Payment Reform for Degenerative Joint Disease

Degenerative joint disease, also known as osteoarthritis (OA), is a leading cause of adult disability and affects over 30 million American adults. Direct costs for osteoarthritis and other non-traumatic joint disorders top $80 billion a year and will grow significantly in coming years. Beyond costs, care for this disease is frequently uncoordinated, varies dramatically, and often does not follow evidence-based guidelines.

Initial payment reforms have focused on joint replacement surgery, and those have shown promise in reducing costs and improving outcomes. There’s further opportunities to move upstream and help people at earlier stages, which may help many avoid surgery and improve outcomes and experiences for a much broader group of people.

On January 26, 2018, Duke-Margolis, in partnership with the Duke Department of Orthopaedic Surgery and Department of Surgery and Perioperative Care at Dell Medical School at UT-Austin and supported by Pfizer, convened stakeholders from across the health care sector to review opportunities for improving degenerative joint disease care and to reach consensus on the core components of a degenerative joint disease payment model. This included discussions on the foundational elements of payment model design; specific challenges in defining, designing, and implementing a payment model that could address the entire condition; and needed infrastructure for better care, including practice culture and data infrastructure. 

Duke-Margolis and its partners plan follow up activities and publications. Sufficient agreement will lay the groundwork for creating an actionable model.