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Background: The Center for Medicare and Medicaid Innovation revised the comprehensive Care for Joint Replacement (CJR) program, a mandatory 90-day bundled payment for lower extremity joint replacement, in December 2017, retaining 34 of the original 67 metropolitan statistical areas with higher volume and historic episode payments., Objectives: We describe differences in costs, quality, and patient selection between hospitals that continued to participate compared with those that withdrew from CJR before and after the implementation of CJR., Research Design: We used a triple difference approach to compare the magnitude of the policy effect for elective admissions between hospitals that were retained in the CJR revision or not, before and after the implementation of CJR, and compared with hospitals in nonparticipant metropolitan statistical areas., Subjects: 694,275 Medicare beneficiaries undergoing elective lower extremity joint replacement from January 1, 2013 to August 31, 2017., Measures: The treatment effect heterogeneity of CJR., Results: Hospitals retained in the CJR policy revision had a greater reduction in 90-day episode-of-care cost compared with those that were allowed to discontinue (-$846, 95% CI: -$1,338, -$435) and had greater cost reductions in the more recent year (2017). We also found evidence that retained CJR hospitals disproportionately reduced treating patients who were older than 85 years., Conclusions: Hospitals that continued to participate in CJR after the policy revision achieved a greater cost reduction. However, the cost reductions were partly attributed to avoiding potential higher - cost patients, suggesting that a bundled payment policy might induce disparities in care delivery., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Slipped capital femoral epiphysis (SCFE), causing posterior and inferior displacement and retroversion of the femoral head, is a well-recognized etiology for femoroacetabular impingement and can lead to premature arthritis in the young adult. The treatment of malunited SCFE remains controversial. Surgical dislocation and subcapital correction osteotomy (SCO) has been described as a powerful method to correct the proximal femoral deformity., Methods: Between January 2003 and January 2010, 11 patients (12 hips) with closed femoral physes and symptomatic femoroacetabular impingement from malunited SCFE were treated with surgical dislocation and SCO. We performed a retrospective review of patient histories, physical examinations, operative findings, and preoperative and postoperative anteroposterior (AP) and groin-lateral (GLat) radiographs. Mean follow-up was 61 months., Results: There were 4 female and 7 male patients with an average age of 15 years at the time of SCO. On the AP radiograph, the mean inferior femoral head displacement (AP epiphyseal-neck angle) was significantly improved (-26 to -6 degrees, P<0.001). On the GLat radiograph, the mean posterior femoral head displacement (lateral epiphyseal-neck angle) was significantly improved (-45 to -3 degrees, P<0.001). The mean α-angle was also significantly improved on both views (AP: 85 to 56 degrees, P<0.001; GLat: 85 to 46 degrees, P<0.001). Operative findings included 1 femoral osteochondral defect, 8 Outerbridge grade 3 to 4 acetabular cartilage lesions, and 10 labral lesions. Significant improvement of the mean Harris Hip Score was seen at latest follow-up (54 to 77, P=0.016). Complications occurred in 4 of the 12 cases with avascular necrosis in 2 patients, a worse postoperative Harris Hip Score in 1 patient, and failure of fixation treated successfully with revision open reduction internal fixation in 1 patient., Conclusions: SCO as an adjunct to surgical dislocation and osteochondroplasty can be used to correct the deformity of the proximal femur associated with malunited SCFE. Normalization of proximal femoral anatomy may postpone progression to severe osteoarthritis and thus delay the need for arthroplasty in this young patient population. However, surgeons and patients should be aware that the risks of this procedure in this population are significant., Level of Evidence: Level IV-therapeutic study.