568 - Trends and Disparities in Knee Viscosupplementation Injections

Friday, February 23, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

Joseph A. Aguirre, III, n/a

PGY-3
Northwestern/SRAL
Chicago, Illinois, United States

Co-Author(s)

SB

Seth Bires, DO

Assistant Professor
SIU Medicine
Springfield, Illinois, United States
DL

Debbie Lee, MD

Assistant Professor
Northwestern University Feinberg School of Medicine / Shirley Ryan Abilitylab
Chicago, Illinois, United States

Objectives: Among healthcare disparities, insurance type is routinely cited to play a major factor in whether a patient receives a recommended procedure. Currently, there is no known literature on how insurance type affects patients' ability to receive knee viscosupplementation injections (KVIs), a common treatment for knee pain secondary to osteoarthritis. The primary objective was to investigate how insurance type affects the authorization process for various KVIs. Secondary objectives were to assess time to verify approval status based on payor, and to identify current trends in demographic and clinical factors for patients for KVIs.

Design: A retrospective chart review of outpatient recipients of KVIs between ages of 18-89 from dates 1/1/2020-12/31/2022 at Shirley Ryan AbilityLab was performed. Outcome measures included authorization status (no prior authorization needed, approved with modification, approved without modification) and duration of days to approval.

Results: 118 subjects (72 Female, 46 Male) were included in the analysis, 14 of whom had Medicaid, 55 Medicare, 49 private insurance. 71.4% with Medicaid required approval with or without modification, 94.5% Medicare and 64% private insurances did not require prior authorization (p=0.001). No significant difference in mean time to approval with Medicare (2.69 days), Medicaid (8.29 days) and private insurances (4.64 days). 54.2% of patients identified as Non-Hispanic White, 21.1% as Non-Hispanic Black, and 5.9% as Hispanic. Race was significantly associated (p< 0.001) with mean median household income of $100,835.66 (±37188.28), $60,335.04 (±26277.17), and $77,486.71 (±31550.99), respectively. 42.9% of Hispanic and 36% of Black patients required prior authorization compared to 17.2% of Non-Hispanic Whites.

Conclusions: A larger proportion of Medicaid patients as well as Hispanic and Black patients required prior authorization, though payor type did not significantly impact time to approval. While knee osteoarthritis may be more common among African Americans, there was a significantly larger percentage of Non-Hispanic White who were referred for KVIs.