Impact of Value-Based Reimbursement on Health-Care Disparities for Total Joint Arthroplasty Candidates.

As the U.S. Centers for Medicare & Medicaid Services (CMS) implements value-based reimbursement models based on predetermined outcome measures, access to total joint arthroplasty (TJA) is jeopardized for patients who are disproportionately affected by conditions that predispose them to higher odds of complications. Obesity, depression, and chronic illness, each of which occur at disproportionately higher rates in minorities or individuals in lower socioeconomic brackets, are individually associated with worse TJA postoperative outcomes, including longer hospital lengths of stay and higher rates of readmission within 90 days. Medicaid may even be considered an independent risk factor for worse outcome measures with TJA as enrollees have higher rates of postoperative mortality and complications and longer lengths of stay than patients on Medicare or with private insurance. As same-day discharge for TJA becomes more common, eligibility requirements for the procedure tighten, and existing disparities in access to the procedure will be further exacerbated. The current CMS uniform quality metrics endanger access to TJA for patients in certain racial and socioeconomic groups and oblige physicians who treat more complex patients to jeopardize their reimbursement.