Does Dual-Eligible Medicare/Medicaid Insurance Status as a Surrogate for Socioeconomic Status Compromise Total Knee Arthroplasty Outcomes?

Koressel, Joseph; Perez, Brian A.; Kerbel, Yehuda E.; DeAngelis, Ryan D.; Israelite, Craig L.; Nelson, Charles L.

doi:10.1016/j.arth.2022.01.014

Cited by 7 publications

(4 citation statements)

References 19 publications

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“…29 They are more likely to have fewer socioeconomic resources, more chronic conditions, and poorer survival outcomes than single eligibles. 15 , 30 , 31 , 32 Future studies should uncover factors influencing survival outcomes and explore policy options to address the unmet needs of the disabled or dually eligible population with SCD.…”

Section: Discussionmentioning

confidence: 99%

Long-term survival with sickle cell disease: a nationwide cohort study of Medicare and Medicaid beneficiaries

et al. 2023

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We report the first population-based period life table, the expected lifetime survival for Medicare and Medicaid beneficiaries with Sickle Cell Disease (SCD), and the disparities in survival by insurance types in the United States. We constructed a retrospective cohort of individuals with diagnosed SCD receiving Common Care (any real-world patterns of care except transplant) based on nationwide Medicare and Medicaid claims data (2008-2016), covering beneficiaries in all 50 states. We analyzed lifetime survival probabilities using Kaplan-Meier curves and projected life expectancies at various ages for all and stratified by sex and insurance types. Our analysis included 94,616 individuals with SCD that have not undergone any transplant. Life expectancy at birth was 52.6 years (95% CI: 51.9, 53.4). Compared to the adults covered by Medicaid only, those covered by Medicare for disabilities or end-stage renal disease and those dually insured by Medicare and Medicaid had significantly worse life expectancy. Similarly, for beneficiaries aged ≥65 years, these two insurance types were associated with significantly shorter life expectancy than those enrolled in Medicare old age and survivor's insurance. Our study underscores the persistent life expectancy shortfall for SCD patients, the burden of premature mortality during adulthood, and survival disparities by insurance status.

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Section: Discussionmentioning

confidence: 99%

Long-term survival with sickle cell disease: a nationwide cohort study of Medicare and Medicaid beneficiaries

et al. 2023

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“…Our key independent variable was the patient's socioeconomic status as measured by a categorical indicator of the payor for the outpatient visit (Private, Medicare, Medicaid, Workers' Compensation, other). Payor type has been utilized as a surrogate for socioeconomic status in multiple studies due to its consistent documentation in the electronic medical record system as a result of its link to billing [12][13][14]. Medicaid is a needs-based insurance that is based on state and federal guidelines regarding poverty indices [15].…”

Section: Key Independent Variablesmentioning

confidence: 99%

Socioeconomic Status Correlates With Initial Patient-Reported Outcomes Measurement Information System-Pain Interference (PROMIS-PI) Scores but Not the Likelihood of Spine Surgery

Lawlor,

Rubery,

Thirukumaran

et al. 2024

Cureus

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Objective To explore how socioeconomic status and patient characteristics may be associated with initial self-reports of pain and determine if there was an increased association with undergoing spine surgery. Methods Patients at an academic center between 2015 and 2021 who completed the Patient-Reported Outcomes Measurement Information System-Pain Interference (PROMIS-PI) questionnaire were included. Multivariable linear regression models were used to determine the association between insurance type and patient factors with initial reports of pain. Multivariable logistic regression models were used to determine the association between PI and the likelihood of surgery in two time periods, three and 12 months. Results The study included 9,587 patients. The mean PROMIS-PI scores were 61.93 (SD 7.82) and 63.74 (SD 6.93) in the cervical and lumbar cohorts, respectively. Medicaid and Workers’ Compensation insurance patients reported higher pain scores compared to those with private insurance: Medicaid (cervical: 2.77, CI (1.76-3.79), p<0.001; lumbar (2.05, CI (1.52-2.59), p<0.001); Workers’ Compensation (cervical: 2.12, CI (0.96-3.27), p<0.001; lumbar: 1.51, CI (0.79-2.23), p<0.001). Black patients reported higher pain compared to White patients (cervical: 1.50, CI (0.44-2.55), p=0.01; lumbar: 1.51, CI (0.94-2.08), p<0.001). Higher PROMIS-PI scores were associated with a higher likelihood of surgery. There was no increased association of likelihood of surgery in Black, Medicaid, or Workers’ Compensation patients when controlling for pain severity. Conclusion Black patients and patients with Medicaid and Workers’ compensation insurance were likely to report higher pain scores. Higher initial pain scores were associated with an increased likelihood of surgery. However, despite increased pain scores, Black patients and those with Medicaid and Workers’ Compensation insurance did not have a higher likelihood of undergoing surgery.

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“…For example, although TJA has been shown to be cost-effective in morbidly obese patients, there is evidence that the rate of complications and costs are higher with increasing obesity [18][19][20][21][22][23] . Although not perfect, area-based geocodes and dualeligibility status do represent reasonable surrogates for socioeconomic status that have been associated with poorer outcomes or increased cost of care 38,39 .…”

Section: Strategies To Maintain Health-care Access For Vulnerable Pat...mentioning

confidence: 99%

Does Value-Based Care Threaten Joint Arthroplasty Access for Vulnerable Patient Populations?

Lin

Bozic

Ibrahim

et al. 2022

Journal of Bone and Joint Surgery

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:Health-care expenses have been projected to increase from 17.7% of the U.S. gross domestic product (GDP) in 2014 to 19.6% in 2024. The unsustainable increase in health-care costs has contributed toward support for value-based health care (VBHC) reform. Contemporary VBHC reform programs relevant to orthopaedic surgery include the voluntary Bundled Payments for Care Improvement initiatives (BPCI and BPCI-Advanced) and the Comprehensive Care for Joint Replacement (CJR) program, a mandatory bundled payment program.The purported benefits of transitioning from volume-based reimbursement to value-based reimbursement include moving from a fragmented provider-centered care model to a patient-centered model, with greater care coordination and alignment among providers focused on improving value. VBHC models allow innovative strategies to proactively invest resources to promote value (e.g., the use of nurse navigators) while eliminating unnecessary resources that do not promote value. However, major concerns regarding VBHC include the absence of medical and socioeconomic risk stratification as well as decreased access for higher-risk patients.This article identifies the benefits and potential unintended consequences of VBHC reform, with a focus on joint arthroplasty. We also discuss some potential strategies to promote innovation and improve value without compromising access for vulnerable patients.

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Does Dual-Eligible Medicare/Medicaid Insurance Status as a Surrogate for Socioeconomic Status Compromise Total Knee Arthroplasty Outcomes?

Cited by 7 publications

References 19 publications

Long-term survival with sickle cell disease: a nationwide cohort study of Medicare and Medicaid beneficiaries

Long-term survival with sickle cell disease: a nationwide cohort study of Medicare and Medicaid beneficiaries

Socioeconomic Status Correlates With Initial Patient-Reported Outcomes Measurement Information System-Pain Interference (PROMIS-PI) Scores but Not the Likelihood of Spine Surgery

Does Value-Based Care Threaten Joint Arthroplasty Access for Vulnerable Patient Populations?

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