Racial Disparities in Total Joint Arthroplasty Bundled Payment Data.

Area of Science:

• Health Economics
• Health Disparities Research
• Orthopedic Surgery Outcomes

Background:

• Bundled payment models are increasingly used in total joint arthroplasty (TJA) to control healthcare spending.
• These models hold providers accountable for quality and costs, shifting from traditional fee-for-service.
• Concerns exist that bundled payments may inadvertently worsen existing racial healthcare disparities.

Purpose of the Study:

• To assess racial disparities among high-cost outlier patients within a TJA bundled payment model.
• To investigate the association between race and cost outliers in TJA.
• To examine if bundled payment models exacerbate racial disparities in TJA outcomes.

Main Methods:

• Retrospective review of Medicare bundled payment plan patients for TJA between January 1, 2022, and June 30, 2023.
• High-cost outliers defined as total adjusted costs >= 5% above the practice mean.
• Statistical analysis using Wilcoxon rank sum and Chi-square tests.

Main Results:

• The study included 170 TJA patients: 34 Black or African American, 133 White, and others.
• Median adjusted costs for TJA were similar between Black ($16,680) and White non-Hispanic ($15,720) patients (P = .4).
• Black race was significantly associated with increased emergency department returns or hospital readmissions (P = .013).

Conclusions:

• Race was not associated with high-cost outliers in TJA bundled payments.
• Black patients demonstrated higher rates of emergency department return and readmission.
• While total costs were not significantly different, findings suggest potential racial disparities in TJA bundled payment models warranting further investigation.