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American Association for Hand Surgery

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Medicaid Payer Status is Associated with Increased 90-Day Morbidity and Resource Utilization Following Primary Shoulder Arthroplasty: a Propensity-Score-Matched Analysis
William Strawn Godfrey, BS1, Kevin Xavier Farley, BS1, John T Hurt, BS1, Alex Dawes, BS2, Roy Toston, BS3, Michael Gottschalk, MD4 and Eric R. Wagner, MD1, (1)Emory University, Atlanta, GA, (2)Emory University School of Medicine, Atlanta, GA, (3)Emory University School Medicine, Atlanta, GA, (4)Orthopedic Surgery, Emory School of Medicine, Atlanta, GA

INTRODUCTION: Few studies have examined the impact of Medicaid payer status on morbidity and resource utilization following primary shoulder arthroplasty. The purpose of this study was to compare the 90-day readmission and reoperation rates, hospital length of stay (LOS), and direct cost following primary shoulder arthroplasty in Medicaid patients to a matched cohort.

METHODS: The National Readmission Database was queried for patients undergoing primary anatomic, reverse, and hemi-shoulder arthroplasty (aTSA, rTSA, HA) from 2011 to 2016. "Medicaid" or "non-Medicaid" status was determined to sort patients into cohorts. Patient variables, along with 90-day readmission and reoperation, LOS, and inflation-adjusted cost were assessed and propensity score matching was utilized with one-to-one matching between the payer groups and type of arthroplasty. Odds ratio (OR) and 95% confidence interval for 90-day readmission and reoperation rates were calculated and LOS and direct cost were compared.

RESULTS: 4,667 Medicaid and 161,147 non-Medicaid patients were identified from 2011 to 2016. After propensity score analysis, 4,637 Medicaid and non-Medicaid patients were matched, each with 1,504 (32.4%) rTSAs, 1,934 (41.7%) aTSAs, and 1,199 (25.9%) HAs. Medicaid patients showed significant increase in 90-day readmission rates (11.6% vs 9.3%; OR=1.28), 90-day shoulder-related readmission rates (3.3% vs. 2.3%; OR=1.44), and 90-day reoperation rates (2.0% vs. 1.3%; OR=1.54). Furthermore, there was increased risk of LOS greater than 2 days (28.4% versus 25.7%; OR=1.14) along with increased direct cost (median of $17,612 versus $16,775).

CONCLUSION: Medicaid payer status is independently associated with increased 90-day readmission and reoperation rates, LOS, and direct cost following primary shoulder arthroplasty. Providers may be disincentivized to treat patient populations who require increased resource utilization following surgery, and risk adjustment models accounting for Medicaid payer status are necessary to avoid decreased access to care for this population and to avoid financial penalty for physicians and hospitals alike.

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