National Disparities in Access to Physical Therapy After Rotator Cuff Repair Between Patients with Medicaid versus Private Health Insurance

Abstract Introduction Arthroscopic rotator cuff repair (RCR) is an effective treatment for patients with symptomatic rotator cuff tears. Ensuring timely and appropriate postoperative access to physical therapy (PT) is paramount to the achievement of optimal patient outcomes. Extended immobility due to a lack of formal rehabilitation can lead to decreased range of motion, continued pain and potential reoperation for stiffness. The purpose of this study is to evaluate national disparities in access to PT services following RCR between patients with private versus Medicaid insurance. This study will further evaluate differences in access to PT services between states that have previously undergone Medicaid expansion as compared to those states which have not. Methods The American Physical Therapy Association (APTA) website was used to identify 10 physical therapy practices from the capital city in every state. Each physical therapy practice was contacted using a mock-patient script for a patient with Medicaid Insurance or Private (Blue Cross BlueShield) insurance. To maintain anonymity, calls were made by two separate investigators. Univariate analysis included independent sample t-test for differences between the study groups for continuous variables. Chi-square or Fisher's exact test assessed differences in discrete variables between the study groups. Results Contact was made 465 out of 510 (91.2%) physical therapy practices. Overall, 52.7% accepted Medicaid insurance while 94.9% accepted Private insurance (p Conclusion Significantly fewer PT practices accepted Medicaid insurance nationally compared to private insurance, which suggests that patients with Medicaid insurance have greater difficulty accessing PT after RCR in the US compared to patients with private insurance. While Medicaid insurance was more likely to be accepted in a Medicaid expansion state, this finding was only borderline significant, which indicates that patients in Medicaid expansion states are still having difficulty accessing PT despite efforts to expand government insurance coverage to improve access to care. Orthopedic surgeons should counsel their patients with Medicaid insurance to seek out PT as early as possible in the postoperative period to avoid delays in rehabilitation. Level of Evidence Survey Study; Other;