Medicare Advantage associated with decreased utilization of elective, inpatient TJA
Click Here to Manage Email Alerts
Key takeaways:
- Patients with Medicare Advantage may have decreased utilization of inpatient TJA vs. patients with traditional Medicare coverage.
- Medicare Advantage enrollees also had increased time to evaluation and surgery.
Results showed patients with Medicare Advantage may have decreased utilization of elective, inpatient total joint arthroplasty procedures and increased time to evaluation and surgery vs. patients with traditional Medicare coverage.
Kelly E. Anderson, PhD, MPP, and colleagues used traditional Medicare claims and Medicare Advantage (MA) encounter records from 2018 to perform a cross-sectional study of 5,300,188 patients with traditional Medicare (mean age of 73 years) and 1,970,032 patients with MA (mean age of 73.6 years) who underwent elective, inpatient total hip or knee arthroplasty.
After controlling for beneficiary and market characteristics, Anderson and colleagues found patients with MA had a 15.6% lower incidence of TJA compared with patients with traditional Medicare. Researchers found HMO enrollees were 28.1% less likely to undergo TJA compared with patients with traditional Medicare.
Patients with MA had increased time to initial evaluation with an orthopedic surgeon and increased time to surgery compared with patients with traditional Medicare. According to the study, 8.6% of patients with traditional Medicare, 6.3% of the preferred provider organization enrollees and 4.6% of the HMO enrollees had undergone inpatient TJA within 1 year. Similarly, 10.4% of patients with traditional Medicare, 7.9% of PPO enrollees and 5.7% of HMO enrollees had undergone inpatient TJA within 2 years.
“The MA plan design, specifically HMO coverage, may limit the utilization of elective surgical procedures such as TJA,” the researchers wrote in the study. “We also found a longer time to the surgical procedure for MA enrollees, although it is possible that these patients were being effectively managed nonoperatively prior to the surgical procedure,” they concluded.
Collapse
Click Here to Manage Email Alerts