Date of Award


Document Type

Open Access

Degree Name

Bachelor of Science


Gender, Sexuality and Women's Studies

First Advisor

Dr. Melinda Goldner


Accountable Care Organization, total knee arthroplasty, total hip arthroplasty, gender, cost


Background. Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are commonly performed procedures, with over one million executed each year in the United States (U.S.) (Steiner et al., 2012). By 2030, THA and TKA are projected to become the most frequently performed elective surgical procedures in the U.S. (Cram et al., 2012; Kurtz et al., 2009). Many of the previous studies on THA and TKA procedures have focused on women, primarily because they are at increased risks of developing knee osteoarthritis and sustaining hip fractures (Cummings et al., 1990; Hedlund et al., 1987; Hinton et al., 1995; Myers et al., 1991; Ray et al., 1997; Schrøder & Erlandsen, 1993; Srikanth et al., 2005). However, there is increasing evidence suggesting that there are differences in postoperative outcomes between male and female patients undergoing these procedures (Dalury et al., 2009; Dzupa et al., 2002; Elliott et al., 2003; Endo et al., 2005; Fox et al., 1994; Fransen et al., 2002; Lavernia et al., 2009; Lim et al., 2015; MacDonald et al., 2008; Ritter et al., 2008; Schrøder & Erlandsen, 1993; Trombetti et al., 2002).

Purpose. To compare post-surgical outcomes after THA and TKA procedures between male and female patients part of a physician-led Accountable Care Organization (ACO) participating in the Medicare Shared Savings Program (MSSP) located in the western U.S. and to determine whether this MSSP ACO has been successful in decreasing these patients’ total costs of health care.

Methods. The physician-led MSSP ACO provided cost and health risk data on their male and female beneficiaries who underwent THA and TKA procedures between the years 2016 and 2018. Health risk data only analyzed patients during the postoperative period. One hundred fifty-six men and 291 women were analyzed in this study.

Results. Most patients who underwent THA and TKA procedures between 2016 and 2018 in this MSSP ACO had Medicare insurance (n=329; 81.7%) and were predominantly Non-Hispanic White (n=365; 81.7%). Over three years (2016-2018), men had a greater average risk stratification score than women (17.7 vs. 15.7), indicating that men undergoing THA and TKA procedures have worse overall health than women undergoing the same procedures. Women had greater total costs of health care than men between 2016 and 2017; however, in 2018, men had greater total costs of care than women. When the patient sample was divided by insurance types, Medicare-only patients had lower total costs of care than dual-eligible patients-those with both Medicare and Medicaid insurance- for all three years. Over the three years, the MSSP ACO was successful in decreasing the total costs of care for its male and female patients who underwent THA and TKA procedures (5.66% and 18.4%, respectively). Also, Medicare-only patients’ average total cost of care decreased by 11.47%, and dual-eligible patients’ average total cost of care decreased by 20.7%.

Conclusion. Male sex/gender was linked with worse health after undergoing THA and TKA procedures. This MSSP ACO was able to decrease its beneficiaries’ total costs of care over three years. Thus, MSSP ACOs may show promise in reducing health care costs for their beneficiaries. Policymakers should offer more support to MSSP ACOs for helping them realize increased revenues.