What Are the Barriers to Access to Pediatric Gait Analysis?

New research from Children’s Hospital Los Angeles has found that children with HMO insurance coverage face an average wait time of nearly two months before they receive authorization to undergo gait lab studies for cerebral palsy and other neuromuscular and orthopedic conditions.

Children from neighborhoods with lower socioeconomic opportunities also experienced insurance delays that were up to three times longer than those from more-resourced areas.

Lead author Melissa Bent, MD, presented the results in a podium presentation at the American Academy for Cerebral Palsy and Developmental Medicine Annual Meeting, held Sept. 10-13 in Chicago.

“One of the things that surprised us is that authorization delays for children with private HMO insurance were significantly longer not only than those with PPO insurance, but also for children who were insured by government programs such as Medicaid and California Children’s Services (CCS),” says Dr. Bent, a pediatric orthopedist in the Jackie and Gene Autry Orthopedic Center at Children’s Hospital Los Angeles.

Impact of gait analysis

The retrospective study examined the electronic health records of 224 patients who underwent gait studies in the John C. Wilson Jr. Motion and Sports Analysis Lab at CHLA.

The lab—which uses a 10-camera motion-capture system to obtain 3D images of how a child walks and moves—evaluates more than 400 children a year. It is the only accredited pediatric motion laboratory in Southern California and is one of just 23 accredited labs for children in the world.

Previous research led by CHLA has shown that, nearly 90% of the time, clinical gait analysis findings result in changes that allow surgeons to address multiple movement problems in one procedure. This can reduce the chances of a child needing additional corrective surgeries by almost 70%. CHLA studies have also shown that this reduces health care costs over the long term.

However, not all children and families can access these studies as readily.

“In my clinical practice, I have found that some patients receive multiple denials of coverage for gait studies from insurers, and this delays their care,” Dr. Bent says. “We wanted to look at this from a health equity standpoint and see if social determinants of health were impacting this access.”

Key findings

The researchers looked at two neighborhood-level measures of social determinants of health: the area deprivation index and the child opportunity index. Both measures are based on U.S. Census data and essentially rank the level of socioeconomic opportunity and resources in a particular area.

Using patient zip codes, the team mapped out how these two measures, along with insurance type, impacted access to gait studies for children and adolescents. The study found that neighborhood social determinants of health are linked to longer delays in insurance authorization for gait analysis, though insurance type played the biggest role:

• Children with HMO coverage waited an average of 51.5 days—nearly two months—to receive authorization for a gait study.
• Children with private PPO insurance waited an average of nine days for authorization.
• Those covered by public plans—Medicaid or California Children’s Services-Los Angeles—waited an average of 28.5 and 22 days, respectively.

Not surprisingly, patients with PPO insurance—and the shortest authorization times—came from neighborhoods with the lowest area deprivation and the highest child opportunity scores. Those with public insurance came from the most economically disadvantaged areas.

“Children with HMO insurance came from areas ranking in the middle in terms of economic opportunity—but they still had the longest delay,” Dr. Bent notes.

She hopes to eventually examine whether factors like race and ethnicity, as well as language, play a role in access to gait lab care, although more complete data is needed for those studies. Meanwhile, the team’s next step is to assess and analyze which patients received insurance denials for gait lab studies and why—and whether those denials impacted clinical outcomes.

“Ultimately the goal is to see if we can better partner with insurers to show the positive impact of gait lab studies and prevent unnecessary delays,” she says. “We want to ensure that all children have access to the care they need.”

Study authors were Melissa Bent, Susan Rethlefsen, Veronica Beltran and Tishya Wren.