Pay-For-Performance in Total Joint Arthroplasty: Correlation between Payer-Defined Performance Measures, Patient Outcomes, and Cost of Care

Recent concerns over rising health care costs in the United States and significant variations in clinical practice patterns have led some payers to create pay-for-performance (P4P) programs to incentivize higher-quality, more cost-efficient care. However, the performance measures used in many P4P programs are not evidence-based, calling into question their relevance in improving quality and reducing costs. The purpose of this study was to evaluate differences in practice patterns related to total hip arthroplasty (THA) and total knee arthroplasty (TKA) in a commercially insured population and to determine whether adherence to payer-defined guidelines for THA and TKA are associated with improved patient outcomes and lower overall cost of care.