Is the Rise of Medicare Advantage Impacting the Fidelity of Traditional Medicare Claims Data? Implications for Reporting of Long-Term Total Hip Arthroplasty Survivorship.

Autor: Chen XT; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota., Glasgow AE; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota., Habermann EE; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota; Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota., Heckmann ND; Department of Orthopedic Surgery, Keck School of Medicine, Los Angeles, California., Callaghan JJ; Department of Orthopedic Surgery, University of Iowa, Iowa City, Iowa., Lewallen DG; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota., Berry DJ; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota., Bedard NA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Jazyk: angličtina
Zdroj: The Journal of arthroplasty [J Arthroplasty] 2024 Sep; Vol. 39 (9S2), pp. S241-S245. Date of Electronic Publication: 2024 Mar 15.
DOI: 10.1016/j.arth.2024.03.014
Abstrakt: Background: Arthroplasty registries often use traditional Medicare (TM) claims data to report long-term total hip arthroplasty (THA) survivorship. The purpose of this study was to determine whether the large number of patients leaving TM for Medicare Advantage (MA) has compromised the fidelity of TM data.
Methods: We identified 10,962 THAs in 9,333 Medicare-eligible patients who underwent primary THA from 2000 to 2020 at a single institution. Insurance type was analyzed, and 83% of patients had TM at the time of THA. Survivorship free from any revision or reoperation was calculated for patients who have TM. The same survivorship end points were recalculated with censoring performed when a patient transitioned to an MA plan after their primary THA to model the impact of losing patients from the TM dataset. Differences in survivorship were compared. The mean follow-up was 7 years.
Results: From 2000 to 2020, there was a decrease in TM insurance (93 to 73%) and a corresponding increase in MA insurance (0 to 19%) among THA patients. Following THA, 23% of TM patients switched to MA. For patients who had TM at the time of surgery, 15-year survivorship free from any reoperation or revision was 90% and 93%, respectively. When censoring patients upon transition from TM to MA, survivorship free from any reoperation became significantly higher (92 versus 90% at 15 years; hazard ratio = 1.16, P = .033), and there was a trend toward higher survivorship free from any revision (95 versus 93% at 15 years; hazard ratio = 1.16, P = .074).
Conclusions: Approximately 1 in 4 patients left TM for MA after primary THA, effectively making them lost to follow-up within TM datasets. The mass exodus of patients out of TM appears to have led to a slight overestimation of survivorship free from any reoperation and trended toward overestimating survivorship free from any revision. If MA continues to grow, efforts to obtain MA data will become even more important.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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