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Musculoskeletal urgent care centers in Connecticut restrict Medicaid patients based on policy and location

September 18, 2019
by Matt O'Rourke

Some urgent care centers in Connecticut deny patients on Medicaid access to musculoskeletal care, a new Yale study finds.

Researchers in the Department of Orthopaedics and Rehabilitation found that some urgent care centers in the state are restricting access to care based on the types of insurance policies patients carry. A team called 29 different orthopedic specific urgent care centers, which are designed to be quicker alternatives to hospital emergency departments, and found that only four accepted patients regardless of their insurance. Nineteen centers – 66 percent – did not accept any form of Medicaid. Six others required that Medicaid patients met specific prerequisites before allowing them to be seen by a physician like only permitting patients an initial visit before referring them to a larger area hospital.

In total, only four centers – 13 percent – accepted patients regardless of their insurance type.

The study, published in the online August issue Clinical Orthopaedics and Related Research, states that the restrictions to care could further exacerbate disparities in healthcare when it pertains to musculoskeletal problems.

“We found strong evidence to suggest that musculoskeletal urgent care centers in Connecticut decline to treat patients with Medicaid,” researchers wrote. “This corroborates the findings of other studies demonstrating that Medicaid-insured patients have more difficulty obtaining access to orthopaedic care.”

The researchers, which included Assistant Professor Daniel H. Wiznia, MD, Professor Mary O’Connor, MD, and lead author, second-year resident Christopher A. Schneble, MD, used a team to ask standardized questions for each care center in the state. Centers were selected based on whether they offered orthopaedic services. The team used Google to search for the clinics utilizing a list of common orthopaedic conditions and terms that potential patients may enter when trying to locate a care center. Fourteen different private practices owned all 29 of the clinics.

“All of the musculoskeletal urgent care centers were co-located in a private practice clinic and had similar or more restrictive policies towards patients with Medicaid insurance,” they wrote. “These centers have great potential to reduce costs to the healthcare system, improve healthcare delivery, and reduce healthcare disparities. Unfortunately, when patients with Medicaid insurance are excluded from receiving care at musculoskeletal urgent care centers, their alternative is to present to the emergency department or forego care.”

Health care disparities are real and this is an example of structural bias in the system promoting such disparities.

Mary O'Connor, MD.

Dr. Wiznia said that “cherry-picking patients leads to systematic healthcare disparities.”

“These privately run orthopedic urgent care centers are selecting the well insured patients,” Dr. Wiznia said. “Medicaid patients may find that they only have access to orthopedic urgent care through public and non-profit safety net hospitals. These community institutions are financially harmed by this practice.”

Dr. O’Connor, who has also been engaged in issues surrounding health inequities through the Movement is Life coalition, concurred. “Health care disparities are real and this is an example of structural bias in the system promoting such disparities,” Dr. O’Connor said.

Their research also suggested that centers located in more affluent communities were more likely not to accept Medicaid patients at all. Conversely, those communities were also more likely to have urgent care centers that offered orthopaedic services.

They also noted that the findings focused solely on Connecticut and may not have broader implications nationally. Connecticut has low Medicaid reimbursement rates compared to other states, while also allowing both for-profit and non-profit clinics to operate in the state.

“Patients who live in medically underserved areas have higher odds of preventable emergency department use, and the effective placement of musculoskeletal urgent care centers may decrease orthopaedic emergency department admissions for issues that do not require admission,” researchers wrote. “Despite being located in more affluent areas and restricting patients with Medicaid insurance, these musculoskeletal urgent care centers provided substantial benefit to those who were able to use them and presumably provided increased access to affordable care.”

Submitted by Matt O'Rourke on September 18, 2019