Investigators at Sinai Hospital of Baltimore Detail Findings in Arthroplasty (Increased Lengths of Stay and Denial Rates Seen With Managed Care Organizations Following Total Hip Arthroplasty): Surgery – Arthroplasty

2025 AUG 26 (NewsRx) -- By a News Reporter-Staff News Editor at Health Policy and Law Daily -- New research on Surgery - Arthroplasty is the subject of a report. According to news reporting out of Baltimore, Maryland, by NewsRx editors, research stated, “As Medicaid has expanded in response to the Affordable Care Act, managed care organizations (MCOs) have become the main health care delivery service for beneficiaries. These plans have prior authorization denial rates of over 12%.”

Our news journalists obtained a quote from the research from the Sinai Hospital of Baltimore, “This finding warrants an ongoing evaluation of potentially modifiable barriers to access to care, such as denial rates, and how this restriction ultimately impacts patient care. This study compared patient characteristics, including age and the Charlson Comorbidity Index (CCI), lengths of stay (LOS), discharge dispositions, and denial rates following primary and revision total hip arthroplasty (THA) between patients who had MCOs and commercial insurance from 2020 to 2023. We reviewed our institutional database to identify patients who underwent primary or revision THA from 2020 to 2023. After excluding patients who had other insurance payer types, a history of hip fracture, and a history of malignancy, we identified 543 patients who underwent primary THA (MCO [n = 211]; commercial [n = 332]) and 96 patients who underwent revision THA (MCO [n = 26]; Commercial [n = 72]). We analyzed patient demographics (age and the CCI), LOS, and denial rates between the two cohorts for primary and revision THA. For patients who underwent primary THA, those who had MCO plans had similar CCIs (1.7 versus 1.7, P = 0.86) but were younger (54 versus 58 years, P< 0.0001) than those who had commercial plans, respectively. For patients who underwent revision THA, those who had MCO plans had a similar average age (53 versus 57 years, P = 0.25) and CCI (1.6 versus 1.7, P = 0.71) as those who had commercial plans, respectively. The average LOS was significantly higher in the MCO cohort compared to the commercial cohort for primary THA (2.5 versus 1.2, P< 0.0001) and revision THA (6.6 versus 2.9 days, P = 0.0001), respectively. The denial rate was significantly higher in the MCO cohort compared to the commercial cohort for primary THA (2.8 versus 0.7%, P< 0.0001) and revision THA (2.4 versus 0.6%, P< 0.0001), respectively. Lengths of stay and denial rates were higher in the MCO cohort than in the commercial cohort.”

According to the news editors, the research concluded: “This could lead to decreased provider participation and potentially serve as a barrier to care for patients who have MCO plans.”

This research has been peer-reviewed.

For more information on this research see: Increased Lengths of Stay and Denial Rates Seen With Managed Care Organizations Following Total Hip Arthroplasty. The Journal of Arthroplasty, 2025;40(8). The Journal of Arthroplasty can be contacted at: Churchill Livingstone Inc Medical Publishers, Curtis Center, Independence Square West, Philadelphia, PA 19106-3399, USA.

Our news journalists report that additional information may be obtained by contacting Ronald E. Delanois, Sinai Hospital Baltimore, Rubin Institute for Advanced Orthopedics, LifeBridge Hlth, Baltimore, MD, United States. Additional authors for this research include Reza Katanbaf, Gabrielle N. Swartz, Jeremy A. Dubin, Sandeep S. Bains, Michael A. Mont and James Nace.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1016/j.arth.2025.03.028. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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