The number of orthopedic practices willing to treat a child with a broken bone who is covered by Medicaid dropped from 62% in 2006 to just 23% today,, Dr. Christopher Lobst, announced at the American Academy of Pediatrics (AAP) National Conference and Exhibition in New Orleans yesterday.

Dr. Lobst added that even privately insured children may find it harder to get a timely appointment with an orthopedic surgeon these days.

In the Abstract, titled “National Access to Pediatric Fracture Care,” the researchers identified five orthopedic practices in each state. Each practice’s office was telephoned, using a cellphone with the following request “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 the 250 practices that were telephone:

  • Only 58 (23.2%) agreed to arrange an appointment for a child Medicaid patient with a fracture

  • Of the practices that turned down a request for an appointment, 38% simply said they do not accept Medicaid patients
  • Among the 10 states with the lowest Medicaid reimbursement rates, only 6% offered an appointment

    Among these 10 lowest reimbursement rate states, 88% offered an appointment to a patient with private PPO insurance

  • Among the 10 states with the highest Medicaid reimbursement rates, 44% offered an appointment

    Among these highest reimbursement rate states, 82% offered an appointment to a patient with private PPO insurance

  • Across the whole nation, 82% of orthopedic offices offered to see a patient with private PPO insurance

  • In the following states, all the offices refused to make an appointment to a Medicaid patient, but were happy to see PPO patients: Texas, Connecticut, South Dakota, Illinois, Rhode Island, Louisiana, New Jersey, Oklahoma, and North Carolina.

  • In 2006, ninety-two percent of practices were willing to see a child with private insurance, this figure dropped to 82% in 2012.
    • 62% of practices were willing to see a Medicaid child patients with a fracture in 2006, compared to just 23% today

Study author, Christopher Iobst, MD, explained that the low Medicaid reimbursement rates are probably the main reason practices refuse to see Medicaid patients.

Lobst added:

“Underinsured children continue to have difficulty accessing care for their fractures. Patients with private insurance are also being turned away at an increasing rate” for a variety of reasons. Forty-six percent of the offices contacted in the study were unable to refer the family to an orthopedist who would take care of the child.

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. (While receiving care at these centers is beneficial) 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.”

Written by Christian Nordqvist