Data from University of Southern California Keck School of Medicine Broaden Understanding of Arthroplasty (Evidence Guiding Commercial Payer Coverage Criteria for Total Ankle Arthroplasty): Surgery – Arthroplasty

2024 APR 10 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Data detailed on arthroplasty have been presented. According to news reporting from Los Angeles, California, by NewsRx journalists, research stated, “Total ankle arthroplasty (TAA), first developed as an alternative to ankle arthrodesis, has become an increasingly popular management option for end-stage ankle arthritis. Prior studies have shown commercial insurance payers base their coverage criteria on limited and low level of evidence research.”

Our news journalists obtained a quote from the research from University of Southern California Keck School of Medicine: “This study aims to quantify and describe the evidence insurance companies use to support TAA coverage policies. The top 11 national commercial health insurance payers for TAA were identified. A google search was performed to identify payer coverage policies. Policy documents were examined and cited references were classified by type of reference as well as reviewed for level of evidence (LOE). Specific coverage criteria for each individual payer were then extracted. Criteria were compared to assess for similarities among commercial payers. Finally, all references cited by each payer were examined to determine whether they mentioned the specific payer criteria. Six of the 11 payers had accessible coverage policies. The majority of cited references were primary journal articles (145, 60.9%) and the majority of references cited (179, 75.2%) were level III or level IV evidence. We found significant homogeneity in coverage criteria among payers. In addition, cited sources inconsistently mentioned specific payer coverage criteria.”

According to the news reporters, the research concluded: “This study demonstrates that commercial insurance payers rely on the relatively low level of currently available scientific evidence when formulating coverage policies for TAA use and adopt criteria that have not been thoroughly analyzed in the literature. More high level of evidence research is needed to help clinicians and insurance companies further refine indications for TAA so that patients who might benefit from the procedure are adequately covered. Level of Evidence: Level IV, review.”

For more information on this research see: Evidence Guiding Commercial Payer Coverage Criteria for Total Ankle Arthroplasty. Foot & Ankle Orthopaedics, 2024,9(1). (Foot & Ankle Orthopaedics - http://journals.sagepub.com/home/fao). The publisher for Foot & Ankle Orthopaedics is SAGE Publications.

A free version of this journal article is available at https://doi.org/10.1177/24730114241239310.

Our news editors report that additional information may be obtained by contacting Jacob L. Kotlier, University of Southern California Keck School of Medicine, Los Angeles, CA, United States. Additional authors for this research include Amir Fathi, Meng-Yung Ong, Josh M. Yazditabar, Ethan E. Panoussi, Cory K. Mayfield, Frank A. Petrigliano, Joseph N. Liu, Alexander B. Peterson, Eric W. Tan.

ORCID is an identifier for authors and includes bibliographic information. The following is ORCID information for the author of this research: Frank A. Petrigliano (http://orcid.org/0000-0001-8816-6256).

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