Award Date


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Health Care Administration and Policy

First Committee Member

Jay Shen

Second Committee Member

Christopher Cochran

Third Committee Member

Josue Epane

Fourth Committee Member

Shawn McCoy

Fifth Committee Member

Ian McDonough

Number of Pages



This study investigates the potential impact of the Bundled Payments for Care Improvement (BPCI) initiative from Center for Medicare and Medicaid Services on hospital performance and behavior related to effectiveness and efficiency. The BPCI is under the Affordable Care Act and provides hospitals with a fixed amount of reimbursement for a total episode of care. Building on the agency theory, I argue that the BPCI initiative has the potential to enhance the effectiveness and efficiency of hospital care. This quasi-experimental study examines the changes in hospital care outcomes of patients with replacement of the lower extremity or sepsis in BPCIparticipating hospitals and their counterparts in non-participating hospitals. Based on the 2013– 2017 inpatient discharge data of Nevada, I apply the difference-in-differences modeling to evaluate hospital care outcomes before and after BPCI initiative implementation. The study produced mixed findings, with positive changes supporting my theoretical predictions and hypotheses in the case of sepsis, but no changes detected in support for my theoretical predictions and hypotheses for major joint replacement of the lower extremity.


alternative payment model; BPCI initiative; bundled payment; medicare; sepsis; total joint replacement


Health and Medical Administration

File Format


File Size

0.101 MB

Degree Grantor

University of Nevada, Las Vegas




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