title: Survey of Patient Insurance Status on Access to Specialty Foot and Ankle Care Under the Affordable Care Act.
abstract: BACKGROUND
  The purpose of this study was to assess the effect of insurance type (Medicaid, Medicare, and private insurance) on access to foot and ankle surgeons for total ankle arthroplasty.
  
  
  METHODS
  We called 240 foot and ankle surgeons who performed total ankle arthroplasty in 8 representative states (California, Massachusetts, Ohio, New York, Florida, Georgia, Texas, and North Carolina). The caller requested an appointment for a fictitious patient to be evaluated for a total ankle arthroplasty. Each office was called 3 times to assess the responses for Medicaid, Medicare, and BlueCross. From each call, we recorded appointment success or failure and any barriers to an appointment, such as need for a referral.
  
  
  RESULTS
  Patients with Medicaid were less likely to receive an appointment compared to patients with Medicare (19.8% vs 92.0%, P < .0001) or BlueCross (19.8% vs 90.4%, P < .0001) and experienced more requests for referrals compared to patients with Medicare (41.9% vs 1.6%, P < .0001) or BlueCross (41.9% vs 4%, P < .0001). Waiting periods were longer for patients with Medicaid compared to those with Medicare (22.6 days vs 11.7 days, P = .004) or BlueCross (22.6 days vs 10.7 days, P = .001). Reimbursement rates did not correlate with appointment success rate or waiting period.
  
  
  CONCLUSIONS
  Despite the passage of the PPACA, patients with Medicaid continue to have difficulty finding a surgeon who will provide care, increased need for a primary care referral, and longer waiting periods for appointments.
  
  
  METHODS
  Level II, prognostic study.
authors.affiliation: Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, CT 06510, USA.
authors.forename: Chang-Yeon
authors.initials: CY
authors.lastname: Kim
authors.affiliation: Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, CT 06510, USA.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Wiznia
authors.affiliation: Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, CT 06510, USA.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Roth
authors.affiliation: Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, CT 06510, USA raymond.walls@yale.edu.
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Walls
authors.affiliation: Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, CT 06510, USA.
authors.forename: Richard R
authors.initials: RR
authors.lastname: Pelker
mesh_terms: D000843:Ankle Joint / Q000503:physiopathology / Q000601:surgery*; D001178:Arthroplasty / Q000191:economics / Q000379:methods*; D006297:Health Services Accessibility / Q000191:economics*; D019458:Insurance Coverage / Q000191:economics*; D008484:Medicaid; D006278:Medicare; D058991:Patient Protection and Affordable Care Act / Q000191:economics*; D014481:United States
keywords: Affordable Care Act; Medicaid; access to care; foot and ankle care; total ankle arthroplasty