{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:46:18Z","timestamp":1787755578907,"version":"build-2784847793"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,6,18]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Traditional Medicare (TM) claims data are widely used by researchers and registries to report survivorship following total knee arthroplasty (TKA). The purpose of the present study was to investigate whether the mass exodus of patients from TM to Medicare Advantage (MA) has compromised the fidelity of TM data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We identified 11,717 Medicare-eligible patients (15,282 knees) who had undergone primary TKA from 2000 to 2020 at a single institution. Insurance type was analyzed, and 84% of TKAs were covered by TM. The rates of survivorship free from revision or reoperation were calculated for patients with TM coverage. The same survivorship end points were recalculated after censoring of patients who transitioned to MA after primary TKA, thereby modeling the impact of losing patients from the TM dataset. Differences in survivorship were compared. The mean duration of follow-up was 10 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>From 2000 to 2020, there was a decrease in TM insurance (from 94% to 68%) and a corresponding increase in MA insurance (from 0% to 19%) among patients undergoing TKA. Following TKA, 25% of patients with TM coverage switched to MA. For patients with TM at the time of surgery, the 15-year rates of survivorship free from any reoperation or revision were 90% and 96%, respectively. When patients were censored upon transition from TM to MA, the 15-year rates of survivorship free from any reoperation (92% versus 90%; hazard ratio [HR] = 1.2; p = 0.001) or any revision (97% versus 96%; HR = 1.3; p = 0.002) were significantly higher.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>One in 4 patients left TM for MA after primary TKA, effectively making them lost to follow-up within TM datasets. The mass exodus of patients out of TM resulted in falsely elevated estimates of survivorship free from reoperation and from revision, with increasing divergence in survivorship over time, when MA data were excluded. As MA continues to grow, efforts to incorporate these data will become increasingly important.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.24.00993","type":"journal-article","created":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T14:00:55Z","timestamp":1745589655000},"page":"1371-1376","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["The Rise of Medicare Advantage is Impacting the Fidelity of Traditional Medicare Claims Data"],"prefix":"10.2106","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5062-7010","authenticated-orcid":false,"given":"Xiao T.","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7583-6094","authenticated-orcid":false,"given":"Amy E.","family":"Glasgow","sequence":"additional","affiliation":[{"name":"Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1140-003X","authenticated-orcid":false,"given":"Elizabeth B.","family":"Habermann","sequence":"additional","affiliation":[{"name":"Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota"},{"name":"Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1293-1702","authenticated-orcid":false,"given":"Nathanael D.","family":"Heckmann","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Keck School of Medicine, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6980-6246","authenticated-orcid":false,"given":"John J.","family":"Callaghan","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Iowa, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3101-9129","authenticated-orcid":false,"given":"David G.","family":"Lewallen","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1422-0306","authenticated-orcid":false,"given":"Daniel J.","family":"Berry","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3151-877X","authenticated-orcid":false,"given":"Nicholas A.","family":"Bedard","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,4,25]]},"reference":[{"key":"bib1-20250618","doi-asserted-by":"crossref","first-page":"267","DOI":"10.2147\/CLEP.S105613","article-title":"Use of the Medicare database in epidemiologic and health services research: a valuable source of real-world evidence on the older and disabled populations in the US","volume":"9","author":"Mues","year":"2017","journal-title":"Clin Epidemiol."},{"key":"bib2-20250618","article-title":"Data.CMS.gov","year":"2024","journal-title":"Medicare Monthly Enrollment."},{"issue":"6","key":"bib4-20250618","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1377\/hlthaff.2020.02149","article-title":"Comparing Medicare Advantage And Traditional Medicare: A Systematic Review","volume":"40","author":"Agarwal","year":"2021","journal-title":"Health Aff (Millwood)."},{"issue":"2","key":"bib6-20250618","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1111\/1468-0009.12061","article-title":"How successful is Medicare Advantage?","volume":"92","author":"Newhouse","year":"2014","journal-title":"Milbank Q."},{"issue":"22","key":"bib7-20250618","doi-asserted-by":"crossref","first-page":"2163","DOI":"10.1056\/NEJMhpr1804089","article-title":"Medicare Advantage Checkup","volume":"379","author":"Neuman","year":"2018","journal-title":"N Engl J Med."},{"issue":"12","key":"bib8-20250618","doi-asserted-by":"crossref","first-page":"2609","DOI":"10.1377\/hlthaff.2012.0179","article-title":"Analysis Of Medicare Advantage HMOs compared with traditional Medicare shows lower use of many services during 2003-09","volume":"31","author":"Landon","year":"2012","journal-title":"Health Aff (Millwood)."},{"issue":"5","key":"bib11-20250618","doi-asserted-by":"crossref","first-page":"e221781","DOI":"10.1001\/jamahealthforum.2022.1781","article-title":"Federal Investigators Find Medicare Advantage Plans Too Often Deny, Delay Needed Care","volume":"3","author":"Stephenson","year":"2022","journal-title":"JAMA Health Forum."},{"issue":"6","key":"bib12-20250618","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1200\/JCO.21.01359","article-title":"Medicare Advantage: A Disadvantage for Complex Cancer Surgery Patients","volume":"41","author":"Raoof","year":"2023","journal-title":"J Clin Oncol."},{"issue":"24","key":"bib15-20250618","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":"Wang","year":"2022","journal-title":"J Bone Joint Surg Am."},{"issue":"344","key":"bib17-20250618","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1097\/00003086-199711000-00007","article-title":"Maintaining a hip registry for 25 years. Mayo Clinic experience","author":"Berry","year":"1997","journal-title":"Clin Orthop Relat Res."},{"issue":"9","key":"bib18-20250618","doi-asserted-by":"crossref","first-page":"2319","DOI":"10.1002\/jor.24014","article-title":"Arthroplasty implant registries over the past five decades: Development, current, and future impact","volume":"36","author":"Malchau","year":"2018","journal-title":"J Orthop Res."},{"issue":"9S2","key":"bib19-20250618","doi-asserted-by":"crossref","first-page":"S241","DOI":"10.1016\/j.arth.2024.03.014","article-title":"Is the Rise of Medicare Advantage Impacting the Fidelity of Traditional Medicare Claims Data? Implications for Reporting of Long-Term Total Hip Arthroplasty Survivorship","volume":"39","author":"Chen","year":"2024","journal-title":"J Arthroplasty."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.24.00993","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:44:16Z","timestamp":1787751856000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.24.00993"}},"subtitle":["Implications for Reporting of Long-Term Total Knee Arthroplasty Survivorship"],"short-title":[],"issued":{"date-parts":[[2025,4,25]]},"references-count":12,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.24.00993","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,25]]}}}