Schilling, PL, He J, et al. - This study was intended to define variation in total hip arthroplasty (THA) episode payments in the United States. Medicare population immediately preceding implementation of the comprehensive care for joint replacement (CJR) bundled care model and proposes a model for ongoing evaluation of hospital performance. Researchers distinguished THA episodes in Medicare part A 2014-2016 ( n = 366,380) and compared 90-day episode payments across years and geographic regions. The risk-adjusted hospital cost performance was defined using random-effects estimates. For THA episodes, Medicare part A payments decreased between 2014 and 2016. It was demonstrated that the time frame for this decrease is notable for preceding full implementation of CJR, therefore implying a more universal embrace of value-based care principles before the start date of CJR. These reduce were primarily because of reduced post-acute care utilization and possibly related to falling readmission rates. Yet, even after risk adjustment, a significant change in hospital cost performance remains.