Impact of Medicaid, Medicare, and Private Insurance on Access to Orthopaedic Surgeons of the Spine: A National Mystery Caller Study.

Abstract

Patients with Medicaid often experience reduced access to specialty care compared to those with Medicare or private insurance. Previous studies have assessed Medicaid acceptance in orthopaedic specialties; however, national-level data on access to spine surgery across different insurance types remain limited. To evaluate how insurance type-Medicaid, Medicare, and Blue Cross/Blue Shield (BCBS)-impacts access to fellowship-trained orthopaedic spine surgeons and appointment wait times. Cross-sectional audit (mystery caller) study. Fellowship-trained orthopaedic spine surgeons listed in the American Academy of Orthopaedic Surgeons public directory. The primary outcomes were insurance acceptance and the number of business days until the earliest new patient appointment. Secondary measures included total call time, hold time, and number of phone transfers. From December 9-13, 2024, trained callers contacted 304 orthopaedic spine surgeon offices across 45 states using a standardized clinical vignette. Each office was called three times-once for Medicaid, once for Medicare, and once for Blue Cross/Blue Shield (BCBS)-in a randomized order, resulting in a total of 912 calls placed. Poisson mixed-effects regression was used to estimate the association between insurance type and wait times, adjusting for physician and practice characteristics. Of 304 physicians called, 192 were successfully contacted and met the inclusion criteria. Among eligible practices, 101 (52%) accepted Medicaid, 182 (95%) accepted Medicare, and 190 (99%) accepted BCBS insurance. If a physician accepted Medicaid insurance, the mean wait time for a new patient appointment was 26.6 business days (95% CI: 25.6-27.6). Patients with Medicare or BCBS insurance waited 23.1 (95% CI: 22.4-23.8) and 22.1 (95% CI: 21.5-22.7) business days for a new patient appointment, which was significantly fewer days than patients with Medicaid (IRR: 0.90 [95% CI: 0.83-0.98], p=0.01; IRR: 0.88 [95% CI: 0.81-0.94], p<0.01, respectively). Additionally, academic affiliation was associated with a 124% longer wait time (IRR: 2.24 [95% CI: 1.25-4.03], p<0.01). Patients with Medicaid experienced decreased access to care and longer wait times for a new patient appointment when seeking care with an orthopaedic spine surgeon compared to patients with Medicare or BCBS insurance. Additionally, academic practice affiliation was associated with the most significant increase in wait time for a new patient appointment. The present findings highlight a critical disparity in care faced by an already vulnerable patient population and further emphasize the need for additional research to implement novel solutions.