{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T22:45:59Z","timestamp":1792622759809,"version":"4.5.0"},"reference-count":31,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["1R36HS029643-01A1"],"award-info":[{"award-number":["1R36HS029643-01A1"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["K01HS029278"],"award-info":[{"award-number":["K01HS029278"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Med Care Res Rev"],"abstract":"<jats:p>\n                    We examined how hospital\u2013physician integration influences hip and knee osteoarthritis treatment under different payment models. We leveraged a natural experiment from Medicare\u2019s random assignment of metropolitan statistical areas (MSAs) to the Comprehensive Care for Joint Replacement (CJR) program. In the 12 months after diagnosis, CJR was associated with more primary care physician and orthopedist visits (0.14 and 0.23,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; .001 for both), while integration was associated with fewer (\u22120.16 and \u22120.59,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; .001 for both). We discovered an extensive margin effect: CJR was associated with lower likelihood of joint replacements (\u22121.9 percentage points [pp],\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; .001); integration was associated with higher likelihood (1.0 pp,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; .001). Among knee replacement patients, those in CJR MSAs were less likely to receive surgery in outpatient settings (\u22124.6 pp,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; .001). Payment models and organizational structure may create opposing incentives, where bundled payment decreases and vertical integration increases the likelihood of joint replacement surgery.\n                  <\/jats:p>","DOI":"10.1177\/10775587261468837","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T10:49:53Z","timestamp":1790592593000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Hospital\u2013Physician Integration and the Comprehensive Care for Joint Replacement Program"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6544-8744","authenticated-orcid":false,"given":"Brady","family":"Post","sequence":"first","affiliation":[{"name":"Northeastern University, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6693-3856","authenticated-orcid":false,"given":"Alexandra","family":"Harris","sequence":"additional","affiliation":[{"name":"Medicare Payment Advisory Commission, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farbod","family":"Alinezhad","sequence":"additional","affiliation":[{"name":"Analysis Group, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Young","sequence":"additional","affiliation":[{"name":"Northeastern University, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"e_1_3_2_2_1","unstructured":"Agency for Healthcare Research and Quality. (2025 February 5). Overview of the national (Nationwide) inpatient sample (NIS). https:\/\/hcup-us.ahrq.gov\/nisoverview.jsp"},{"key":"e_1_3_2_3_1","doi-asserted-by":"crossref","unstructured":"Baicker K. Levy H. (2013). Coordination versus competition in health care reform. New England Journal of Medicine 369(9) 789\u2013791. https:\/\/doi.org\/10.1056\/NEJMp1306268","DOI":"10.1056\/NEJMp1306268"},{"key":"e_1_3_2_4_1","doi-asserted-by":"crossref","unstructured":"Barnett M. L. Wilcock A. McWilliams J. M. Epstein A. M. Joynt Maddox K. E. Orav E. J. Grabowski D. C. Mehrotra A. (2019). Two-year evaluation of mandatory bundled payments for joint replacement. New England Journal of Medicine 380(3) 252\u2013262. https:\/\/doi.org\/10.1056\/NEJMsa1809010","DOI":"10.1056\/NEJMsa1809010"},{"key":"e_1_3_2_5_1","doi-asserted-by":"crossref","unstructured":"Cavanaugh A. M. Rauh M. J. Thompson C. A. Alcaraz J. Mihalko W. M. Bird C. E. Eaton C. B. Rosal M. C. Li W. Shadyab A. H. Gilmer T. LaCroix A. Z. (2019). Racial and ethnic disparities in utilization of total knee arthroplasty among older women. Osteoarthritis and Cartilage 27(12) 1746\u20131754. https:\/\/doi.org\/10.1016\/j.joca.2019.07.015","DOI":"10.1016\/j.joca.2019.07.015"},{"key":"e_1_3_2_6_1","unstructured":"Centers for Medicare & Medicaid Services. (n.d.-a). Arthroplasty knee condyle and plateau; medial and lateral compartments with or without patella resurfacing (total knee arthroplasty). https:\/\/www.medicare.gov\/procedure-price-lookup\/cost\/27447\/"},{"key":"e_1_3_2_7_1","unstructured":"Centers for Medicare & Medicaid Services. (n.d.-b). Comprehensive care for joint replacement model. https:\/\/www.cms.gov\/priorities\/innovation\/innovation-models\/cjr"},{"key":"e_1_3_2_8_1","unstructured":"Centers for Medicare & Medicaid Services. (2023). Shared savings and losses assignment and quality performance standard methodology. https:\/\/www.cms.gov\/files\/document\/medicare-shared-savings-program-shared-savings-and-losses-and-assignment-methodology-specifications.pdf-2"},{"key":"e_1_3_2_9_1","doi-asserted-by":"crossref","unstructured":"Charlson M. E. Pompei P. Ales K. L. MacKenzie C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases 40(5) 373\u2013383. https:\/\/doi.org\/10.1016\/0021-9681(87)90171-8","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"e_1_3_2_10_1","doi-asserted-by":"crossref","unstructured":"David G. Lindrooth R. C. Helmchen L. A. Burns L. R. (2014). Do hospitals cross-subsidize? Journal of Health Economics 37 198\u2013218. https:\/\/doi.org\/10.1016\/j.jhealeco.2014.06.007","DOI":"10.1016\/j.jhealeco.2014.06.007"},{"key":"e_1_3_2_11_1","doi-asserted-by":"crossref","unstructured":"Harris A. Philbin S. Post B. Jordan N. Beestrum M. Epstein R. McHugh M. (2025). Cost quality and utilization after hospital-physician and hospital-post acute care vertical integration: A systematic review. Medical Care Research and Review 82(1) 3\u201342. https:\/\/doi.org\/10.1177\/10775587241247682","DOI":"10.1177\/10775587241247682"},{"key":"e_1_3_2_12_1","unstructured":"Health Affairs. (2022 December 1). Value-based payment as a tool to address excess US health spending. https:\/\/www.healthaffairs.org\/do\/10.1377\/hpb20221014.526546\/"},{"key":"e_1_3_2_13_1","doi-asserted-by":"crossref","unstructured":"Jung J. Feldman R. Kalidindi Y. (2019). The impact of integration on outpatient chemotherapy use and spending in Medicare. Health Economics 28(4) 517\u2013528. https:\/\/doi.org\/10.1002\/hec.3860","DOI":"10.1002\/hec.3860"},{"key":"e_1_3_2_14_1","doi-asserted-by":"crossref","unstructured":"Kocher R. Sahni N. R. (2011). Hospitals\u2019 race to employ physicians\u2014the logic behind a money-losing proposition. New England Journal of Medicine 364(19) 1790\u20131793. https:\/\/doi.org\/10.1056\/NEJMp1101959","DOI":"10.1056\/NEJMp1101959"},{"key":"e_1_3_2_15_1","doi-asserted-by":"crossref","unstructured":"Kolasinski S. L. Neogi T. Hochberg M. C. Oatis C. Guyatt G. Block J. Callahan L. Copenhaver C. Dodge C. Felson D. Gellar K. Harvey W. F. Hawker G. Herzig E. Kwoh C. K. Nelson A. E. Samuels J. Scanzello C. White D. .\u2004.\u2004.Reston J. (2020). 2019 American college of rheumatology\/Arthritis foundation guideline for the management of osteoarthritis of the hand hip and knee. Arthritis & Rheumatology 72(2) 220\u2013233. https:\/\/doi.org\/10.1002\/art.41142","DOI":"10.1002\/art.41142"},{"key":"e_1_3_2_16_1","doi-asserted-by":"crossref","unstructured":"Machta R. M. Reschovsky J. D. Jones D. J. Kimmey L. Furukawa M. F. Rich E. C. (2020). Health system integration with physician specialties varies across markets and system types. Health Services Research 55(Suppl. 3) 1062\u20131072. https:\/\/doi.org\/10.1111\/1475-6773.13584","DOI":"10.1111\/1475-6773.13584"},{"key":"e_1_3_2_17_1","doi-asserted-by":"crossref","unstructured":"MacMahon A. S. Mekkawy K. L. Barry K. Khanuja H. S. (2023). Racial and ethnic disparities in short-stay total knee arthroplasty. Journal of Arthroplasty 38(7) 1217\u20131223. https:\/\/doi.org\/10.1016\/j.arth.2022.12.044","DOI":"10.1016\/j.arth.2022.12.044"},{"key":"e_1_3_2_18_1","doi-asserted-by":"crossref","unstructured":"Neprash H. T. Chernew M. E. Hicks A. L. Gibson T. McWilliams J. M. (2015). Association of financial integration between physicians and hospitals with commercial health care prices. JAMA Internal Medicine 175(12) 1932\u20131939. https:\/\/doi.org\/10.1001\/jamainternmed.2015.4610","DOI":"10.1001\/jamainternmed.2015.4610"},{"key":"e_1_3_2_19_1","doi-asserted-by":"crossref","unstructured":"Neprash H. T. Chernew M. E. McWilliams J. M. (2017). Little evidence exists to support the expectation that providers would consolidate to enter new payment models. Health Affairs 36(2) 346\u2013354. https:\/\/doi.org\/10.1377\/hlthaff.2016.0840","DOI":"10.1377\/hlthaff.2016.0840"},{"key":"e_1_3_2_20_1","doi-asserted-by":"crossref","unstructured":"Post B. Alinezhad F. Mukherjee S. Young G. J. (2023). Hospital-physician integration is associated with greater use of cardiac catheterization and angioplasty. Health Affairs 42(5) 606\u2013614. https:\/\/doi.org\/10.1377\/hlthaff.2022.01294","DOI":"10.1377\/hlthaff.2022.01294"},{"key":"e_1_3_2_21_1","doi-asserted-by":"crossref","unstructured":"Post B. Buchmueller T. Ryan A. M. (2018). Vertical integration of hospitals and physicians: Economic theory and empirical evidence on spending and quality. Medical Care Research and Review 75(4) 399\u2013433. https:\/\/doi.org\/10.1177\/1077558717727834","DOI":"10.1177\/1077558717727834"},{"key":"e_1_3_2_22_1","doi-asserted-by":"crossref","unstructured":"Post B. Norton E. C. Hollenbeck B. Buchmueller T. Ryan A. M. (2021). Hospital-physician integration and Medicare\u2019s site-based outpatient payments. Health Services Research 56(1) 7\u201315. https:\/\/doi.org\/10.1111\/1475-6773.13613","DOI":"10.1111\/1475-6773.13613"},{"key":"e_1_3_2_23_1","doi-asserted-by":"crossref","unstructured":"Quan H. Li B. Couris C. M. Fushimi K. Graham P. Hider P. Januel J. M. Sundararajan V. (2011). Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. American Journal of Epidemiology 173(6) 676\u2013682. https:\/\/doi.org\/10.1093\/aje\/kwq433","DOI":"10.1093\/aje\/kwq433"},{"key":"e_1_3_2_24_1","doi-asserted-by":"crossref","unstructured":"Reschovsky J. D. Rich E. C. Lake T. K. (2015). Factors contributing to variations in physicians\u2019 use of evidence at the point of care: A conceptual model. Journal of General Internal Medicine 30(Suppl. 3) S555\u2013S561. https:\/\/doi.org\/10.1007\/s11606-015-3366-7","DOI":"10.1007\/s11606-015-3366-7"},{"key":"e_1_3_2_25_1","doi-asserted-by":"crossref","unstructured":"Richards M. R. Seward J. A. Whaley C. M. (2022). Treatment consolidation after vertical integration: Evidence from outpatient procedure markets. Journal of Health Economics 81 102569. https:\/\/doi.org\/10.1016\/j.jhealeco.2021.102569","DOI":"10.1016\/j.jhealeco.2021.102569"},{"key":"e_1_3_2_26_1","doi-asserted-by":"crossref","unstructured":"Shichman I. Roof M. Askew N. Nherera L. Rozell J. C. Seyler T. M. Schwarzkopf R. (2023). Projections and epidemiology of primary hip and knee arthroplasty in Medicare patients to 2040-2060. JB & JS Open Access 8(1) e22.00112. https:\/\/doi.org\/10.2106\/jbjs.Oa.22.00112","DOI":"10.2106\/JBJS.OA.22.00112"},{"key":"e_1_3_2_27_1","doi-asserted-by":"crossref","unstructured":"Thai N. H. Post B. Young G. J. (2023). Hospital-physician integration and value-based payment: Early results from MIPS. Medical Care 61(12) 822\u2013828. https:\/\/doi.org\/10.1097\/mlr.0000000000001923","DOI":"10.1097\/MLR.0000000000001923"},{"key":"e_1_3_2_28_1","doi-asserted-by":"crossref","unstructured":"Trombley M. J. Joneydi R. Buatti L. A. Schneider K. L. Kummet C. M. Morrall I. (2022). Impact of the Comprehensive Care for Joint Replacement model on patient-reported outcomes. Health Services Research 57(5) 1094\u20131103. https:\/\/doi.org\/10.1111\/1475-6773.13966","DOI":"10.1111\/1475-6773.13966"},{"key":"e_1_3_2_29_1","unstructured":"Werner R. Emanuel E. Pham H. Navathe A. (2021 February 17). The future of value-based payment: A road map to 2030. Leonard Davis Institute of Health Economics. https:\/\/ldi.upenn.edu\/our-work\/research-updates\/the-future-of-value-based-payment-a-road-map-to-2030\/"},{"key":"e_1_3_2_30_1","doi-asserted-by":"crossref","unstructured":"Whaley C. M. Zhao X. Richards M. Damberg C. L. (2021). Higher Medicare spending on imaging and lab services after primary care physician group vertical integration. Health Affairs 40(5) 702\u2013709. https:\/\/doi.org\/10.1377\/hlthaff.2020.01006","DOI":"10.1377\/hlthaff.2020.01006"},{"key":"e_1_3_2_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/poms.14074"},{"key":"e_1_3_2_32_1","doi-asserted-by":"crossref","unstructured":"Young G. J. Zepeda E. D. Flaherty S. Thai N. (2021). Hospital employment of physicians in Massachusetts is associated with inappropriate diagnostic imaging. Health Affairs 40(5) 710\u2013718. https:\/\/doi.org\/10.1377\/hlthaff.2020.01183","DOI":"10.1377\/hlthaff.2020.01183"}],"container-title":["Medical Care Research and Review"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10775587261468837","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10775587261468837","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10775587261468837","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T06:46:49Z","timestamp":1790923609000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10775587261468837"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,28]]},"references-count":31,"alternative-id":["10.1177\/10775587261468837"],"URL":"https:\/\/doi.org\/10.1177\/10775587261468837","relation":{},"ISSN":["1077-5587","1552-6801"],"issn-type":[{"value":"1077-5587","type":"print"},{"value":"1552-6801","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,28]]},"article-number":"10775587261468837"}}