango2 and Dale Segal2, (1)Orthopedic Surgery, Miami Children's Hospital, Miami, FL, (2)FIU Herbert Wertheim College of Medicine, Miami, FL

Purpose

Access to care for children with fractures is becoming increasingly difficult in some communities regardless of insurance status.  The purpose of this study is to see if there is difficulty obtaining access to care for children with fractures nationally and compare our results to Skaggs et al’s published results of a national survey in 2006. 

Methods

Five orthopedic offices were identified in each state using an internet search with Google Maps by typing “general orthopedics” under the search heading for each state.  Each office was called with a private cell phone and the following script was used: “My ten 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.”  The office was then told the patient has Medicaid insurance.  If no appointment was given, the reason was recorded and the office was asked to refer us to another orthopedic surgeon.   A second phone call was made to the same office a few days later using the same script but the office was told the patient has a private PPO insurance.  If no appointment was given, the reason was recorded and the office was asked to refer us to another orthopedic surgeon. 

Results

58 out of 250 (23.2%) offices across the country would see a pediatric fracture patient with Medicaid.  38% (72/192) of the offices refusing the patient stated that they do not accept Medicaid patients.  205 out of 250 (82%) of the offices across the country would see a pediatric fracture patient with a private PPO insurance.  42% (23/45) of the offices refusing the patient could not schedule the patient within one week.  The 10 states with lowest Medicaid reimbursement offered an appointment 14% of the time and the 10 states with the best Medicaid reimbursement offered an appointment 28% of the time.   The same group of 10 lowest Medicaid reimbursement states offered an appointment to a PPO patient 76% of the time and the 10 best Medicaid reimbursement states offered an appointment 74% of the time.  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).  

Conclusion

The access to care for children with fractures is becoming more difficult across the country.  Compared to published data in 2006, the number of offices willing to see a child with private insurance has decreased from 92% to 82%.  The number of offices willing to see a child with a fracture and Medicaid insurance has decreased from 62% to 23% over the same time span.