Geospatial Trends in Insurance Payor Reimbursements Based on Area Deprivation Index for Total Ankle Arthroplasty across Southwestern Pennsylvania
Authors: Findlay Garcia , Munoz Marfred Umanes , Cotton Kenzo M. , Scott Devon , Smith Richard Michael , Cain Jarrett D. , Lewis Lauren , Hogan Macalus V. 
Published: December 2024

Category: Ankle Arthritis; Trauma Introduction/Purpose: Total ankle arthroplasty (TAA) is increasing in popularity as a viable alternative to arthrodesis in the management of ankle osteoarthritis. Existing disparities in patients' access to and utilization of TAA, as well as unequal insurance payor reimbursements have significant public health implications. Equitable medical coverage hinges on the interplay between socioeconomic factors and quality metrics. Limited information exists regarding geospatial trends in the utilization of TAA and medical insurance payor types. The Area Deprivation Index (ADI) illustrates relative socioeconomic conditions of neighborhoods and can elucidate variations in payor types. Our study analyzes the geospatial trends in medical reimbursement types and TAA utilization across Southwestern Pennsylvania whether a significant association between neighborhood socioeconomic conditions, as measured by the ADI, and reimbursement type exists. Methods: Institutional review board approval was obtained (IRB 20020136). Data from an institution-based registry was prospectively collected and queried for patients who underwent TAA for ankle osteoarthritis between 2017 and 2021. Demographics including age, sex, race, home address, and insurance payor type were collected. Home addresses were converted to geographic coordinates using Google Maps API and visualized with R-Tool geospatial mapping based on insurance payor. The Pennsylvania ADI dataset from 2020-2021 was obtained, was obtained, providing ADI comprised of cores for 9,740 block groups. Home addresses were additionally geocoded to census block groups. Correlation analyses and ANOVA with Post Hoc Tukey analyses were performed to analyze geospatial trends among Medicare, Medicaid, commercial and self-pay insurance payors based on ADI scores. Results: The cohort consisted of 278 patients who underwent TAA, with a mean age of 65 ± 9 years, 156 (56%) were males, and 266 (96%) were White. Among the reimbursements, 161 (54%) were covered by Medicare, 100 (36%) had commercial insurance, 14 (5%) had Medicaid insurance, and 3 (1%) were self-pay insurance payors. The mean national ADI scores for Medicare, commercial, Medicaid, and self-pay insurance payors were 62.07 ±21.96, 57.28 ±22.36, 75.5 ±20.08 and 83 ±11.36 respectively, and mean state ADI were 5.66 ±2.64, 5.17 ±2.64, 7.5 ±2.59 and 8.33 ±1.53 respectively. ANOVA demonstrated significant differences among state ADI (p = 0.005) and national ADI (p = 0.008) scores, with significant differences additionally found between commercial and Medicaid reimbursements at the national and state level. Conclusion: This study identified disparities in TAA utilization among insurance payor populations in Southwestern Pennsylvania. Our study found significant differences among varying ADIs and insurance payor types in patients undergoing TAA procedures. Our findings demonstrate that more disadvantaged neighborhoods in Southern Pennsylvania have lower TAA utilization, and increased rates of commercial and Medicaid insurance payor types. A larger sample size is necessary to validate the results of this study.