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Medicaid Insurance Correlates With Increased Resource Utilization Following Total Hip Arthroplasty.

Publication ,  Journal Article
Plate, JF; Ryan, SP; Goltz, DE; Howell, CB; Bolognesi, MP; Seyler, TM
Published in: J Arthroplasty
February 2019

BACKGROUND: With increased restraints and efforts to contain costs in total hip arthroplasty (THA), an emphasis has been placed on risk stratification. The purpose of this study was to determine whether Medicaid patients have increased resource utilization (including 90-day emergency department [ED] visits and readmissions) compared to Medicare or commercial insurance carriers. The study hypothesized that the Medicaid population would represent a high-risk cohort with increased resource utilization. METHODS: The institutional database was retrospectively queried for primary THAs from 2013 to 2017 based on Current Procedural Terminology codes and patients undergoing revision surgery were excluded. Demographic information including age, sex, and body mass index (BMI) and medical comorbidities including American Society of Anesthesiologists (ASA) scores were evaluated. Patients were stratified by insurance type and length of stay (LOS), and 90-day ED visits and 90-day readmissions were assessed in univariable and multivariable analysis. RESULTS: A total of 3674 primary THA patients were included in the analysis (including 116 with Medicaid, 1713 with Medicare, and 1845 with other insurance providers). Medicaid patients had significantly higher ASA scores (P < .001) and BMI (P < .001), with corresponding increase in procedure duration (115 vs 99 vs 105 minutes; P < .001). They had a prolonged LOS (2.5 vs 2.5 vs 1.5 days; P < .001) compared with other insurances, but similar to Medicare patients. Following discharge, in multivariable analysis controlling for age, BMI, and ASA score, Medicare patients were significantly more likely to return to the ED (odds ratio, 3.15; 95% confidence interval, 1.88-5.27; P < .001) and be readmitted (odds ratio, 2.46; 95% confidence interval, 1.26-4.81; P = .009). CONCLUSION: Medicaid patients represent a higher risk cohort with increased resource utilization perioperatively, including longer LOS, and more 90-day ED visits and readmissions. This should be considered in outcome assessments and alternative expectations for the episode of care should be set for this population.

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Published In

J Arthroplasty

DOI

EISSN

1532-8406

Publication Date

February 2019

Volume

34

Issue

2

Start / End Page

255 / 259

Location

United States

Related Subject Headings

  • United States
  • Risk Factors
  • Retrospective Studies
  • Patient Readmission
  • Patient Discharge
  • Orthopedics
  • Odds Ratio
  • Middle Aged
  • Medicare
  • Medicaid
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Plate, J. F., Ryan, S. P., Goltz, D. E., Howell, C. B., Bolognesi, M. P., & Seyler, T. M. (2019). Medicaid Insurance Correlates With Increased Resource Utilization Following Total Hip Arthroplasty. J Arthroplasty, 34(2), 255–259. https://doi.org/10.1016/j.arth.2018.10.011
Plate, Johannes F., Sean P. Ryan, Daniel E. Goltz, Claire B. Howell, Michael P. Bolognesi, and Thorsten M. Seyler. “Medicaid Insurance Correlates With Increased Resource Utilization Following Total Hip Arthroplasty.J Arthroplasty 34, no. 2 (February 2019): 255–59. https://doi.org/10.1016/j.arth.2018.10.011.
Plate JF, Ryan SP, Goltz DE, Howell CB, Bolognesi MP, Seyler TM. Medicaid Insurance Correlates With Increased Resource Utilization Following Total Hip Arthroplasty. J Arthroplasty. 2019 Feb;34(2):255–9.
Plate, Johannes F., et al. “Medicaid Insurance Correlates With Increased Resource Utilization Following Total Hip Arthroplasty.J Arthroplasty, vol. 34, no. 2, Feb. 2019, pp. 255–59. Pubmed, doi:10.1016/j.arth.2018.10.011.
Plate JF, Ryan SP, Goltz DE, Howell CB, Bolognesi MP, Seyler TM. Medicaid Insurance Correlates With Increased Resource Utilization Following Total Hip Arthroplasty. J Arthroplasty. 2019 Feb;34(2):255–259.
Journal cover image

Published In

J Arthroplasty

DOI

EISSN

1532-8406

Publication Date

February 2019

Volume

34

Issue

2

Start / End Page

255 / 259

Location

United States

Related Subject Headings

  • United States
  • Risk Factors
  • Retrospective Studies
  • Patient Readmission
  • Patient Discharge
  • Orthopedics
  • Odds Ratio
  • Middle Aged
  • Medicare
  • Medicaid