Lending a Hand to Health Care Disparities: A Cross-sectional Study of Variations in Reimbursement for Common Hand...

Background: Despite the role of one's hands in human function and quality of life, financial disincentives to perform common hand procedures in patients with government-sponsored insurance plans may lead to longer wait times and decreased access to care. Here, we identify the variations in reimbursement for 4 common hand procedures as a step toward understanding these financial implications to develop safeguards to minimize effects on access to care. Methods: Billing data were collected over a 10-year period for patients undergoing carpal tunnel release (open, Current Procedural Terminology 64721; endoscopic, 29848), cubital tunnel release (64718), ganglion cyst excision (25111), and interposition arthroplasty (25447). Patients were placed into cohorts according to insurance type-private insurance, Medicare, Medicaid, or worker's compensation-and these were directly compared. Results: A total of 3489 procedures between 2005 and 2015 were identified in this study (carpal tunnel 65.8%, cubital tunnel 28.7%, ganglion cyst excision 4.1%, and interposition arthroplasty 13.8%). In all, 54.7% of patients had private insurance; 26.3%, Medicare; 10.5%, worker's compensation; and 8.5%, Medicaid. Reimbursement, as a percentage of charge, differed significantly by payor type for all cases and by procedure. On average, worker's compensation plans reimbursed 65.5% of submitted charges; private insurance, 50.6%; Medicare, 25.1%; and Medicaid, 24.6%. Conclusions: We found that wide variations in reimbursement for common hand procedures exist and may preclude some surgeons from offering certain procedures to a subset of patients. Understanding these discrepancies is a key first step in minimizing a potential care delivery disparity for this patient population.