# Comparing the Impact of Voluntary and Mandatory Bundled Payments on Disparities in Surgical Care

> **NIH NIH R01** · UNIVERSITY OF PENNSYLVANIA · 2022 · $553,757

## Abstract

Project Summary
This study examines how bundled payments implemented via voluntary and mandatory participation impact
access and outcomes among vulnerable patients – evidence needed to inform policymakers about the broader
policy impact and whether to scale bundled payments through voluntary and/or mandatory participation. As the
largest payer for lower extremity joint replacement (LEJR), one of the fastest growing elective procedures in
the country, Medicare has implemented bundled payments in an effort to improve value. However, there are
marked disparities in access and outcomes for LEJR. Bundled payments could reduce or exacerbate LEJR
disparities for patients who are vulnerable based on race/ethnicity or socioeconomic status, and these effects
may vary by participation mechanism. Hospitals serving vulnerable patients may be less likely to participate in
voluntary bundled payment programs because of perceptions that cost and outcomes are harder to influence
among these patients. Different effects may occur among vulnerable patients in mandatory bundled payment
programs, in which hospital participation is based on policymaker perceptions about the likelihood of cost
savings. As a result, it is important for policymakers to understand whether and how access and outcomes
change differentially for vulnerable versus non-vulnerable individuals after hospitals initiate participation in
bundled payments. Additionally, understanding how observed effects vary by duration of participation,
continuation versus disenrollment in bundled payments, or safety-net status of hospitals are key facets of
understanding policy impact. We hypothesize that hospitals in bundled payments will be less likely than non-
bundled payment hospitals to be located in markets with a high proportion of vulnerable patients; that
compared to non-vulnerable patients, vulnerable patients will have a lower likelihood of receiving elective LEJR
after hospitals start participating in bundled payments compared to hospitals that do not participate; and that
compared to non-vulnerable patients, vulnerable patients will experience smaller increases in quality and
smaller decreases in utilization and cost after hospital participation in bundled payments.

## Key facts

- **NIH application ID:** 10326375
- **Project number:** 5R01MD013859-04
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Said A Ibrahim
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $553,757
- **Award type:** 5
- **Project period:** 2019-06-19 → 2024-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10326375

## Citation

> US National Institutes of Health, RePORTER application 10326375, Comparing the Impact of Voluntary and Mandatory Bundled Payments on Disparities in Surgical Care (5R01MD013859-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10326375. Licensed CC0.

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