Do Medicare Advantage Patients Require More Follow-up to Complete Patient-Reported Outcome Measures After Total Knee Arthroplasty? An Analysis of 7,267 Medicare Patients.

Patient-reported outcome measures (PROMs) are increasingly used to evaluate quality and guide reimbursement in total joint arthroplasty. While PROM collection is mandated for Traditional Medicare beneficiaries under value-based care models, little is known about how enrollment in Medicare Advantage (MA) affects PROM completion and follow-up burden in clinical practice. We analyzed a prospectively collected cohort of 7,267 Medicare patients who underwent primary total knee arthroplasty (TKA) between 2019 and 2023 at a large academic health system. Baseline and 1-year PROMs, including Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, Physical Function Short Form (PS), Veterans RAND-12 Mental Component Score (MCS) were collected through a structured digital and manual follow-up protocol. Multivariable logistic regression assessed predictors of requiring active (manual) outreach for 1-year PROMs. PROM completion rates were significantly lower among MA patients at both baseline (74.2 vs. 80.3%, p < 0.001) and 1-year (53.5 vs. 61.9%, p < 0.001). However, MA enrollment was not independently associated with the need for active follow-up (odds ratio [OR] = 0.99, 95% confidence interval [CI] = 0.89-1.10; p = 0.79). Instead, increased follow-up burden was associated with older age (OR = 1.16 per interquartile range), non-White race (Black: OR = 1.89; Other: OR = 1.79), greater Area Deprivation Index (OR = 1.15), and poorer baseline physical/mental health (Pain - PS - MCS phenotype: OR = 1.40; all p < 0.01). While MA patients are less likely to complete PROMs after TKA, they do not place greater follow-up demands on clinical teams. Disparities in PROM capture appear to reflect underlying patient complexity rather than insurance design. As Centers for Medicare and Medicaid Services may expand PROM-based reimbursement models to include MA populations, equitable reporting will require targeted outreach and structural risk adjustment to avoid penalizing systems that serve more vulnerable groups.