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How Americans pay for care and how providers are reimbursed is the subject of this month’s issue of Health Affairs. The issue includes the first of three bundled payment programs established by the Centers for Medicare and Medicaid Services (CMS) in 2009. The authors found participation in the Bundled Payments for Care Improvement initiative was associated with “a 1.6 percent decrease in average lower extremity joint replacement episode spending, driven by the performance of early participants, with no changes in quality.” CMS should continue to scale up the initiative and a separate payment program for lower extremity joint replacement, in the authors’ view, but “ for differences in patient characteristics and risk, and consider changes to certain episode design features.”