{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T21:23:20Z","timestamp":1791494600120,"version":"4.3.4"},"reference-count":26,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T00:00:00Z","timestamp":1637107200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006545","name":"National Institute on Minority Health and Health Disparities","doi-asserted-by":"publisher","award":["R01MD013859"],"award-info":[{"award-number":["R01MD013859"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R01HS027595"],"award-info":[{"award-number":["R01HS027595"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["shmpublications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Hospital Medicine"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>Under Medicare\u2019s Bundled Payments for Care Improvement (BPCI) program, hospitals have maintained quality and achieved savings for medical conditions. However, safety net hospitals may perform differently owing to financial constraints and organizational challenges.<\/jats:p><\/jats:sec><jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>To evaluate whether hospital safety net status affected the association between bundled payment participation and medical episode outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>DESIGN, SETTING, AND PARTICIPANTS<\/jats:title><jats:p>This observational difference\u2010in\u2010differences analysis was conducted in safety net and non\u2013safety net hospitals participating in BPCI for medical episodes (BPCI hospitals) using data from 2011\u20102016 Medicare fee\u2010for\u2010service beneficiaries hospitalized for acute myocardial infarction, pneumonia, congestive heart failure, and chronic obstructive pulmonary disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>EXPOSURE(S)<\/jats:title><jats:p>Hospital BPCI participation and safety net status.<\/jats:p><\/jats:sec><jats:sec><jats:title>MAIN OUTCOME(S) AND MEASURE(S)<\/jats:title><jats:p>The primary outcome was postdischarge spending. Secondary outcomes included quality and post\u2013acute care utilization measures.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Our sample consisted of 803 safety net and 2263 non\u2013safety net hospitals. Safety net hospitals were larger and located in areas with more low\u2010income individuals than non\u2013safety net hospitals. Among BPCI hospitals, safety net status was not associated with differential postdischarge spending (adjusted difference\u2010in\u2010differences [aDID], $40; 95% CI, \u2013$254 to $335; <jats:italic>P<\/jats:italic> = .79) or quality (mortality, readmissions). However, BPCI safety net hospitals had differentially greater discharge to institutional post\u2013acute care (aDID, 1.06 percentage points; 95% CI, 0.37\u20101.76; <jats:italic>P<\/jats:italic> = .003) and lower discharge home with home health (aDID, \u20131.15 percentage points; 95% CI, \u20131.73 to \u20130.58; <jats:italic>P<\/jats:italic> &lt; .001) than BPCI non\u2013safety net hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Under medical condition bundles, safety net hospitals perform differently from other hospitals in terms of post\u2013acute care utilization, but not spending. Policymakers could support safety net hospitals and consider safety net status when evaluating bundled payment programs.<\/jats:p><\/jats:sec>","DOI":"10.12788\/jhm.3722","type":"journal-article","created":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T16:04:57Z","timestamp":1637165097000},"page":"716-723","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Effect of Hospital Safety Net Status on the Association Between Bundled Payment Participation and Changes in Medical Episode Outcomes"],"prefix":"10.1002","volume":"16","author":[{"given":"Joshua M","family":"Liao","sequence":"first","affiliation":[{"name":"Department of Medicine University of Washington School of Medicine Seattle Washington"},{"name":"Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Chatterjee","sequence":"additional","affiliation":[{"name":"Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia Pennsylvania"},{"name":"Department of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erkuan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Medical Ethics and Health Policy Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Connolly","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingsan","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Medical Ethics and Health Policy Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah S","family":"Cousins","sequence":"additional","affiliation":[{"name":"Department of Medical Ethics and Health Policy Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amol S","family":"Navathe","sequence":"additional","affiliation":[{"name":"Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia Pennsylvania"},{"name":"Department of Medical Ethics and Health Policy Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania"},{"name":"Corporal Michael J Crescenz VA Medical Center Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,11,17]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2019.00466"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m1780"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000687"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.299.18.2180"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2011.1028"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2014.1059"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.94856"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.8609"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.0678"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2018.05264"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.5118"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2018.3098"},{"key":"e_1_2_6_14_1","unstructured":"Department of Medicine University of Wisconsin School of Medicine and Public Health. 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