Three big ideas for improving access to care

Few, if any, would argue that every child is entitled to a fair chance at a healthy and happy life.

Part of that equation requires unencumbered access to quality healthcare, both preventative and in times of greatest need. Putting political rhetoric and debate aside, this is a moral imperative in which we are all invested.

Sadly, however, there is not a level playing field across America – or even within a single community – when it comes to a child's ability to access timely medical care. Reasons for this disparity are multi and likely include a combination of patient, provider and payer factors. Finances, insurance, referral networks and authorization processes each may contribute while private versus government-funded insurance types may contribute as well. This discrepancy in timely access to care has been shown to negatively affect the severity of a child's injury or the natural history of their disease.

One example of this was brought to light in a recently published study, which looked at the comparative surgical wait times (private insurance vs. government-funded) for adolescents with an ACL rupture. When the ACL is torn, often one (or both) meniscus is torn at the same time; but meniscus tears can also happen during the time between the ACL tear and its surgical repair. Given that meniscal tears affect future knee arthritis and pain, the study of 121 patients looked at the wait time between ACL tear and surgical repair and related that time to meniscal tear rates seen at the time of surgical repair in adolescents.

The results of this study showed increased severity of and rates of meniscal tears in adolescent patients with ACL ruptures who waited six or more months between injury and surgery. The reasons for this wait time were many, including the patient not being referred to a specialist in a timely manner; delays in financial approval from insurance carriers; and the specialist simply not scheduling the surgery in a timely manner. Most tellingly, the study showed that patients with public insurance had longer surgical wait times (than did their privately insured counterparts) and an increased risk of having a medial meniscus tear at time of surgery.

While this was just one study focused on one disorder, the lessons here are clear and can easily be extrapolated to unearth systemic shortcoming in our healthcare system. Without waiting for Washington to solve this problem, there are many things we can do at our hospital and within our own communities to have an immediate and positive impact. Here are three places to start:

1. We need to make sure that we have the proper facilities and equipment to care for these patients in a timely manner. At the Orthopaedic Institute for Children, last year we opened Los Angeles' first ambulatory surgery center designed and built exclusively to provide orthopaedic outpatient surgical care to children. The center is designed to reduce surgery wait times while greatly enhancing quality outcomes and enriching the patient experience for children and their parents. The 13,000-square-foot center houses two expansive operating rooms and six pre- and post-surgical suits and is staffed by physicians and other professionals specially trained to address the distinct needs of children. More centers like this are badly needed across the country.

2. Education is key and needs to be addressed on three levels. First we need to provide education programs to healthcare professionals to help them recognize children's injuries so they can make timely referrals to specialists. At the same time, we need to build relationships with athletic organizations and local school coaches and trainers to educate them so they, too, can recognize injuries and make referrals in a timely manner. Third we need to do a better job of educating parents on the need to pay prompt attention to a child's injury. Hospitals should use all of the tools at their disposal – community forums; social media; newsletters; articles in the local media – to take the lead in this educational process.

3. Within our own facilities we need to implement internal workflow changes to rapidly identify these patients and schedule their surgery promptly. All of the external education that we do will have little impact if the system breaks down at the hospital's end. In this regard we need to be creative in how we make sure this happens. At OIC, for example, we have hired an athletic trainer to help "fast-track" patients with time-sensitive injuries like ACL tears.

Admittedly access to care as it relates to cost of care is a hotbed political issues and in all likelihood will continue to be so for the foreseeable future. But we must not let innocent children be part of this scuffling and be the victims of our inability to arrive at sensible solutions. It is incumbent upon us to make sure that doesn't happen.

Richard E. Bowen is director of the Center for Sports Medicine at the Orthopaedic Institute for Children in Los Angeles.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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