JOA - 2026-09-01 - Journal Article
Dual Eligibility Status Is Associated With Lower Surgeon Reimbursement Despite Greater Patient Complexity in Primary Total Joint Arthroplasty.
Persaud SG, Kucherina A, Ortiz S, Burgio C, Zepeda KE, Vigdorchik JM, Debbi EM
Topics
Key Takeaway
Surgeons in the highest dual-eligibility quartile received $31 less per THA and $24 less per TKA compared to the lowest quartile, despite managing greater comorbidity burden.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This cross-sectional Medicare database analysis examined whether surgeon dual-eligibility proportion independently predicted standardized reimbursement per primary THA and TKA in 2023. Surgeons were stratified into quartiles by dual-eligible patient panel proportion, with multivariable regression adjusting for HCC risk score, minority beneficiary proportion, and rurality. Higher dual-eligibility proportion was independently associated with lower reimbursement for both THA (β = -1.58, P < 0.001) and TKA (β = -1.04, P < 0.001), with Q4 surgeons earning $971 vs $1,002 per THA and $981 vs $1,005 per TKA compared to Q1.
Key Limitation
Standardized Medicare reimbursement captures only the professional fee component and excludes facility fees, supplemental Medicaid payments, and value-based care bonuses that may partially offset the observed disparity.
Original Abstract
BACKGROUND
Patient dual eligibility status for Medicare and Medicaid is known to be a well-established proxy for socioeconomic vulnerability. Many studies have examined the impact that dual eligibility status has on patient outcomes after total joint arthroplasty (TJA), but its association with surgeon-level reimbursement after TJA remains insufficiently characterized. This study evaluated whether surgeon dual eligibility proportion was independently associated with standardized Medicare reimbursement per procedure for primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) in 2023.
METHODS
A cross-sectional retrospective analysis of a Medicare database was performed for 2023. A total of 4,506 THA surgeons performing 161,221 procedures and 6,618 TKA surgeons performing 297,919 procedures were identified. Surgeons performing primary THA and primary TKA in 2023 were identified and stratified into quartiles based on the proportion of their patient panel that was dual-eligible. The primary outcome was mean standardized Medicare reimbursement per procedure. Multivariable linear regressions were used to evaluate independent associations. Surgeon panel covariates included Hierarchical Condition Category (HCC) risk score, minority beneficiary proportion, and practice rurality.
RESULTS
For THA, mean standardized reimbursement declined from $1,002 in Q1 to $971 in Q4 (P < 0.001). For TKA, mean reimbursement declined from $1,005 in Q1 to $981 in Q4 (P < 0.001). A higher dual eligibility proportion was independently associated with lower reimbursement for both THA (β = -1.58, P < 0.001) and TKA (β = -1.04, P < 0.001) after adjustment for rurality, HCC risk score, and minority beneficiary proportion per surgeon.
CONCLUSIONS
Among surgeons performing primary TJA, a higher dual-eligible patient proportion was associated with reduced standardized reimbursement, despite the greater medical comorbidity and psychosocial complexity characterizing this population. These findings suggest that existing reimbursement frameworks may be associated with lower reimbursement for surgeons who disproportionately serve socioeconomically disadvantaged patients, with potential implications for equitable access to total joint arthroplasty.
LEVEL OF EVIDENCE
Level III, retrospective cross-sectional study.