INFLUENCE OF MEDICAL INSURANCE UNDER THE AFFORDABLE CARE ACT ON ACCESS TO PAIN MANAGEMENT

Background: The Affordable Care Act intended to “extend affordable coverage” and “ensure access” for vulnerable patient populations. Therefore, this investigation examined whether the type of insurance (Medicaid, Medicare, BlueCross, cash pay) carried by trauma patients influences access to pain management specialty care. The study was designed to identify barriers that patients experience as well as determine if Medicaid reimbursement rates are responsible for the decreased likelihood of Medicaid patients from securing office visits. The hypothesis was that patients with Medicaid insurance coverage would have reduced access to medical care by pain management specialists, even despite the passage of the PPACA. Methods: Investigators phoned 443 randomly selected board certified pain specialists, securing office visits with 235 pain physicians from eight different states: four with expanded Medicaid eligibility, and four without expanded Medicaid eligibility. Appointments for pain management were for a fictitious patient that sustained an ankle fracture requiring surgery and experiencing difficulty weaning off opioids. Offices enrolled were phoned four times assessing responses to the four different payment methodologies. Results: 53% of pain specialists contacted (235 of 443) were willing to see new patients to manage pain medication. Within the 53% of positive responses, 7.2% of physicians scheduled appointments for Medicaid patients, compared to 26.8% for cash paying patients, 39.6% for those with Medicare, and 41.3% with BlueCross (p < 0.0001). There were no differences in appointment access between states that had expanded Medicaid eligibility for low-income adults versus states that had not expanded Medicaid eligibility. Neither Medicaid nor Medicare reimbursement levels for new patient visits correlated with ability to schedule an appointment or influenced wait times. Conclusions: Access to pain specialists for management of pain medication in the postoperative trauma patient proved challenging. Despite the Affordable Care Act, Medicaid patients still experienced curtailed access to pain specialists and confronted the highest incidence of barriers to receiving appointments.