CORR Insights®: Musculoskeletal Urgent Care Centers in Connecticut Restrict Patients with Medicaid Insurance Based on Policy and Location.

The United States continues to struggle with its ability to provide health care for all of its residents and citizens. Healthcare costs for the government, employers, and individuals continue to rise quickly. Because medical care, drugs, and medical supplies generally are provided on a for-profit basis, it has been difficult to find efficiencies. As there is no universal coverage in the United States, individual coverage is necessary, and providing this for those who cannot afford it has been a real challenge. Enacted in 2010, the Patient Protection and Affordable Care Act (sometimes called Obamacare) sought to provide care for more of the US population. Much of this new coverage has occurred through Medicaid expansion, by extending Medicaid eligibility to individuals with annual incomes below 133 percent of the federal poverty level (USD 15,880 for an individual or USD 32,319 for a family of four in 2016) who are under 65 years of age [3, 8]. In June 2012, the Supreme Court ruled to make Medicaid expansion voluntary for states. Most but not all states have expanded their Medicaid program. While this coverage now includes more people, it has not been a panacea; reimbursement for providers is low, and there is considerable administrative burden [4]. As a result, while more lives are covered, actual access to care may not be increased as providers are not as likely to see and treat patients with Medicaid coverage as they are patients with commercial insurance. Increased coverage does not necessarily lead to increased access to care. A relatively new concept in the provision of musculoskeletal care is the musculoskeletal urgent care center which, of course is of interest to orthopaedic surgeons. Will these centers help to increase access to care and result in efficiencies that benefit all? Wiznia and colleagues [10] interviewed owners of musculoskeletal urgent care centers throughout Connecticut. They found that most musculoskeletal urgent care centers in Connecticut do not accept patients with Medicaid insurance and have similar or stricter Medicaid policies to those of the groups that own them. Additionally, musculoskeletal urgent care centers generally were located in more-affluent neighborhoods. The authors felt that private practices are using musculoskeletal urgent care centers to capture patients with more favorable insurance. A major causative factor seems to be the relatively low Medicaid reimbursement rates in Connecticut (as well as other states). At first glance, musculoskeletal urgent care centers appear to offer marked benefits compared to services offered at primary care offices and emergency rooms in the provision of acute care for musculoskeletal conditions. These include shorter patient wait times, potentially increased patient satisfaction and more cost-effective and specialized care [1, 7]. While urgent care centers have This CORR Insights is a commentary on the article “Musculoskeletal Urgent Care Centers in Connecticut Restrict Patients with Medicaid Insurance Based on Policy and Location” by Wiznia and colleagues available at: DOI: 10.1097/CORR.0000000000000957. The author certifies that neither he, nor any members of his immediate family, have any commercial associations (such as consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR or The Association of Bone and Joint Surgeons. R. D. Blasier MD, FRCS(C), MBA (✉), Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 W. Markham, Little Rock AR 72205, Email: blasierrobertd@uams.edu