Black Joint Arthroplasty Patients Have Higher Episode-of-care Costs Than White Patients

Episode-of-care costs following total hip arthroplasty (THA) and total knee arthroplasty (TKA) are higher for black patients than white patients, according to a study.

“Concerns exist that minorities who utilize more resources in an episode-of-care following total hip (THA) and knee arthroplasty (TKA) may face difficulties with access to quality arthroplasty care in bundled payment programs,” the researchers explained. “The purpose of this study is to determine if African American patients undergoing TKA or THA have higher episode-of-care costs compared to Caucasian patients.”

Medicare claims data were assessed for 7,310 consecutive primary THA and TKA patients treated at a single institution between 2015 and 2018. Black and white patients were compared in terms of patient demographics, comorbidities, readmissions, and 90-day episode-of-care costs.

Black patients tended to be younger than white patients but had higher pulmonary disease and diabetes rates. Black patients, compared to white patients, were more likely to be discharged to a rehabilitation facility (20% vs. 13%; P<0.001) and had higher subacute rehabilitation ($1,909 vs. $1,284; P<0.001), home health ($819 vs. $698; P=0.022), post-acute care ($5,656 vs. $4,961; P=0.008), and overall 90-day episode-of-care costs ($19,457 vs. $18,694; P=0.001). Black race was correlated with a $440 increase in episode-of-care costs when controlling for confounding comorbidities (P<0.001).

The study was published in The Journal of Arthroplasty.

“African American patients have increased episode-of-care costs following THA and TKA when compared to Caucasian patients, mainly due to increased rates of home health and rehabilitation utilization. Further study is needed to identify social variables that can help reduce post-acute care resources and prevent reduction in access to arthroplasty care in bundled payment models,” the researchers concluded.

Previous research similarly found that black TKA patients were 2.5 to five times more likely than white patients to be discharged to an inpatient rehabilitation facility or skilled nursing facility instead of home.