Barriers to Care for Total Joint Arthroplasty Patients With Medicaid Insurance: A Survey Study of the Surgeon Perspective.

Background: The purpose of this study was to assess the demographic characteristics of orthopaedic surgeons in Louisiana taking care of patients with Medicaid insurance and to assess any perceived barriers to care, with a focus on total joint arthroplasty (TJA). Methods: An electronic survey was distributed to all practicing surgeon members of the Louisiana Orthopaedic Association with questions about practice type, subspecialty, demographics, estimated percentage of Medicaid patient volume, and perceived barriers to care. Responses were collected using a secure database, and statistical analysis was performed. Results: The 114 respondents were mostly male (95.6%), white (87.7%), and in private practice (61.4%). Most respondents (73.8%) did not accept Medicaid insurance (22.8%) or took care of <25% patients with Medicaid (50.9%). Fifty-eight respondents (50.9%) reported performing TJA. The majority of surgeons performing TJA (76.6% total hip arthroplasty [THA], 93.7% total knee arthroplasty [TKA]) either did not accept Medicaid insurance (36.2% THA, 47.3% TKA) or performed less than 25% of their TJA volume on patients with Medicaid insurance (40.4% THA, 36.4% TKA). The most commonly reported perceived barriers to care were lower physician and facility reimbursement, and difficulty referring to ancillary services. Surgeons in academic practice were significantly more likely to take care of a higher percentage of patients with Medicaid insurance ( Conclusions: Most orthopaedic surgeons performing TJA in Louisiana either do not accept or perform a relatively small percentage of their practice volume on patients with Medicaid insurance. Low physician and facility reimbursement rates and difficulty referring to ancillary services were perceived as the greatest barriers to caring for these patients.