Hospital-Physician Integration and Differences in the Use of Orthopedic Care Across Race and Ethnicity

OBJECTIVES: To determine if hospital-orthopedist integration is associated with larger or smaller race and ethnicity gaps in the utilization of total knee arthroplasty (knee replacement) and physical therapy among Medicare beneficiaries. DATA SOURCES AND STUDY SETTING: Inpatient and outpatient Medicare claims data from 2015 to 2021. STUDY DESIGN: Retrospective study of patients newly diagnosed with osteoarthritis. We compared utilization among patients of hospital-integrated orthopedists and independent orthopedists. PRINCIPAL FINDINGS: A total of 18% of patients received knee replacements, and 32% received physical therapy within 12 months of an initial osteoarthritis diagnosis. Black patients were less likely to receive knee replacements (-6.6 percentage points, 95% CI: -7.6 to -5.6) and physical therapy (-9.3, 95% CI: -10.5 to -8.0) than White patients. Hispanic patients' likelihood of knee replacements and physical therapy was not statistically different from that of White patients. Hospital-orthopedist integration was not associated with receipt of knee replacements but was negatively associated with receipt of physical therapy (-9.5 percentage points, 95% CI: -10.1 to -8.8). Race/ethnicity differences persisted across practice settings: the interaction between orthopedist integration status and race/ethnicity did not affect the likelihood of receiving knee replacements or physical therapy. CONCLUSIONS: Disparities persisted across both hospital-integrated and independent settings for Black patients. As large integrated health systems become dominant, policymakers may need to create incentives that harness their strengths to close care gaps.