Assessing Medicaid Accessibility to Total Knee Arthroplasty: Comparison of Ambulatory Surgery Centers and Hospitals.

Abstract

Ambulatory surgery centers (ASCs) are increasingly becoming the preferred setting for elective orthopaedic procedures, including total knee arthroplasty (TKA). The ASC's favorable cost containment, reimbursements, and patient outcomes have driven their growth, but access to the Medicaid population remains an issue. This study aimed to evaluate these barriers for patients seeking TKA at ASCs compared to public hospitals using a cross-sectional survey design. All current ASCs registered within the United States were queried, and ASCs offering orthopaedic surgery services were isolated. Trained researchers contacted ASCs and public hospitals using a standardized inquiry script. Key data points included Medicaid acceptance, appointment availability, and out-of-pocket costs. Data were analyzed utilizing Chi-square and Student's t-tests. A total of 98 ASCs and 98 matched public hospitals were contacted for the study (Vermont and South Dakota had one ASC meeting initial criteria), with 77 ASCs and 94 public hospitals having complete data for analyses. Public hospitals demonstrated greater Medicaid acceptance compared to ASCs (95 versus 78%, P = 0.002). Both ASCs and public hospitals offered similar appointment availability (14.4 versus 19.1 days, P = 0.258). There were no differences between ASC and hospital out-of-pocket consultation ($470 versus $200, P = 0.483) or procedure costs ($199,167 versus $28,000, P = 0.317); however, only one public hospital and six ASCs provided cost information. Although ASCs and public hospitals offer comparable appointment availability for elective TKA procedures, ASCs provide much lower Medicaid acceptance rates. Despite the benefits of ASCs, barriers for Medicaid patients persist, highlighting the need for targeted strategies to enhance access to specialized orthopaedic care in the ambulatory setting.