Utilization of In-Hospital Orthopaedic Spine Consultations: Evaluating the Impact of Health Care Policy.

Authors

• Parker L Brush
• Alexa Tomlak
• Nick Pohl
• Yunsoo Lee
• Rajkishen Narayanan
• Matthew H Meade
• Mark J Lambrechts
• Charles L Lawall
• Jackson Weber
• Amit Syal
• Patrick O'Connor
• Jose A Canseco
• I David Kaye
• Mark F Kurd
• Alexander R Vaccaro
• Chris K Kepler
• Alan S Hilibrand
• Gregory D Schroeder

Publication/Presentation Date

11-1-2023

Abstract

Access to specialty and private practice providers has been a divisive policy issue over the last decade, complicated by the conflict between a reduction in government-funded health care reimbursement and the need for health care providers to sustain a financially sound practice. This study evaluates the orthopedic spine consult service at an academic tertiary care center at 2 separate time points over a 5-year period to better understand the impact of decreasing orthopedic reimbursement rates and the increasing prevalence of federally supported medical insurance on the access to specialty care. In total 500 patients in 2017 and 480 patients in 2021 were included for the final analysis. A higher percentage of consults in 2021 came from the emergency department (74.0% versus 60.4%, P < 0.001); however, the emergency department saw fewer spinal cord injuries (11.9% versus 21.4%, P < 0.001), and the spinal cord injuries were less severe (3.1% versus 6.2% Association Impairment Scale A or B, P = 0.034). A smaller percentage of patients in 2021 went on to receive orthopedic spine surgery following consultation (35.2% versus 43.8%, P = 0.007), and those receiving surgery had an operation performed farther out from the initial consultation (4.73 versus 4.09 days, P < 0.001). Additionally, fewer patients with Medicare insurance (23.5% versus 30.8%) and more patients with Medicaid insurance (20.2% versus 12.4%) were seen in 2021 compared with 2017 (P = 0.003). Overall, this study found an increased proportion of Medicaid patients seen by the spine consult service but a decrease in the acuity of consults. Measures to improve access to health insurance under the Affordable Care Act have revealed the complexity of this issue in health care. This study's findings have demonstrated that while more patients did have insurance coverage following the Affordable Care Act, they still face a barrier to accessing outpatient orthopedic spine providers.

Volume

38

Issue

6

First Page

300

Last Page

305

ISSN

1555-824X

Published In/Presented At

Brush, P. L., Tomlak, A., Pohl, N., Lee, Y., Narayanan, R., Meade, M. H., Lambrechts, M. J., Lawall, C. L., Weber, J., Syal, A., O'Connor, P., Canseco, J. A., Kaye, I. D., Kurd, M. F., Vaccaro, A. R., Kepler, C. K., Hilibrand, A. S., & Schroeder, G. D. (2023). Utilization of In-Hospital Orthopaedic Spine Consultations: Evaluating the Impact of Health Care Policy. American journal of medical quality : the official journal of the American College of Medical Quality, 38(6), 300–305. https://doi.org/10.1097/JMQ.0000000000000155

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

37908033

Department(s)

Administration and Leadership

Document Type

Article