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An Evaluation of Emergency Hand Coverage in Tennessee After Implementation of the Affordable Care Act

Jackson, Kianna R. BS*; Nixon, Alexander T. MD; Pollins, Alonda MLI; Mueller, Melissa A. MD§; Thayer, Shelby M.; Anthony, Joshua R. MD; Thayer, Wesley P. MD, PhD‡∥

doi: 10.1097/SAP.0000000000001912
Hand Surgery

Although the upper extremity is the most commonly injured part of the body, many studies have indicated that there is a lack of emergency hand coverage in the United States. In 2010, our laboratory evaluated on-call hand coverage in Tennessee (TN) and found that only 7% of hospitals had a hand surgeon on call for emergency cases at all times. In 2014, the Affordable Care Act (ACA) was implemented with the goal of increasing overall access to care and decreasing health care costs. Hand surgeons were surveyed on their attitudes toward the ACA, and the majority of surgeons surveyed disagreed or strongly disagree that the ACA would improve access to emergent hand surgery. This study aimed to determine if there has been an increase in emergency hand coverage in TN since the implementation of the ACA. A survey was administered to all hospitals in TN with both an emergency department and operating room to determine the percentage of TN hospitals offering elective hand surgery and on-call emergency hand coverage. With 94% of TN hospitals responding to the emergency department survey, we determined that there has been a 138% significant increase in the percentage of hospitals reporting 24/7 emergency hand coverage by a hand specialist since our last study in 2010. There has also been a significant increase in elective hand coverage in TN, although much smaller at 13% since 2010. This study suggests that there has been an overall increase in access to hand care in TN since the implementation of the ACA, most profoundly seen in the increase in hand specialists available for emergent cases.

From the *Vanderbilt University School of Medicine;

Department of General Surgery, The University of Tennessee Health Science Center;

Department of Plastic Surgery, Vanderbilt University Medical Center;

§University of California, Irvine Department of Plastic Surgery;

Vanderbilt University Medical Center; and

Meharry Medical School, Nashville, TN.

Received November 20, 2018, and accepted for publication, after revision February 4, 2019.

Conflicts of interest and sources of funding: none.

Reprints: Wesley P. Thayer, MD, PhD, Department of Plastic Surgery, Vanderbilt University Medical Center, 1161 21st Ave S, MCN D4207 Nashville, TN 37232-2345. E-mail:

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