Purpose
To evaluate the null hypothesis that Medicaid patients receive carpal tunnel release
(CTR) at the same time interval from diagnosis as do patients with Medicare Advantage
or private insurance.
Methods
We conducted a retrospective review using a database containing claims records from
2007 to 2016. The cohort consisted of patient records with a diagnosis code of carpal
tunnel syndrome (CTS) and a procedural code for CTR within 3 years of diagnosis. We
stratified patients into 3 groups by insurance type (Medicaid managed care, Medicare
Advantage, and private) for an analysis of the time from diagnosis until surgery and
use of preoperative electrodiagnostic testing.
Results
Of all patients who received CTR within 3 years of diagnosis, Medicaid patients experienced
longer intervals from CTS diagnosis to CTR compared with Medicare Advantage and privately
insured patients (median, 99 days vs 65 and 62 days, respectively). The Medicaid cohort
was significantly less likely to receive CTR within 1 year of diagnosis compared with
the Medicare Advantage cohort (adjusted odds ratio [OR] = 0.54) or within 6 months
of diagnosis compared with the privately insured cohort (adjusted OR = 0.61). Those
in the Medicaid cohort were less likely to receive electromyography and nerve conduction
studies within 9 months before surgery compared with their Medicare Advantage (adjusted
OR = 0.43) and privately insured (adjusted OR = 0.41) counterparts. These effects
were statistically significant after accounting for age, sex, region, and Charlson
comorbidity index.
Conclusions
Medicaid managed care patients experience longer times from diagnosis to surgery compared
with Medicare Advantage or privately insured patients in this large administrative
claims database. Similar variation exists in the use of electrodiagnostic testing
based on insurance type.
Clinical relevance
Medicaid patients may experience barriers to CTS care, such as delays from diagnosis
to surgery and reduced use of electrodiagnostic testing.
Key words
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Article info
Publication history
Published online: December 20, 2018
Accepted:
November 2,
2018
Received:
March 27,
2018
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2019 by the American Society for Surgery of the Hand. All rights reserved.
