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On August 13, 2015, CMS announced that 2,100 participants of its Bundled Payments for Care Improvement pilot program (BPCI) had moved to the contract, risk-bearing phase of the program. This phase includes 1,071 skilled nursing facilities and 101 home health agencies in addition to other participants. According to a July 12, 2015 article published in McKnight’s, bundled payments for hip and knee replacements in particular could threaten referrals to skilled nursing facilities with 1 or 2 star ratings. Under the bundled payment system, hospitals will be choosing their partners more carefully and making sure that they refer to “medically advanced facilities that can handle bundles with a high quality of care”. See http://www.mcknights.com/news/cms-announces-participants-in-bundled-payment-pilot-program/article/432911/ and http://www.mcknights.com/news/bundled-payments-for-hip-knee-replacements-would-put-pressure-on-snfs/article/425885/.