Shaina Lipa, MD completed her Orthopedic Residency in the Harvard Combined Orthopedic Residency Program and her spine fellowship at New York University Langone Medical Center. She was previously Vice Chair of the Massachusetts General Hospital Center for Diversity Inclusion Resident and Fellow Committee. Dr. Lipa is dedicated to the improvement of health and healthcare disparities, with a particular need for advocacy in orthopedic surgery. She aspires to improve musculoskeletal health and the healthcare disparities that women, African Americans, and Hispanics face with regard to more severe arthritis and functional limitations. She has a long history of involvement with the Student National Medical Association, serving as University of California, San Francisco (UCSF) chapter president and several regional leadership positions. She has mentored young men and women in pipeline programs, such as the Physicians Medical Form’s “Doctors On Board Program,” whose mission is to encourage more African American/Black students to become physicians. She was a recipient of the National Medical Fellowship Community Service-Learning Program, where she led an intervention program for women at high risk for violence. Dr. Lipa received her medical degree with distinction from the UCSF School of Medicine in 2014. During medical school, she participated in the Visiting Clerkship Program in the Office for Diversity Inclusion and Community Partnership at Harvard Medical School.
Shaina Lipa, MD, MPH
Spine Surgeon, Department of Orthopedic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
Does the implementation of Medicare Accountable Care Organizations (ACOs) reduce healthcare disparities among patients treated for spinal fractures?
Healthcare disparities associated with orthopedic surgical interventions are widely reported for racial and ethnic minorities. Documented disparities include reduced access to surgical services and higher rates of peri-operative complications. Recent healthcare reform efforts have been proposed as initiatives that would not only reduce costs and improve quality, but also lead to reductions in healthcare disparities. National changes in healthcare disparities within the setting of trauma care have not been examined within ACOs or non-ACOs. In this context, we examined the impact of Medicare ACO formation on post-treatment outcomes and surgical rates for White and non-white beneficiaries treated for spinal fractures.
Examine the impact of Accountable Care Organizations (ACO) on post-treatment outcomes (in-hospital mortality, 90-day complications and readmissions), as well as surgical intervention among Whites and non-Whites treated for spinal fractures.
We identified all beneficiaries treated for spinal fractures between 2009 and 2014 using national Medicare fee for service claims data. Claims were used to identify sociodemographic and clinical criteria, receipt of surgery and in-hospital mortality, 90-day complications and readmissions. Multivariable logistic regression analysis accounting for all confounders was used to determine the effect of race/ethnicity on outcomes. Non-Whites were compared to Whites treated in non-ACOs between 2009-2011 as the referent.
We identified 245,704 patients who were treated for spinal fractures. Two percent of the cohort received care in an ACO, while 7% were non-White. We found that disparities in the use of surgical fixation for spinal fractures were present in non-ACOs over the period 2009-2014 but did not exist in the context of care provided through ACOs (OR 0.75; 95% CI 0.44, 1.28). A disparity in the development of complications existed for non-Whites in non-ACOs (OR 1.09; 95% CI 1.01, 1.17) that was not encountered among non-Whites receiving care in ACOs (OR 1.32; 95% CI 0.90, 1.95). An existing disparity in readmission rates for non-Whites in ACOs over 2009-2011 (OR 1.34; 95% CI 1.01, 1.80) was eliminated in the period 2012-2014 (OR 0.85; 95% CI 0.65, 1.09).
Our work reinforces the idea that ACOs could improve healthcare disparities among non-Whites. There is also the potential that, as ACOs become more familiar with care integration and streamlined delivery of services, further improvements in disparities could be realized.
Preceptor: Andrew Schoenfeld, MD, MPH, Brigham and Women’s Center of Surgery and Public Health