Arthroplasty Surgeons Taking Care of the Highest Social Risk Populations Are More Often Osteopathic Trained, Less Experienced, and More Likely to be Penalized by the Merit Based Incentive Payment System.

Background: The purpose of this study was to examine how hip and knee arthroplasty surgeon Merit-based Incentive Payment System (MIPS) performance, surgeon demographics, practice characteristics, and patient population varied based on the social risk of their caseload in 2017 and 2021. Methods: Multiple databases published by the Centers for Medicare and Medicaid Services were combined and utilized to examine all US hip and knee arthroplasty surgeons. Surgeons were placed into quintiles of social risk based on the proportion of dual-eligible Medicare-Medicaid patients in their patient population. Demographics, Distressed Community Index scores, patient population information, and MIPS performance were compared between quintiles in years 2017 and 2021. Results: In 2017, arthroplasty surgeons with the highest social risk caseloads scored lower on MIPS (70.0 vs 73.5, Conclusions: These findings suggest that while policy adjustments have started to address inequities in performance assessments, they are not sufficient. More work needs to be done to ensure equitable reimbursements for hip and knee arthroplasty surgeons providing care to the most vulnerable patients.