Patients with Medicaid have low functional outcome scores after shoulder arthroplasty
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Patients with Medicaid are younger, have more debilitating disease, and lower preoperative and postoperative American Shoulder and Elbow Surgeons scores after shoulder arthroplasty compared with those with private insurance and Medicare.
Researchers at Loyola University Medical Center analyzed results of 84 patients who underwent elective total shoulder arthroplasty (TSA; 91 procedures) from Jan. 1, 2013 to Jan. 1, 2016. All procedures were performed by a single surgeon and had 1-year minimum follow-up.
According to the study, researchers compared patient characteristics and outcomes of 14 patients with Medicaid, 46 patients with Medicare, 19 patients with private insurance and five patients with workers’ compensation using preoperative and postoperative ASES scores.
Of all insurance types, patients with Medicaid had the lowest preoperative and postoperative mean ASES scores (20.4 and 55.2, respectively), highest postoperative VAS score (4.31) and highest reoperation rate (20%).
Although patients with Medicaid only accounted for 1.5% to 1.8% of payers for TSA procedures, incidence of this population seeking TSA could increase with Medicaid expansion, the researchers wrote in the study.
“This finding is important as the population of public aid patients continues to grow and becomes a larger proportion of the practice of many surgeons,” the researchers wrote. “Future studies may continue to investigate the specific factors that contribute to discrepancies between patients with Medicaid and other types of insurance and may seek to determine which of these factors may be modifiable before shoulder arthroplasty,” they added.
Perspective
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Frank A. Petrigliano, MD
I read with interest the article “Effect of insurance status on clinical outcomes after shoulder arthroplasty” by Patrick Strotman, MD, and colleagues performed at Loyola University Medical Center. Shoulder arthroplasty generally has a high success rates, however a variety of factors may influence subjective patient-reported outcomes. In this study, the authors found that patients with Medicaid insurance had the lowest preoperative and postoperative ASES scores, as well as highest postoperative VAS scores and re-operation rates. These insights are consistent with the reported correlation between insurance status and patient outcomes following hip and knee arthroplasty. While there are many factors that may influence the relationship between insurance status and surgical outcomes, it is clear that Medicaid patients often face significant barriers to timely surgical care, as well as appropriate post-surgical rehabilitation.
As the proportion of the population that relies on Medicaid continues to grow, surgeons must advocate for their patients to improve access to the perioperative resources that may improve surgical outcomes. Furthermore, these findings should encourage government payors to invest in studying the various factors that may influence such outcomes and invest in systemic improvements in access to care for Medicaid patients.
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