Comparison of hospitals participating in Medicare's voluntary and mandatory orthopedic bundle programs

Amol S. Navathe, Joshua M. Liao, Daniel Polsky, Yash Shah, Qian Huang, Jingsan Zhu, Zoe M. Lyon, Robin Wang, Josh Rolnick, Joseph R. Martinez, Ezekiel J. Emanuel

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


We analyzed data from Medicare and the American Hospital Association Annual Survey to compare characteristics and baseline performance among hospitals in Medicare's voluntary (Bundled Payments for Care Improvement initiative, or BPCI) and mandatory (Comprehensive Care for Joint Replacement Model, or CJR) joint replacement bundled payment programs. BPCI hospitals had higher mean patient volume and were larger and more teaching intensive than were CJR hospitals, but the two groups had similar risk exposure and baseline episode quality and cost. BPCI hospitals also had higher cost attributable to institutional postacute care, largely driven by inpatient rehabilitation facility cost. These findings suggest that while both voluntary and mandatory approaches can play a role in engaging hospitals in bundled payment, mandatory programs can produce more robust, generalizable evidence. Either mandatory or additional targeted voluntary programs may be required to engage more hospitals in bundled payment programs.

Original languageEnglish (US)
Pages (from-to)854-863
Number of pages10
JournalHealth Affairs
Issue number6
StatePublished - Jun 1 2018
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)


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