Medicaid coverage associated with low-volume hospitals, poor outcomes for TJA

ByMax R. Wursta

Fact checked byGina Brockenbrough, MA

Key takeaways:

Patients with Medicaid are more likely to undergo total joint arthroplasty at a low-volume hospital compared with patients without Medicaid.
Patients with Medicaid had increased postoperative complications.

Compared with patients without Medicaid, patients with Medicaid were more likely to undergo total joint arthroplasty at a low-volume hospital and have higher rates of postoperative complications, according to published results.

Anna Cohen-Rosenblum, MD, MSc, and investigators at the Keck School of Medicine of USC used the Premier Healthcare Database to analyze 986,230 patients who underwent TJA from 2016 to 2019. According to the study, 44,370 (4.5%) of these patients had Medicaid insurance coverage. Researchers assessed annual hospital and surgeon case volume and 90-day postoperative complications among the cohorts.

Hospital corridor — Patients with Medicaid are more likely to undergo total joint arthroplasty at a low-volume hospital. *Image: Adobe Stock*

Overall, researchers found 46.4% of patients with Medicaid and 34.3% of patients without Medicaid were treated by surgeons who performed less than or equal to 100 TJA surgeries annually. Similarly, 50.8% of patients with Medicaid and 35.5% of patients without Medicaid were treated at hospitals with less than or equal to 500 TJA surgeries annually.

Researchers also noted patients with Medicaid had increased risks for postoperative deep vein thrombosis (OR = 1.16), pulmonary embolism (adjusted OR = 1.39), periprosthetic joint infection (adjusted OR = 1.35) and 90-day readmissions (adjusted OR = 1.25).

“Hospital systems should consider targeted interventions in this specific population to reduce disparities in access to care and poor outcomes,” the researchers wrote in the study. “Policymakers should consider revisiting payment strategies that take into account the increased risk of complications associated with this underinsured patient population if equal access to high-quality arthroplasty care is to be attained,” they concluded.

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Sources/Disclosures

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Source:

Cohen-Rosenblum A, et al. J Bone Joint Surg. 2023;doi:10.2106/JBJS.22.01336.

Disclosures: Cohen-Rosenblum reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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Medicaid coverage associated with low-volume hospitals, poor outcomes for TJA

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