Objective: To explore the variations in access to spasticity chemodenervation specialists across several geographical, ethnic, racial, and population density factors.

Background: Equity in access to healthcare services is a growing area of interest in the medical literature.

Method: This was a retrospective analysis on 2017 Medicare Provider Utilization and Payment Data: Physician and Other Supplier dataset from Center for Medicare & Medicaid Services, which includes data on 34 million fee-for-service beneficiaries.  The primary outcome was Medicare beneficiaries per provider. Providers with substantial adult spasticity chemodenervation practices (SASCPs) were included (defined as having ≥ 11 unique Medicare patients with claims for Current Procedural Terminology codes related to chemodenervation for spasticity).  Ratios were assessed across census defined geographical regions as well as hospital referral regions (HRRs).  Urban was defined as being part of a metropolitan statistical area ≥ 500,000.  A multivariate linear regression model for the top 100 HRRs by beneficiary population was created, using backward stepwise selection to eliminate variables with p-values > 0.10 from final model.

Results: There was a total of 566 providers with SASCPs, the majority of which were neurologists or physiatrists (546/566; 96.5%). Unadjusted results showed lower access in non-urban versus urban areas in the form of higher patient:provider ratios (83,106 vs 51,897). Access ratios were also lower in areas with ≥25% Hispanic populations (141,800 vs 58,600). Multivariate linear regression results showed similar findings with urban HRRs having significantly lower ratios (-45,764 [p=0.004] versus non-urban) and areas with ≥25% Hispanic populations having significantly higher ratios (+96,249 [p=0.003] versus <25% Hispanic areas). Factors such as proportion of population that was white, black, or on Medicaid was not found to be predictive.

Conclusion: This study found that patients in non-urban and highly Hispanic communities face inequities in access to chemodenervation specialists. Future studies should venture to confirm whether findings are limited to this specialization or are part of a larger issue in access to healthcare specialty services. Additionally, strategies to improve access for these underserved communities should be explored.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/disparities-in-access-to-spasticity-chemodenervation-specialists-in-the-united-states-a-national-analysis-of-medicare-data/