Length of Stay in Hospitals Reporting Participation in Bundled Payment Programs: 2016 to 2022

Bundled payment programs aim to align the incentives of acute and post-acute providers during an episode of care. Prior studies of the impact of bundled payments on hospital length of stay (LOS) were mixed, and none evaluated hospital exposure to bundled payments across all payers (public and commercial). In this study, we used the American Hospital Association survey data for 2016 to 2022 to compare the LOS of hospitals that participated in bundled payments to those that did not participate. We used regression analysis with interaction terms to compare the changes in LOS of hospitals that participated in bundled payments with concurrent changes in LOS of hospitals that did not participate in bundled payments. The models included hospital and year fixed effects. We also conducted subgroup analyses by payer type. All-payer LOS was not associated with participation in bundled payment (ATT 0.08 days; 95% CI -0.34, 0.17; P = .54). Participation in bundled payments was associated with slightly longer LOS for stays paid for by Medicare (ATT 0.13 days, 95% CI 0.02, 0.25; P = .03), but not for the other payer types. Bundled payment program participation had a negligible impact on hospital LOS, acknowledging the limitation that the impact might be diminished due to evaluating average LOS across all admissions rather than condition-specific bundled payment programs.