Average Medicare payments for a lower extremity joint replacement hospitalization and 90-day post-discharge period declined $1,166 more for hospitals participating in the first 21 months of the Bundled Payments for Care Improvement initiative than for comparison hospitals that did not participate, according to a study published online today by the Journal of the American Medical Association. The lower Medicare payments were primarily due to reduced use of institutional post-acute care, the authors said. Claims-based quality measures, including unplanned readmissions, emergency department visits and mortality, were not statistically different between the BPCI and comparison populations. “Further studies are needed to assess longer-term follow-up as well as patterns for other types of clinical care,” the authors said. Separately, the Centers for Medicare & Medicaid Services today released a report on first-year results for Models 2 to 4 of the initiative, which include retrospective and prospective bundled payments that may or may not include the acute inpatient hospital stay for a given episode of care.