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21-10-2012 | Article

Orthopedists reject Medicaid-insured children with fractures

Abstract

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medwireNews: Less than a quarter of US orthopedic practices would agree to treat a child with a fracture if that child was insured by Medicaid, suggest study results.

When five orthopedic practices in each state were called by someone posing as the parent of a boy with a fractured, splinted arm, only 23.2% of the 250 practices agreed to see the child when told he was covered by Medicaid.

In contrast, 82% of the practices, given the identical scenario, agreed to treat the patient after being told that he was covered by a preferred-provider insurance plan (PPO), report Christopher Iobst and colleagues from Miami Children's Hospital and Herbert Wertheim College of Medicine in Florida.

A 2006 study, using the same methodology, showed that 62% of orthopedic offices said they would treat children on Medicaid.

The current study, presented at the annual meeting of the American Academy of Pediatrics, shows that even private insurance is no guarantee of treatment, Iobst commented.

"This paradigm shift has resulted in a greater number of children getting referred to pediatric tertiary care centers for their care, even for routine injuries," he said in a statement. This means that "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."

The investigators identified five general orthopedic practices in each state via an internet search, and called each from a private cell phone using 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."

The practices were then told that the child was covered by Medicaid, and if he was refused an appointment, the reason was recorded and the caller asked for a referral to another orthopedist. Offices refusing Medicaid patients were called again a few days later with the caller using the same script, but saying the child was covered by private insurance.

Practices in the 10 states with the lowest Medicaid reimbursement offered appointments to Medicaid-insured children only 14% of the time, compared with 28% in the 10 states with the highest reimbursement rates. The respective rates of appointments offered to PPO-insured patients were 76% and 74%.

In nine states (Connecticut, Illinois, Louisiana, New Jersey, North Carolina, Oklahoma, Rhode Island, South Dakota, and Texas), all five offices refused the purported Medicaid patient but accepted the alleged PPO patient.

By Neil Osterweil, medwireNews Reporter