Patients living in Massachusetts who receive Medicaid have limited access to reimbursable physical therapy after undergoing anterior cruciate ligament (ACL) reconstruction procedures, suggest researchers from Boston Medical Center.

Only slightly more than half of PT clinics in the metropolitan Boston area accept Medicaid, and patients with Medicaid insurance have to wait longer for their initial PT appointments compared to those with private insurance, the researchers add, in their study published in The Orthopaedic Journal of Sports Medicine.

“In our orthopaedic sports medicine clinic, we’ve heard firsthand from patients with Medicaid that it is increasingly difficult for them to find PT practices that accept their insurance,” says Xinning Li, MD, orthopaedic surgeon specializing in sports medicine and shoulder surgery at Boston Medical Center, in a media release.

“This results in Medicaid patients returning for follow-up or postoperative visits without having been able to do the prescribed PT treatment and exercises, which leads to delayed functional improvement and stiffness.”

Using Google, Yelp, and Yellow Pages Internet services, the researchers identified locations in the greater Boston area that offer PT services. Of the 139 practices that researchers made contact with, 96.4% took private insurance, while only 51.8% accepted Medicaid. Among locations that did not accept Medicaid, less than one-third were able to refer patients to a location that would accept Medicaid. “No contract” was the most common reason why Medicaid was not accepted (39.4%).

The average time to first appointment also differed significantly between privately insured patients and those with Medicaid—5.8 days verses 8.4. There was no difference between PT practice locations (town median income or poverty level) and insurance type accepted. Patients residing in lower income areas did not have improved access to PT facilities that would take Medicaid, and they may have to travel farther distances with limited resources to find a PT practice that would accept their insurance, the release continues.

“The faster, easier access to PT for privately insured individuals could be due to the difference in reimbursement rates between the two insurances, or because the physical therapy centers have limited spots available for patients with Medicaid,” says Li, who is also an associate professor of sports medicine and shoulder surgery at Boston University School of Medicine.

Li suggests that providers counsel Medicaid patients on how to establish a postoperative rehabilitation plan when initially preparing a patient for ACL surgery. Another possibility for such patients could be to establish a home-based exercise program.

“Our study shows a gap for some of our most vulnerable patients, and providers and insurers need to collaborate in order to address these barriers so that patients can more readily access the treatment and services necessary for their recovery,” Li notes.

[Source(s): Boston Medical Center, EurekAlert]