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Comment & Response
January 1/8, 2019

Potential Unintended Effects of Medicare’s Bundled Payments for Care Improvement Program—Reply

Author Affiliations
  • 1Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 2Department of Medicine, University of Washington School of Medicine, Seattle
JAMA. 2019;321(1):107-108. doi:10.1001/jama.2018.18162

In Reply We agree with Ms Bilinski and Dr Hatfield about the difference between failing to reject and accepting the null hypothesis. In our study, we failed to reject the null hypothesis that BPCI participation was not associated with differential changes in LEJR surgery volume.1 Although we also agree that our analysis of beneficiaries within 306 markets could be underpowered to detect small effects, simulations suggested that large volume responses would be needed to overwhelm savings from BPCI participation. Toward that end and as a matter of practical significance, Medicare would still retain 83% of its savings from bundled payments if volume changes occurred at the upper bound of our confidence interval (a 0.69% increase in volume). This provides reassuring evidence that bundled payments for LEJR are associated with significant Medicare savings.

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