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July 23, 2021

The Triple Aim for Payment Reform in Joint Replacement Surgery: Quality, Spending, and Disparity Reduction

Author Affiliations
  • 1Department of Orthopaedics, University of Rochester, Rochester, New York
  • 2Department of Public Health Sciences, University of Rochester, Rochester, New York
  • 3Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
JAMA. 2021;326(6):477-478. doi:10.1001/jama.2021.12070

Elective total hip and knee replacements (“joint replacements”) are effective treatments for end-stage osteoarthritis. Because of the clinical benefits of these procedures, racial and ethnic– and income-based disparities in the use and outcomes of these surgical procedures are particularly troubling. According to data from 2009 to 2017, joint replacements were less common for Black Medicare beneficiaries compared with White beneficiaries (in 2017, rates of 2.80 total hip replacements and 6.13 total knee replacements both per 1000 beneficiaries for Black beneficiaries and 4.77 total hip replacements and 9.93 total knee replacements both per 1000 beneficiaries for White beneficiaries), and income was a significant moderator of this relationship.1 These disparities have persisted for decades despite targeted interventions that have been implemented locally to address the patient-, clinician-, and system-level causes. Hence, large-scale national reform to mitigate these marked disparities is needed.2 The Triple Aim framework, which conveys the idea that health systems need to simultaneously optimize over multiple interlinked yet diverse goals including care experience, population health, and per-capita costs,3 may provide a model for incorporating disparity reduction into the goals of payment reform.

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