Exhibit 4.

Average episode spending breakdown by component for major hip and knee joint replacement for hospitals participating in the Bundled Payments for Care Improvement (BPCI) initiative and Comprehensive Care for Joint Replacement (CJR) program, 2016

Source/Notes: SOURCE Authors’ analysis of Medicare claims data for 2010–16. NOTES Episode spending is for Medicare Severity–Diagnosis-Relate Group (MS-DRG) 470, major hip and knee joint replacement or reattachment of lower extremity without a major complicating or comorbid condition. Other inpatient facilities include long-term acute care facilities, inpatient psychiatric facilities, and critical access hospitals.