ER Becomes Only Option for Medicaid, Uninsured

HOUSTON, Jan. 13 -- The Baylor College of Medicine issued the following news release:

The Emergency Medical Treatment and Active Labor Act is a federal law that ensures care to any patient who goes to an emergency department (ED) that accepts Medicare funding, regardless of their ability to pay. However, availability of follow-up orthopedic care to these patients is not guaranteed, and it often depends on the insurance status of the patient.

In a paper by Baylor College of Medicine researchers published recently by the Society for Academic Emergency Medicine, appointment price and availability of ED follow-up orthopedic care are compared across three different insurance statuses: privately insured, uninsured and Medicaid. The findings show that only 14 percent of Medicaid patients were able to make an orthopedic follow-up appointment for a broken ankle, and while uninsured patients were able to schedule follow-up at the same rates as privately insured, they needed to pay an average of $350 up-front in order to be seen.

The study, led by Dr. Laura Medford-Davis, assistant professor in the Department of Emergency Medicine at Baylor College of Medicine, aimed to demonstrate the barriers in access to follow-up care for uninsured and Medicaid patients.

"Broken ankles require casting and oftentimes surgery after initial emergency care, making follow-up care critical for these patients to heal correctly," said Medford-Davis. "Delaying care due to limited appointment availability, or forgoing care all together due to high costs, can lead to improper healing and long-term disability."

Researchers posing as patients called the same 102 eligible general orthopedic practices twice, using a standard script, asking to schedule a follow-up appointment for a broken ankle diagnosed in a local ED. They made one call acting as an uninsured patient and another call acting either as a privately insured patient or a Medicaid patient.

The outcomes Medford-Davis and her team were most interested in were appointment availability and appointment price for the uninsured, as well as wait time between the day the call was placed and the next available appointment date for practices that offered an appointment to both callers.

Privately insured vs. uninsured

While all 102 orthopedic practices received an uninsured call, 59 received a privately insured call. In this test, the success rate of getting an appointment was 83.1 percent for privately insured and 81.4 percent for uninsured callers. The average wait time for an appointment once the call was made was three days for privately insured and two days for uninsured patients.

All uninsured callers who were scheduled for an appointment were asked by the practice to bring upfront payment to the appointment, with the average price for an appointment falling at $353.74. Only two uninsured callers were able to secure an appointment for $100 or less up front.

Medicaid vs. uninsured

Of the 102 practices that received an uninsured call, 43 also received a Medicaid call. Of these 43 callers, only 14 percent (three callers) were offered an appointment, which means an uninsured caller was 5.7 times more likely to secure an appointment than a Medicaid caller. Many of these Medicaid callers were told their insurance was not accepted by the practice, including by practices that were listed on the Medicaid website as accepting new Medicaid patients. The average wait time for those practices that did offer the Medicaid caller an appointment was five days.

Looking for alternatives

With the price for an appointment being cost-prohibitive for many uninsured patients, and Medicaid patients unable to find orthopedists that accept their insurance, these patients have limited options. Forty-nine of the uninsured callers were directed to local public hospital EDs, and the rest were given no alternative by the practice. Only one of the Medicaid callers was directed to the local public hospital, with most of these callers receiving no additional direction from the practice.

"For Medicaid and uninsured patients seeking follow-up orthopedic care, the county ED becomes the only option. Increasing access to care requires policy change, such as increasing the reimbursement to physicians for Medicaid patients," said Medford-Davis.

30TagarumaMar-5746267 30TagarumaMar