Access to Total Knee Arthroplasty in Medicare Advantage Patients

Abstract

Background: Total knee arthroplasty (TKA) is one of the most frequently performed procedures in Medicare patients in the United States. Among this population, enrollment in Medicare Advantage (MA) plans is rising but rates of elective TKA are 10-20% lower in MA health maintenance organization (HMO) plans compared to Traditional Medicare (TM). The purpose of this study was to evaluate the effect of Medicare type on patient access to TKA within the large population in Florida. Methods: The AAOS directory was queried for total joint surgeon practices within five Florida counties. Each office was called to assess the response to four insurance scenarios (Traditional Medicare, Blue Medicare Select PPO, Humana Gold Plus HMO, and commercial Cigna). Investigators used a Secret Shopper methodology with a standardized script to request a TKA. Data was gathered on insurance types accepted and number of business days to the next available appointment. Results: Of the 133 orthopaedics clinics called, 63 were accepting new TKA patients. Of those accepting new TKA patients, 91.7% accepted commercial Cigna, 96.8% accepted TM, 70.5% accepted MA HMO Humana Gold Plus, and 50.8% accepted MA PPO Blue Medicare Select. Compared to TM and commercial Cigna, both MA plans had significantly lower appointment success rates (all p<.003). Time to earliest appointment did not significantly vary by insurance type or county (p>.14). Conclusions: Patients in Florida with MA have decreased access to TKA compared to those with TM or commercial insurance, possibly explaining the lower rates of TKA utilization in the MA population.