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Black patients using Medicare are less likely to receive joint replacement services, study finds

Despite improved health outcomes, barriers to care remain under Comprehensive Care for Joint Replacement model
a healthcare worker assists a senior Black man with a walker
A a new study, published in JAMA Network Open, has determined that The Comprehensive Care for Joint Replacement model may be associated with relative decreases in joint replacement surgery for Black Midicare enrollees. (Getty Images)

A nationwide model for hip and joint replacements, introduced in 2016, aims to reduce health care costs and improve quality for Medicare beneficiaries. While previous studies have shown the Comprehensive Care for Joint Replacement, or CJR, model improves overall health outcomes, a new retrospective study -- conducted by researchers at Oregon Health & Science University -- has determined that CJR may be associated with relative decreases in joint replacement surgery for Black patients.

The study findings published in the journal JAMA Network Open.

Using a comprehensive sample of more than 49 million Medicare enrollees in several U.S. metropolitan areas – some randomly selected for CJR model participation -- the research team examined differences in the likelihood of obtaining elective joint replacement surgery under CJR.

Overall findings suggest that Black patients receiving care in cities with the CJR model showed a smaller increase in the rate of elective joint replacements, compared to those in non-CJR participation areas. In contrast, Hispanic and White beneficiaries showed a relative increase and no change in the rate of joint replacement under CJR, respectively.

Headshot of Thomas Meath, a smiling young adult with long hair, glasses, and a beard
Thomas Meath

According to study author Thomas Meath, M.P.H., the decrease in elective joint replacements among Black Medicare enrollees suggests that value-based payment models, such as CJR, should be monitored for unintended consequences including differential impacts across racial/ethnic groups.

“Knee and hip replacement is an effective treatment option that helps to improve overall quality of life,” says Meath, a senior research statistician at the Center for Health Systems Effectiveness at OHSU. “This data is concerning, as it suggests that health care facilities may be less likely to provide necessary surgical interventions to Black patients, a group that may be perceived as requiring more expensive follow-up care due to underlying medical conditions or socio-economic status. Additional work is necessary to help ensure that vulnerable populations are not disproportionately denied effective treatment options.”

This study was supported by the National Institute of Minority Health and Health Disparities (grant R01MD011403) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant K24AR055259), both a part of the National Institutes of Health.

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