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Medicaid Expansion Is Associated With Increases in Medicaid-Funded Total Joint Arthroplasty.

Authors
  • Homer, Alexander S1
  • Johnson, Keir G1
  • Alsoof, Daniel2
  • Daniels, Alan H2
  • Cohen, Eric M2
  • 1 Warren Alpert Medical School, Brown University, Providence, Rhode Island.
  • 2 Department of Orthopedics, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
Type
Published Article
Journal
The Journal of arthroplasty
Publication Date
Feb 01, 2024
Volume
39
Issue
2
Identifiers
DOI: 10.1016/j.arth.2023.08.058
PMID: 37611679
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Existing literature presents competing views concerning the impact of Medicaid expansion on total joint arthroplasty (TJA) utilizations. While some reports demonstrate that expansion does not increase Medicaid acceptance by surgeons, others show increases in Medicaid-funded TJA via limited analyses. We conducted a nationwide, multi-insurance, econometric study to determine if Medicaid-funded and all-funding-source total hip arthroplasty (THA) or total knee arthroplasty (TKA) utilizations increased following expansion. This study examined 999,015 THA and 2,099,975 TKA from 2010 to 2017 using a commercially available national payer database. Difference-in-differences analyses, econometric regression methods used to assess the impact of policy change, were used to examine the impact of Medicaid expansion on TJA utilizations, and event analyses were used to confirm the parallel trends assumption, which helps to ensure that the estimated effect is not a result of existing differences in trends between treatment and nontreatment groups. Event analyses confirmed parallel trends in the pre-expansion period. Difference-in-differences analyses found a persistent increase in Medicaid-funded THA (40.4%, P = .001, confidence interval [CI]: 12.7, 62.1%), but not THA from all funding sources (4.6%, P = .128, CI: -1.3, 10.8%). Medicaid-funded TKA (35.8%, P < .001, CI: 17.4, 68.0%) increased, but not TKA from all funding sources (3.4%, P = .321, CI: -3.1, 10.1%). While the number of Medicaid-funded TJAs increased, expansion had no significant effect when examining all funding sources. This suggests that Medicaid expansion primarily affected source of TJA funding, not overall volume. Further research is needed to examine state-specific predictors of response to Medicaid expansion. Copyright © 2023 Elsevier Inc. All rights reserved.

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