The AAHKS Clinical Research Award: What Are the Costs of Knee Osteoarthritis in the Year Prior to Total Knee Arthroplasty?

Bedard, Nicholas A.; Dowdle, S. Blake; Anthony, Christopher A.; DeMik, David E.; McHugh, Michael; Bozic, Kevin J.; Callaghan, John J.

doi:10.1016/j.arth.2017.01.011

Cited by 61 publications

(67 citation statements)

References 17 publications

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“…In addition to these limitations, our analysis does not evaluate the timing of relevant services in relation to one another. In the literature, there has been commentary on timing of services with relation to total knee arthroplasty (23,24). While our study focused on total costs, we foresee including service sequencing in future analysis.Our list of relevant services represents a potential area for bias, although these services were selected from a thorough discussion among subject matter experts and review of practice guidelines.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal analysis of historical payments and utilization in patients with hip and knee osteoarthritis

Allen¹,

Mg²,

Lm³

et al. 2019

Preprint

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Background Osteoarthritis (OA) is a highly prevalent condition associated with substantial clinical and economic burden. Value-based payment reform requires detailed understanding of care utilization. However, previous analyses of OA care have limitations, such as constraining analysis to a single year or to surgical patients. We aimed to more comprehensively characterize health services utilization and payment for hip and knee OA through a 3-year longitudinal analysis, including both operative and non-operative services, using Medicare claims data. Methods We utilized Medicare Standard Analytic Files available from PearlDiver, Inc. The target population for analysis was patients with osteoarthritis in the hip, knee, or both, identified by ICD-9 diagnosis codes. Patients were limited to those whose 1) first instance of hip or knee OA diagnosis in the payer dataset occurred between 2008 and 2011 and 2) who were continuously active in the payer dataset for one year prior to and three years following diagnosis. Results Payments for relevant hip and knee OA services were highest during the first year after diagnosis, representing 55.6%, 65.3%, and 51.2% of total payments for patients with knee, hip, or knee and hip OA, respectively. Payments and utilization of services in the second and third treatment years were lower, and similar to the year prior to OA diagnosis. Service-level analysis revealed that total payments were driven by utilization of high-intensity services like surgery, which accounted for 57.7%, 60.6%, and 63.6% of payments in the first year for knee, hip, and knee and hip OA patients, respectively. High utilization of Medical Services like physician-administered medications, arthrocentesis, and physical therapy drove high payments as well, especially later in treatment. Conclusion Hip and knee OA treatment intensity is highest in the year immediately following a new diagnosis and decreases considerably in the second- and third-years following diagnosis across all relevant service categories. This analysis supports the identification of specific, time-sensitive opportunities to transform hip and knee OA care and payment models to optimize patient-centered outcomes while controlling costs across the episode of care.

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Section: Discussionmentioning

confidence: 99%

Longitudinal analysis of historical payments and utilization in patients with hip and knee osteoarthritis

Allen¹,

Mg²,

Lm³

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…We appreciate your thoughts and comments on our study [1,2]. We agree that our findings are by no means definitive and much work still needs to be completed in this arena.…”

mentioning

confidence: 83%

Response to Letter to the Editor on “The AAHKS Clinical Research Award: What Are the Costs of Knee Osteoarthritis in the Year Prior to Total Knee Arthroplasty?”

Bedard

Dowdle

Anthony

et al. 2018

The Journal of Arthroplasty

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“…Numerous clinical practice guidelines have been developed to standardize management of knee OA [8][9][10]. However, despite a general consensus on major management strategies across guidelines [11], there remains wide variation in practice patterns with low adherence to recommendations [12,13]. Furthermore, most knowledge on cost and care delivery patterns in knee OA focuses on the end-stage treatment of joint arthroplasty [12,14,15].…”

Section: Introductionmentioning

confidence: 99%

“…However, despite a general consensus on major management strategies across guidelines [11], there remains wide variation in practice patterns with low adherence to recommendations [12,13]. Furthermore, most knowledge on cost and care delivery patterns in knee OA focuses on the end-stage treatment of joint arthroplasty [12,14,15]. However, OA is a chronic condition, and optimal disease-based care will require a deeper understanding of the entire nonarthroplasty treatment episode, One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field whichmay be perceived to have potential conflict of interest with this work.…”

Section: Introductionmentioning

confidence: 99%

Disparity of health services in patients with knee osteoarthritis before total knee arthroplasty

et al. 2020

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Background: Recent evidence describes which interventions are driving insurance payments in the management of osteoarthritis (OA) before total knee arthroplasty (TKA); however, relatively little is known about how these costs are distributed among patients. Methods: We reviewed the Humana claims database for patients who underwent primary TKA from 2009 to 2016. Insurance payments for treatment, imaging, and evaluation and management were calculated from OA diagnosis to TKA, the distribution of payments was determined, and a high-payment group was identified by determining the point at which patients began to account for a disproportionate percentage of payments. This group of high-payment patients was compared with remaining patients (low-payment patients) based on demographic factors and nonarthroplasty payments and utilization. Results: The top 30% of patients accounted for more than 70% of nonarthroplasty payments. Highpayment patients were more likely to be younger, female, and more comorbid. Median time from diagnosis to TKA for high-payment patients was 3 times longer than that for low-payment patients (654 days [320-1191] vs 204 days [68-582], P < .001), and median payment per patient was more than 5 times higher ($1891 [1405-2782] vs $362 [198-613], P < .001). Conclusions: Identification of high-payment patients in the management of knee OA may allow for targeted care pathways and cost-reduction strategies in the nonarthroplasty period, although additional studies are necessary to further characterize this population and efficiently recognize appropriate TKA candidates and timing.

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The AAHKS Clinical Research Award: What Are the Costs of Knee Osteoarthritis in the Year Prior to Total Knee Arthroplasty?

Cited by 61 publications

References 17 publications

Longitudinal analysis of historical payments and utilization in patients with hip and knee osteoarthritis

Longitudinal analysis of historical payments and utilization in patients with hip and knee osteoarthritis

Response to Letter to the Editor on “The AAHKS Clinical Research Award: What Are the Costs of Knee Osteoarthritis in the Year Prior to Total Knee Arthroplasty?”

Disparity of health services in patients with knee osteoarthritis before total knee arthroplasty

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