Shoulder Arthroplasty Patients with Medicaid Insurance Have Worse Pain, Follow-Up Rates

A study published in the Journal of Shoulder and Elbow Surgery assessed differences in patient outcomes following shoulder arthroplasty based on insurance payor. They observed that patients with Medicaid insurance had worse pre- and postoperative American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) pain scores, as well as lower follow-up rates.

“Disparities associated with socioeconomic status (SES) and insurance coverage have been shown to affect outcomes in different medical conditions and surgical procedures. We hypothesized that [shoulder arthroplasty] patients insured by Medicaid will be associated with lower follow-up rates and inferior outcomes relative to those with Medicare or private insurance,” the researchers predicted.

The researchers collected preoperative demographics, payor (Medicaid, Medicare, or private insurance), and baseline ASES scores for patients undergoing anatomic shoulder arthroplasty, reverse arthroplasty, and hemiarthroplasty between 2012 and 2017. ASES scores were collected again at different postoperative time points. Follow-up was also compared, with follow-up completion rates defined as “the number of follow-up visits completed relative to possible visits.”

Final analysis included 491 shoulder arthroplasty procedures performed in 438 patients. Medicaid patients had a significantly lower mean follow-up completion rate (62.6% ± 33.7%; P<0.001) than Medicare patients (80.2% ± 26.7%; P<0.001) and those with private insurance (77.8% ± 22.1%; P=0.001). All patients demonstrated significant improvements in ASES Composite scores from baseline to final follow-up; however, scores were significantly lower for Medicaid patients at baseline and each postoperative time point. At final follow-up, the ASES Composite score was significantly lower for Medicaid patients (66.1 ± 28.7) than those with private insurance (78.3 ± 20.8; P=0.023). ASES Pain subscores were significantly lower for Medicaid patients both pre- (P<0.001) and postoperatively (P=0.018). Multivariate regression analysis unearthed a correlation between Medicaid insurance and inferior pre- and postoperative ASES scores in comparison with Medicare or privately insured patients.

The study authors concluded that “all patients, regardless of insurance payor, improved by similar magnitudes after shoulder arthroplasty, though patients with Medicaid insurance had significantly lower preoperative and postoperative ASES scores, primarily because of the ASES Pain subscore. Patients with Medicaid insurance also have lower follow-up rates than other payors.”