Disclosures: Rashid Kazerooni, PharmD, MS, BCPS, BCMAS: Merz Pharmaceuticals, LLC (Products/Services: Yes) (Employment)

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

Design: Retrospective Analysis on 2017 Medicare Provider Utilization and Payment Data: Physician and Other Supplier dataset from Center for Medicare & Medicaid Services.Setting : Outpatient Medicare claimsParticipants : 2017 Medicare fee-for-service beneficiaries (34 million patient cohort)

Interventions: N/A

Main Outcome Measures: 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 treated with chemodenervation for spasticity). Ratios were assessed across census defined geographical regions as well as hospital referral regions (HRRs). 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.Conclusions: 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.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/disparities-in-access-to-spasticity-chemodenervation-specialists-in-the-united-states-a-national-analysis-of-medicare-data/