Studies from University of Colorado Yield New Data on Managed Care (Navigating the Orthopaedic Maze As a New Patient: a National Mystery Caller Study On Medicaid Coverage and Access To Specialized Surgeons): Managed Care

2025 FEB 13 (NewsRx) -- By a News Reporter-Staff News Editor at Sports Research Daily -- Investigators publish new report on Managed Care. According to news reporting out of Aurora, Colorado, by NewsRx editors, research stated, “Medicaid coverage is associated with longer appointment wait times, decreased access to care, and poorer health outcomes compared with private insurance across medical subspecialties. The purpose of this study was to evaluate new patient appointment wait times for subspecialty Orthopaedic care based on insurance type and to identify factors influencing these wait times.”

Our news journalists obtained a quote from the research from the University of Colorado, “Orthopaedic physicians were identified using the American Academy of Orthopaedic Surgeons patient-facing database in the fields of Adult Reconstruction, Foot and Ankle, Hand, Sports Medicine, Spine, Pediatric, and General Orthopaedic surgery. Mystery callers, posing as patients with either Medicaid or Blue Cross/Blue Shield (BCBS) insurance, contacted physicians to request the next available new patient appointment. The business days until the first available new patient appointment were recorded and analyzed using a linear mixed Poisson model. A total of 1,002 phone calls were made to 501 unique physicians in 47 states. Among the 349 physicians meeting inclusion criteria, 37% (n = 130) did not accept Medicaid. Medicaid patients experienced a 10% longer wait for a new patient appointment compared with patients with BCBS (incidence rate ratio: 1.10; CI: 1.05 to 1.15; P< 0.01) with mean wait times of 24.9 business days (SD +/- 24) and 19.6 business days (SD +/- 23), respectively. Increased waiting times were also associated with academic institutions (P < 0.01), prolonged call times (P < 0.01), and specific geographic regions (P < 0.05). Our model achieved an R-squared value of 0.94, demonstrating strong explanatory power. Patients with Medicaid experience longer wait times and decreased access to care when scheduling an appointment with an Orthopaedic surgeon compared with patients with private insurance. This may be due to reimbursement structures in Medicaid that do not cover the full cost of treatment.”

According to the news editors, the research concluded: “Aside from advocating for higher reimbursement rates, telehealth initiatives may help bridge this gap to ensure accessibility to orthopaedic surgery for all patients.”

This research has been peer-reviewed.

For more information on this research see: Navigating the Orthopaedic Maze As a New Patient: a National Mystery Caller Study On Medicaid Coverage and Access To Specialized Surgeons. Journal of the American Academy of Orthopaedic Surgeons, 2025;33(3). Journal of the American Academy of Orthopaedic Surgeons can be contacted at: Lippincott Williams & Wilkins, Two Commerce Sq, 2001 Market St, Philadelphia, PA 19103, USA.

Our news journalists report that additional information may be obtained by contacting Nicholas A. Felan, University of Colorado, Anschutz School of Medicine, Aurora, CO 80045, United States. Additional authors for this research include Elizabeth Garcia-Creighton, Ankit Hirpara, Isabella Narvaez, Ryan Tseng, Alessandra Santiago, Adam Miller, Alexis J. Batiste, Daniel J. Stokes, Benjamin R. Wharton, Eric C. Mccarty, Anthony Smyth, Nicholas R. Pulciano and Tyler M. Muffly.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.5435/jaaos-d-24-00668. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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