Monday, December 15, 2025 12/15/2025

Effects of Musculoskeletal Surgery Rates on Outcomes

Award Number: R01HS027177
ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY
OPDIV: AHRQ
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/30/2020
PERIOD OF PERFORMANCE END DATE: 05/31/2026

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Effects of Musculoskeletal Surgery Rates on Outcomes - Musculoskeletal (MSK) conditions affect more than half of the U.S. population and account for 1 in 5 healthcare visits. MSK care annual costs exceed $176 billion in direct and $876 billion in indirect healthcare costs and show large increases in per capita costs. Yet, there is remarkably little Level I evidence supporting this level of healthcare utilization with little consensus on proper treatment approaches across MSK conditions. Because of difficulties with randomization and blinding, less than 10% of MSK related-studies are clinical trials, and of the trials, less than 40% meet minimal guidelines. Thus, it is not surprising that substantial geographic variation exists in the use of invasive and costly treatments for MSK conditions. Using anecdotes, the popular press suggests that early surgery for new MSK conditions is overused. Simulation studies suggest that lower utilization rates of treatments not supported by clinical evidence, like surgery for MSK conditions, can dramatically lower Medicare costs without sacrificing quality. However, beyond anecdote and simulation studies, there is no evidence supporting the notion that lower surgery rates for patients with MSK conditions will lower costs and maintain quality. Lower surgery rates may keep surgery from patients who would benefit little from surgery. Conversely, lower surgery rates may result in many patients delaying beneficial treatment causing MSK conditions to worsen and result in poorer outcomes and higher long run costs. Our approach is to use the documented geographic variation in early surgery rates as natural experiments and apply instrumental variable estimators to assess the impact of higher rates of early surgery on outcomes and costs. In addition, we will use charts abstracted for a sample of patients to measure confounders unmeasured in Medicare claims to assess the assumptions underlying our natural experiment. We will then carefully interpret our estimates considering the outcomes measured and the validity of the assumptions associated with treatment effect heterogeneity and confounding. The investigative team has substantial experience assessing treatment effectiveness using Medicare data and a strong MSK clinical and empirical background. This study builds on our shoulder-related research using Medicare data from 2011. It will identify important relationships between early surgery choice, treatment success and costs for patients with MSK conditions. AHRQ has authority to conduct and support research to reﬂect the needs and priorities of the Medicare program. This research will provide key evidence for policy makers to assess whether early surgery for these MSK conditions are over or underused in practice for Medicare patients. Our study goals align with AHRQ’s goal of “producing evidence that can be used to increase the affordability and efficiency of health care”. 1


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $0 )
2026	2023	UNIVERSITY OF SOUTH CAROLINA	1600 HAMPTON ST	COLUMBIA	SC	29208	RICHLAND	USA	Research on Healthcare Costs, Quality and Outcomes	000	4	12/8/2025	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2024 ( Subtotal = $0 )
2024	2023	UNIVERSITY OF SOUTH CAROLINA	1600 HAMPTON ST	COLUMBIA	SC	29208	RICHLAND	USA	Research on Healthcare Costs, Quality and Outcomes	000	4	6/13/2024	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2023 ( Subtotal = $214,148 )
2023	2023	UNIVERSITY OF SOUTH CAROLINA	1600 HAMPTON ST # 414	COLUMBIA	SC	29208	RICHLAND	USA	Research on Healthcare Costs, Quality and Outcomes	000	4	7/31/2023	NON-COMPETING CONTINUATION	$214,148
														Subtotal = $214,148

Issue Date FY: 2022 ( Subtotal = $373,790 )
2022	2022	UNIVERSITY OF SOUTH CAROLINA	1600 HAMPTON ST # 414	COLUMBIA	SC	29208	RICHLAND	USA	Research on Healthcare Costs, Quality and Outcomes	000	3	7/26/2022	NON-COMPETING CONTINUATION	$373,790
														Subtotal = $373,790

Issue Date FY: 2021 ( Subtotal = $382,756 )
2021	2021	UNIVERSITY OF SOUTH CAROLINA	1600 HAMPTON ST # 414	COLUMBIA	SC	29208	RICHLAND	USA	Research on Healthcare Costs, Quality and Outcomes	000	2	8/12/2021	NON-COMPETING CONTINUATION	$382,756
														Subtotal = $382,756

Issue Date FY: 2020 ( Subtotal = $399,999 )
2020	2020	UNIVERSITY OF SOUTH CAROLINA	1600 HAMPTON ST # 414	COLUMBIA	SC	29208	RICHLAND	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	9/9/2020	NEW	$399,999
														Subtotal = $399,999

Grand Total All Awards = $1,370,693

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Effects of Musculoskeletal Surgery Rates on Outcomes

Award Number: R01HS027177

ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY

OPDIV: AHRQ

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 09/30/2020

PERIOD OF PERFORMANCE END DATE: 05/31/2026

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