title: The Effect of Insurance Type on Patient Access to Carpal Tunnel Release Under the Affordable Care Act.
abstract: OBJECTIVE
  To assess the effect of insurance type (Medicaid, Medicare, and private insurance) on access to hand surgeons for carpal tunnel syndrome (CTS).
  
  
  METHODS
  The research team called 240 hand surgeons in 8 states (California, Massachusetts, Ohio, New York, Florida, Georgia, Texas, and North Carolina). The caller requested an appointment for her fictitious mother to be evaluated for CTS and possible surgical management through carpal tunnel release (CTR). Each office was called 3 times to assess the responses for Medicaid, Medicare, or Blue Cross Blue Shield. From each call, we recorded whether an appointment was given and whether there were barriers to an appointment, such as the need for a referral.
  
  
  RESULTS
  Twenty percent of offices scheduled an appointment for a patient with Medicaid, compared with 89% for Medicare and 97% for Blue Cross Blue Shield. Patients with Medicaid had an easier time scheduling appointments (28% vs 13%) and experienced fewer requests for referrals (25% vs 67%) in states with expanded Medicaid eligibility. Neither Medicaid nor Medicare reimbursement for CTR was significantly correlated with the incidence of successful appointments. Although the difference in Medicaid and Medicare reimbursements for CTR was small, the appointment success incidence for Medicare was approximately 5 times higher.
  
  
  CONCLUSIONS
  Despite the passage of the Affordable Care Act, patients with Medicaid have reduced access to surgical care for CTS and more complex barriers to receiving an appointment. Although Medicaid was accepted at a higher rate in states with expanded Medicaid eligibility, a more robust strategy for increasing access to care may be helpful for patients with Medicaid.
  
  
  METHODS
  Prognostic II.
authors.affiliation: Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT.
authors.forename: Chang-Yeon
authors.initials: CY
authors.lastname: Kim
authors.affiliation: Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Wiznia
authors.affiliation: Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT.
authors.forename: Yuexin
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT.
authors.forename: Ameya V
authors.initials: AV
authors.lastname: Save
authors.affiliation: Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT.
authors.forename: Nidharshan S
authors.initials: NS
authors.lastname: Anandasivam
authors.affiliation: Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT. Electronic address: carrie.swigart@yale.edu.
authors.forename: Carrie R
authors.initials: CR
authors.lastname: Swigart
authors.affiliation: Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT.
authors.forename: Richard R
authors.initials: RR
authors.lastname: Pelker
mesh_terms: D001071:Appointments and Schedules; D002349:Carpal Tunnel Syndrome / Q000601:surgery*; D017558:Elective Surgical Procedures; D006297:Health Services Accessibility; D006801:Humans; D019458:Insurance Coverage; D007349:Insurance, Health, Reimbursement; D008484:Medicaid; D006278:Medicare; D058991:Patient Protection and Affordable Care Act; D012017:Referral and Consultation; D014481:United States
keywords: Affordable Care Act; Medicaid; access to care; carpal tunnel surgery; hand specialty care