title: What is the level of evidence substantiating the Medicare local coverage determinations?
abstract: Total joint arthroplasty (TJA) accounts for large expenditures of Medicare resources. Recovery audit contractors (RACs) utilize Local Coverage Determinations (LCDs) documents to retrospectively assess the medical necessity of performed procedures. The Florida LCD requires 3 months of documented unsuccessful nonoperative care prior to TJA. The purpose of our study was to evaluate the applicability and quality of the evidence cited in the Florida LCD for patients undergoing TJA. Applicability was assessed by evaluating the efficacy of nonoperative treatment in candidates for TJA. There were 23 citations, of which 11 mentioned nonoperative treatment and only 5 provided references. No citations provided Level I or II evidence substantiating the effectiveness of 3 months of nonoperative treatment in patients who would otherwise be candidates for TJA.
authors.affiliation: Rothman Institute, Philadelphia, Pennsylvania.
authors.forename: Antonia F
authors.initials: AF
authors.lastname: Chen
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Bloomfield
authors.affiliation: Stanford University Department of Orthopaedic Surgery, Redwood City, California.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Lichstein
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Adolph J
authors.initials: AJ
authors.lastname: Yates
authors.affiliation: Rothman Institute, Philadelphia, Pennsylvania.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Austin
mesh_terms: D000368:Aged; D019643:Arthroplasty, Replacement; D019317:Evidence-Based Medicine; D005260:Female; D005431:Florida; D006801:Humans; D007592:Joint Diseases / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D008297:Male; D006278:Medicare / Q000191:economics*; D012189:Retrospective Studies; D014481:United States
keywords: Local Coverage Determinations; level of evidence; non-operative treatment; quality of evidence; recovery audit contractors; total joint arthroplasty