Disparities in Access to Spasticity Chemodenervation Specialists in the United States: A Retrospective Cross-Sectional Study.
Rashid Kazerooni, Sean Healy, Monica Verduzco-Gutierrez
PMID 38014884WHAT IT FOUND
Medicare beneficiaries in nonurban areas and communities with large Hispanic populations face greater difficulty accessing spasticity chemodenervation specialists.
Urban areas had significantly fewer beneficiaries per provider, while regions with at least 25% Hispanic beneficiaries had significantly more beneficiaries per provider.
Key findings
01Urban hospital referral regions had significantly fewer Medicare beneficiaries per provider compared to nonurban areas.
02Areas with at least 25% Hispanic beneficiaries had significantly more Medicare beneficiaries per provider compared to areas with less than 25%.
03The proportion of Black beneficiaries or those on Medicaid was not predictive of beneficiary-to-provider ratios.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study only included Medicare fee-for-service beneficiaries, excluding approximately 19.5 million people in Medicare Advantage plans, who are more likely to be lower income, Black, or Hispanic. Only providers with at least 11 unique spasticity chemodenervation patients were included, potentially biasing results toward areas with larger practices. The analysis did not include patients with commercial or no insurance. The study assessed the presence of specialists, not whether patients actually accessed care or faced socioeconomic barriers to doing so. Smaller hospital referral regions with no qualifying providers were excluded from the regression model.
Declared interests
The authors reported no conflicts of interest.
The easy way to misread this
Do not interpret the lack of significant association between Black beneficiary populations and provider ratios as evidence of equitable access. The study did not analyze whether Black patients actually received care, only the number of specialists present, and it excluded Medicare Advantage beneficiaries who are disproportionately Black.