{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T23:19:59Z","timestamp":1783466399449,"version":"3.55.0"},"reference-count":40,"publisher":"Georg Thieme Verlag KG","issue":"09","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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\u2009&lt;\u20090.001) and 1-year (53.5 vs. 61.9%, p\u2009&lt;\u20090.001). However, MA enrollment was not independently associated with the need for active follow-up (odds ratio [OR]\u2009=\u20090.99, 95% confidence interval [CI]\u2009=\u20090.89\u20131.10; p\u2009=\u20090.79). Instead, increased follow-up burden was associated with older age (OR\u2009=\u20091.16 per interquartile range), non-White race (Black: OR\u2009=\u20091.89; Other: OR\u2009=\u20091.79), greater Area Deprivation Index (OR\u2009=\u20091.15), and poorer baseline physical\/mental health (Pain\u2009\u2212\u2009PS\u2009\u2212\u2009MCS phenotype: OR\u2009=\u20091.40; all p\u2009&lt;\u20090.01). 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.<\/jats:p>","DOI":"10.1055\/a-2778-9046","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T00:17:17Z","timestamp":1767053837000},"page":"455-462","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.1055","volume":"39","author":[{"given":"Benjamin E.","family":"Jevnikar","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled A.","family":"Elmenawi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuxuan","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuta","family":"Umeda","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed K.","family":"Emara","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3007-7538","authenticated-orcid":false,"given":"Nicolas S.","family":"Piuzzi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Cleveland Clinic Adult Reconstruction Research (CCARR)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,1,13]]},"reference":[{"issue":"05","key":"ref1","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1016\/j.arth.2024.01.038","article-title":"Implementation of the new Medicare-mandated patient-reported outcomes after joint arthroplasty performance measure","volume":"39","author":"J F Plate","year":"2024","journal-title":"J Arthroplasty"},{"issue":"13","key":"ref2","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.2106\/JBJS.23.01013","article-title":"New CMS policy on the mandatory collection of patient-reported outcome measures for total hip and knee arthroplasty by 2027: what orthopaedic surgeons should know","volume":"106","author":"I Pasqualini","year":"2024","journal-title":"J Bone Joint Surg Am"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"S100","DOI":"10.1016\/j.arth.2025.04.034","article-title":"Medicare reimbursement for primary and revision total hip and knee arthroplasty: an updated analysis from 2000 to 2024","volume":"40","author":"R Palmer","year":"2025","journal-title":"J Arthroplasty"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"S105","DOI":"10.1016\/j.arth.2025.04.088","article-title":"Medicare reimbursement for primary hip and knee arthroplasty is disproportionately decreasing relative to other high-volume inpatient procedures: leader of the pack","volume":"40","author":"R C Palmer","year":"2025","journal-title":"J Arthroplasty"},{"issue":"02","key":"ref5","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1377\/hlthaff.2022.00668","article-title":"Substantial growth in Medicare Advantage and implications for reform","volume":"42","author":"E Trish","year":"2023","journal-title":"Health Aff (Millwood)"},{"issue":"09","key":"ref6","first-page":"1203","article-title":"Medicare switching: patterns of enrollment growth in Medicare Advantage, 2006-22","volume":"42","author":"L Xu","year":"2023","journal-title":"Health Aff (Millwood)"},{"issue":"11","key":"ref7","doi-asserted-by":"crossref","first-page":"2799","DOI":"10.1016\/j.arth.2025.05.082","article-title":"Comparing Medicare and non-Medicare inpatient total knee arthroplasty: is the new Centers for Medicare and Medicaid Services patient-reported outcomes performance measure mandate applicable to all?","volume":"40","author":"K A Elmenawi","year":"2025","journal-title":"J Arthroplasty"},{"issue":"24","key":"ref8","doi-asserted-by":"crossref","first-page":"2145","DOI":"10.2106\/JBJS.22.00254","article-title":"The rise of Medicare Advantage: effects on total joint arthroplasty patient care and research","volume":"104","author":"J C Wang","year":"2022","journal-title":"J Bone Joint Surg Am"},{"issue":"10","key":"ref9","doi-asserted-by":"crossref","first-page":"e541","DOI":"10.5435\/JAAOS-D-24-01000","article-title":"The new Centers for Medicare and Medicaid Services patient-reported outcome-based performance measure: what it means and how can I align","volume":"33","author":"L M Shapiro","year":"2025","journal-title":"J Am Acad Orthop Surg"},{"issue":"04","key":"ref10","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1377\/hlthaff.2022.00891","article-title":"Differences in use of services and quality of care in Medicare Advantage and Traditional Medicare, 2010 and 2017","volume":"42","author":"B E Landon","year":"2023","journal-title":"Health Aff (Millwood)"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"198","DOI":"10.2106\/JBJS.23.00507","article-title":"Medicare Advantage is associated with lower utilization of total joint arthroplasty","volume":"106","author":"K E Anderson","year":"2024","journal-title":"J Bone Joint Surg Am"},{"issue":"12","key":"ref12","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.2106\/JBJS.24.00993","article-title":"The rise of Medicare Advantage is impacting the fidelity of Traditional Medicare claims data: implications for reporting of long-term total knee arthroplasty survivorship","volume":"107","author":"X T Chen","year":"2025","journal-title":"J Bone Joint Surg Am"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2025.07.045","article-title":"Inpatient Medicare total hip arthroplasties have distinct characteristics and are less likely to achieve substantial clinical benefit for hip disability and osteoarthritis outcome score for joint replacement: implications for Centers for Medicare and Medicaid Services patient-reported outcome measures policy","author":"I Pasqualini","year":"2025","journal-title":"J Arthroplasty"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1055\/a-2693-0702","article-title":"Comparable PROM gains and satisfaction after TKA in Medicare Advantage vs. Traditional Medicare: a multivariable analysis of 6,010 patients","author":"B E Jevnikar","year":"2025","journal-title":"J Knee Surg"},{"issue":"11","key":"ref15","doi-asserted-by":"crossref","first-page":"3479","DOI":"10.1016\/j.arth.2018.07.011","article-title":"Validation of a novel surgical data capturing system following total hip arthroplasty","volume":"33","author":"G L Curtis","year":"2018","journal-title":"J Arthroplasty"},{"issue":"05","key":"ref16","doi-asserted-by":"crossref","first-page":"458","DOI":"10.2106\/JBJS.18.00767","article-title":"Implementing a scientifically valid, cost-effective, and scalable data collection system at point of care: the Cleveland Clinic OME cohort","volume":"101","author":"O ME Cleveland","year":"2019","journal-title":"J Bone Joint Surg Am"},{"issue":"05","key":"ref17","doi-asserted-by":"crossref","first-page":"419","DOI":"10.2106\/JBJS.19.00531","article-title":"Value in research: achieving validated outcome measurements while mitigating follow-up cost","volume":"102","author":"O ME Cleveland","year":"2020","journal-title":"J Bone Joint Surg Am"},{"key":"ref18","first-page":"329","article-title":"Expanding the scope of Centers for Medicare and Medicaid Services patient-reported outcome measures mandatory reporting: evaluating total hip arthroplasty outcomes beyond substantial clinical benefit for hip disability and osteoarthritis outcome score-joint replacement","volume":"41","author":"K A Elmenawi","year":"2025","journal-title":"J Arthroplasty"},{"issue":"09","key":"ref19","doi-asserted-by":"crossref","first-page":"2166","DOI":"10.1016\/j.arth.2024.04.028","article-title":"A nationwide analysis of the impact of socioeconomic status on complications and health care utilizations after total knee arthroplasty using the area deprivation index: consideration of the disadvantaged patient","volume":"39","author":"A M Gordon","year":"2024","journal-title":"J Arthroplasty"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"S37","DOI":"10.1016\/j.arth.2022.01.032","article-title":"Neighborhood socioeconomic disadvantages associated with prolonged lengths of stay, nonhome discharges, and 90-day readmissions after total knee arthroplasty","volume":"37","author":"A Khlopas","year":"2022","journal-title":"J Arthroplasty"},{"issue":"10","key":"ref21","doi-asserted-by":"crossref","first-page":"1980","DOI":"10.1016\/j.arth.2022.04.041","article-title":"Neighborhood socioeconomic disadvantage associated with increased healthcare utilization after total hip arthroplasty","volume":"37","author":"D Grits","year":"2022","journal-title":"J Arthroplasty"},{"issue":"03","key":"ref22","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1016\/j.arth.2024.09.014","article-title":"Neighborhood socioeconomic disadvantage is associated with increased health care utilization after septic and aseptic revision total hip arthroplasty","volume":"40","author":"B E Jevnikar","year":"2025","journal-title":"J Arthroplasty"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.knee.2024.08.006","article-title":"Impacts of neighborhood deprivation on septic and aseptic revision total knee arthroplasty outcomes: a comprehensive analysis using the area deprivation index","volume":"51","author":"B E Jevnikar","year":"2024","journal-title":"Knee"},{"issue":"02","key":"ref24","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1097\/CORR.0000000000002392","article-title":"Racial disparities in outcomes after THA and TKA are substantially mediated by socioeconomic disadvantage both in Black and White patients","volume":"481","author":"M J Hadad","year":"2023","journal-title":"Clin Orthop Relat Res"},{"issue":"01","key":"ref25","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1097\/BRS.0000000000004459","article-title":"Opioid and sedative NarxCare Scores greater than 300 are associated with adverse outcomes after nonemergent spine surgery","volume":"48","author":"A K Emara","year":"2023","journal-title":"Spine"},{"issue":"02","key":"ref26","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1016\/j.arth.2024.07.041","article-title":"Predictive modeling of medical and orthopaedic-related 90-day-readmissions following primary total knee arthroplasty","volume":"40","author":"S T Khan","year":"2025","journal-title":"J Arthroplasty"},{"issue":"22","key":"ref27","doi-asserted-by":"crossref","first-page":"e91","DOI":"10.2106\/JBJS.21.00030","article-title":"A call for a standardized approach to reporting patient-reported outcome measures: clinical relevance ratio","volume":"103","author":"M N Orr","year":"2021","journal-title":"J Bone Joint Surg Am"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"S498","DOI":"10.1016\/j.arth.2022.02.042","article-title":"Dissatisfaction after total hip arthroplasty associated with preoperative patient-reported outcome phenotypes","volume":"37","author":"M N Orr","year":"2022","journal-title":"J Arthroplasty"},{"issue":"11","key":"ref29","doi-asserted-by":"crossref","first-page":"2178","DOI":"10.1016\/j.arth.2022.05.033","article-title":"Preoperative Veterans Rand-12 Mental Composite Score of < 40 leads to increased healthcare utilization and diminished improvement after primary knee arthroplasty","volume":"37","author":"N B Rogers","year":"2022","journal-title":"J Arthroplasty"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"S258","DOI":"10.1016\/j.arth.2022.12.001","article-title":"Preoperative Veteran RAND-12 Mental Composite Score of >60 associated with increased likelihood of patient satisfaction after total hip arthroplasty","volume":"38","author":"D Grits","year":"2023","journal-title":"J Arthroplasty"},{"issue":"20","key":"ref31","doi-asserted-by":"crossref","first-page":"e910","DOI":"10.5435\/JAAOS-D-19-00609","article-title":"Costs and outcomes of Medicare Advantage and Traditional Medicare beneficiaries after total hip and knee arthroplasty","volume":"28","author":"M F Yayac","year":"2020","journal-title":"J Am Acad Orthop Surg"},{"issue":"09","key":"ref32","doi-asserted-by":"crossref","first-page":"2275","DOI":"10.1016\/j.arth.2025.02.040","article-title":"Associated risk of Medicaid and Medicare payer status on outcomes following total joint arthroplasty: a 10-year report","volume":"40","author":"M G DeClercq","year":"2025","journal-title":"J Arthroplasty"},{"issue":"03","key":"ref33","doi-asserted-by":"crossref","first-page":"e25.00127","DOI":"10.2106\/JBJS.OA.25.00127","article-title":"Lower 1-Year PROM completion rates and need for intensive follow-up in inpatient Medicare THA patients: implications for the CMS PROM policy","volume":"10","author":"K A Elmenawi","year":"2025","journal-title":"JBJS Open Access"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2025.10.023","article-title":"Implementing the total hip and knee arthroplasty patient-reported outcome-based performance measure in outpatient and ambulatory surgical center settings: a practical review of new Centers for Medicare and Medicaid Services policies","author":"I Pasqualini","year":"2025","journal-title":"J Arthroplasty"},{"issue":"10","key":"ref35","doi-asserted-by":"crossref","first-page":"879","DOI":"10.2106\/JBJS.23.00558","article-title":"How to raise the bar in the capture of patient-reported outcome measures in total joint arthroplasty: results from active and passive follow-up measures","volume":"106","author":"P J Rull\u00e1n","year":"2024","journal-title":"J Bone Joint Surg Am"},{"issue":"10","key":"ref36","doi-asserted-by":"crossref","first-page":"e1004459","DOI":"10.1371\/journal.pmed.1004459","article-title":"Cost-effectiveness of a patient-reported outcome-based remote monitoring and alert intervention for early detection of critical recovery after joint replacement: a randomised controlled trial","volume":"21","author":"L Sch\u00f6ner","year":"2024","journal-title":"PLoS Med"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2025.06.080","article-title":"Is it fair that patient-reported outcome measures completion is tied to reimbursement? patient demographics are associated with rates of PROM completion and potential health disparities","author":"J Laverdiere","year":"2025","journal-title":"J Arthroplasty"},{"key":"ref38","doi-asserted-by":"crossref","first-page":"S69","DOI":"10.1016\/j.arth.2023.01.005","article-title":"Non-English speakers and socioeconomic minorities are significantly less likely to complete patient-reported outcome measures for total hip and knee arthroplasty: analysis of 16,119 cases","volume":"38","author":"J A Konopka","year":"2023","journal-title":"J Arthroplasty"},{"key":"ref39","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2025.10.028","article-title":"Greater resource utilization for patient-reported outcome measures collection in Medicare inpatient versus outpatient total knee arthroplasty: implications for the new Centers for Medicare and Medicaid Services PRO-PM policy","author":"K A Elmenawi","year":"2025","journal-title":"J Arthroplasty"},{"key":"ref40","doi-asserted-by":"crossref","first-page":"S63","DOI":"10.1016\/j.arth.2022.09.026","article-title":"Poor patient compliance limits the attainability of patient-reported outcome measure completion thresholds for the comprehensive care for joint arthroplasty model","volume":"38","author":"R M Sutton","year":"2023","journal-title":"J Arthroplasty"}],"container-title":["The Journal of Knee Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2778-9046.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T22:30:38Z","timestamp":1783463438000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2778-9046"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,29]]},"references-count":40,"journal-issue":{"issue":"09","published-online":{"date-parts":[[2026,7,7]]},"published-print":{"date-parts":[[2026,7]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2778-9046","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1538-8506","1938-2480"],"issn-type":[{"value":"1538-8506","type":"print"},{"value":"1938-2480","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,12,29]]},"published":{"date-parts":[[2025,12,29]]}}}