The effect of Medicare coverage on access to bunionectomies among the elderly population: A secret shopper study

Authors

  • Luis Rodriguez Anaya, DPM Associate Professor at Barry University School of Podiatric Medicine, HCA Florida Mercy Hospital, Miami, Florida, USA
  • Patricia Toledo Barry University School of Podiatric Medicine, Miami, Florida, USA
  • Juan C. Alvarez Jr. B.S. Herbert Wertheim College of Medicine at Florida International University, Miami, Florida, USA
  • Andrea Delgado Barry University School of Podiatric Medicine, Miami, Florida, USA
  • Malachi Brown Barry University School of Podiatric Medicine, Miami, Florida, USA
  • Hansel Viera Barry University School of Podiatric Medicine, Miami, Florida, USA

DOI:

https://doi.org/10.55067/jifaf.v2i12.75

Keywords:

bunion, bunionectomy, HMO, PPO, Medicare Advantage, Medicaid, insurance, hallux valgus

Abstract

Hallux Valgus (HV) deformity, commonly known as a bunion, is a prevalent foot condition and a highly performed procedure across various insurance demographics. With the continuous growth of the Medicare population and its working share, the financial burden of incapacitating injuries like HV becomes more significant. Given the substantial proportion of bunionectomy surgeries performed on Medicare beneficiaries, it is imperative to explore how a significant shift from Traditional Medicare (TM) to Medicare Advantage (MA) coverage might impact patient access to bunionectomy surgeries. This study aims to evaluate the effect of Medicare type on patient access to bunionectomy procedures within Miami-Dade County, where the population is predominantly enrolled in Medicare and Medicare Advantage plans. The research seeks to understand potential differences in access to care, as disparities in access to podiatric care. The findings of this research will shed light on whether Medicare Advantage beneficiaries have greater access to bunionectomy procedures compared to Traditional Medicare beneficiaries in Miami-Dade County. By understanding the impact of Medicare type on access to care, policymakers, healthcare providers, and insurance companies can make informed decisions to improve patient outcomes and address potential disparities in healthcare access. The implications of this study are of great importance, considering the prevalence of HV and the rising Medicare population. Enhancing access to bunionectomy surgeries for Medicare beneficiaries can alleviate the financial burden on patients and the healthcare system and improve health outcomes in Miami-Dade County. Of the 100 clinics, 50 (50 %) accepted new patients for HV deformity evaluation, although only 31 (31%) had podiatric specialists currently performing bunionectomy surgeries. Traditional Medicare (TM) had the highest appointment success rate of 96.67%, and commercial coverage was comparable at 93.33% (p = .55). Our study found that patients in Miami-Dade County with Medicare Advantage (MA) have decreased access to Hallux Valgus deformity correction surgery (bunionectomy) compared to those with Traditional Medicare or commercial insurance; this could be a potential reason for lower rates of bunionectomy utilization in the MA population.

References

Coughlin MJ. Hallux valgus. J Bone Joint Surg Am. 1996.

Nix S, Smith M, Vicenzino B. Prevalence of hallux valgus in the general population: a systematic review and meta-analysis. J Foot Ankle Res. 2010 Sep 27;3:21. doi: 10.1186/1757-1146-3-21. PMID: 20868524; PMCID: PMC2955707.

Belatti DA, Phisitkul P. Economic burden of foot and ankle surgery in the US Medicare population. Foot Ankle Int. 2014;35(4):334-340

Sutherland JM, Mok J, Liu G, et al. Cost-Utility Study of the Economics of Bunion Correction Surgery. Foot & Ankle International. 2019;40(3):336-342. doi:10.1177/1071100718815663

Yeung K, Dorsey, CN, Mettert, K. Effect of new Medicare enrollment on health, healthcare utilization, and cost: A scoping review. J Am Geriatr Soc. 2021; 69: 2335– 2343. https://doi.org/10.1111/jgs.17113

Neuman P, Jacobson GA. Medicare Advantage Checkup. New England Journal of Medicine. 2018;379(22):2163-2172. doi:10.1056/nejmhpr1804089

Kingsdale J. Medicare Advantage for Most. Vol 99.; 2021.

Baker LC, Bundorf MK, Devlin AM, Kessler DP. Medicare advantage plans pay hospitals less than traditional medicare pays. Health Affairs. 2016;35(8):1444-1451. doi:10.1377/hlthaff.2015.1553

Trish E, Ginsburg P, Gascue L, Joyce G. Physician reimbursement in medicare advantage compared with traditional medicare and commercial health insurance. JAMA Internal Medicine. 2017;177(9):1287-1295. doi:10.1001/jamainternmed.2017.2679

Keenan PS, Elliott MN, Cleary PD, Zaslavsky AM, Landon BE. Quality Assessments by Sick and Healthy Beneficiaries in Traditional Medicare and Medicare Managed Care. Med Care. 2009;47:882-888.

Henke RM, Karaca Z, Gibson TB, et al. Medicare Advantage and Traditional Medicare Hospitalization Intensity and Readmissions. Medical Care Research and Review. 2018;75(4):434-453. doi:10.1177/1077558717692103

Panagiotou OA, Kumar A, Gutman R, et al. Hospital readmission rates in Medicare advantage and traditional Medicare a retrospective population-based analysis. Annals of Internal Medicine. 2019;171(2):99-106. doi:10.7326/M18-1795

Jung DH, DuGoff E, Smith M, Palta M, Gilmore-Bykovskyi A, Mullahy J. Likelihood of hospital readmission in Medicare Advantage and Fee-For-Service within same hospital. Health Services Research. 2020;55(4):587-595. doi:10.1111/1475-6773.13315

CMS Program Statistics. Total Medicare Enrollment: Total, Original Medicare, and Medicare Advantage and Other Health Plan Enrollment and Resident Population, by Area of Residence, Calendar Year 2019.

AHIP. Medicare Advantage Demographics Report, 2016.; 2019. www.ahip.org

Freed M, Damico A, Neuman T. A Dozen Facts About Medicare Advantage in 2020. KFF. Published online January 13, 2021. doi:10.1056/nejmhpr1804089

Jacobson G, Cicchiello A, Sutton JP, Shah A. Medicare Advantage vs. Traditional Medicare: How Do Beneficiaries’ Characteristics and Experiences Differ? Commonwealth Fund. Published online October 2021. doi:10.26099/yxq0-1w42

Kingsdale J. Medicare Advantage for Most. Vol 99.; 2021.

Landon BE, Zaslavsky AM, Saunders RC, Gregory Pawlson L, Newhouse JP, Ayanian JZ. Analysis of medicare advantage HMOs compared with traditional medicare shows lower use of many services during 2003-09. Health Affairs. 2012;31(12):2609-2617. doi:10.1377/hlthaff.2012.0179

Jacobson G, Cicchiello A, Sutton JP, Shah A. Medicare Advantage vs. Traditional Medicare: How Do Beneficiaries’ Characteristics and Experiences Differ? Commonwealth Fund. Published online October 2021. doi:10.26099/yxq0-1w42

Berenson RA, Sunshine JH, Helms D, Lawton E. Why medicare advantage plans pay hospitals traditional medicare prices. Health Affairs. 2015;34(8):1289-1295. doi:10.1377/hlthaff.2014.1427

Lavernia CJ, Contreras JS, Alcerro JC. Access to Arthroplasty in South Florida. The Journal of Arthroplasty. 2012;27(9).

Downloads

Published

2023-12-01

How to Cite

1.
Rodriguez Anaya L, Toledo P, Alvarez Jr. JC, Delgado A, Brown M, Viera H. The effect of Medicare coverage on access to bunionectomies among the elderly population: A secret shopper study. J Int Foot Ankle [Internet]. 2023 Dec. 1 [cited 2024 Feb. 23];2(12). Available from: https://internationalfootankle.org/journal/index.php/JIFAF/article/view/75

Most read articles by the same author(s)