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Costs and Outcomes of Medicare Advantage and Traditional Medicare Beneficiaries After Total Hip and Knee Arthroplasty

Yayac, Michael F. MD; Harrer, Samantha L. BA; Janiec, David A. MBA; Courtney, P. Maxwell MD

Journal of the American Academy of Orthopaedic Surgeons: November 05, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.5435/JAAOS-D-19-00609
Research Article: PDF Only

Introduction: Medicare Advantage (MA) has increased popularity among eligible participants by providing additional benefits from a private insurer, but these plans are omitted from several government cost savings programs, including bundled payment models. The purpose of this study was to determine whether 90-day episode-of-care (EOC) costs and outcomes were different for patients with MA plans undergoing total joint arthroplasty compared with traditional Medicare patients.

Methods: We reviewed claims data for a consecutive series of patients undergoing primary total hip and knee arthroplasty from 2015 to 2018 at our institution with traditional Medicare coverage or MA through a single private insurer. Demographics, comorbidities, 90-day costs, readmissions, complications, and discharge disposition were compared between the groups. A multivariate regression analysis was performed to determine the independent effect of insurance status on EOC costs and outcomes.

Results: Of the 10,869 patients in the study, 1,076 (9.9%) were covered under an MA plan. MA patients were more likely to be discharged to a rehabilitation facility (19% versus 14%, P < 0.0001). No significant differences were observed in length of stay (1.88 versus 1.88 days, P = 0.1439), complications (3.9% versus 3.5%, P = 0.4554), or readmissions (5.9% versus 4.9%, P = 0.1893). EOC costs were significantly higher for the MA group ($21,347 versus $19,551, P < 0.0001).

Discussion: Patients with MA have higher total EOC costs than traditional Medicare beneficiaries with comparable short-term outcomes after total hip and knee arthroplasty. Further study is needed to determine whether alternative payment models in MA patients can improve care and reduce costs.

From the Rothman Orthopaedic Institute at Thomas Jefferson University (Dr. Yayac, Mr. Janiec, Dr. Courtney), Philadelphia, PA, and the Sidney Kimmel Medical College (Ms. Harrer), Thomas Jefferson University, Philadelphia, PA.

Correspondence to Dr. Courtney:

None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Yayac, Ms. Harrer, Mr. Janiec, and Dr. Courtney.

© 2019 by American Academy of Orthopaedic Surgeons
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