Abstract(#br)Background(#br)The Center for Medicare and Medicaid Services (CMS) is transitioning Medicare from a fee-for-service program into a value-based pay-for-performance program. In order to accomplish this goal, CMS initiated 3 programs that attempt to define quality and seek to reward high-performing hospitals and penalize poor-performing hospitals. These programs include (1) penalties for hospital-acquired conditions (HACs), (2) penalties for excess readmissions for certain conditions, and (3) performance on value-based purchasing (VBP). The objective of this study was to determine whether high-volume total joint hospitals perform better in these programs than their lower-volume counterparts.(#br)Methods(#br)We analyzed data from the New York Statewide Planning and Research... Cooperative System database on total New York State hospital discharges from 2013 to 2015 for total knee and total hip arthroplasty. This was compared to data from Hospital Compare on HAC's, excess readmissions, and VBP. From these databases, we identified 123 hospitals in New York, which participated in all 3 Medicare pay-for-performance programs and performed total joint replacements. A regression analysis was then used to evaluate the relationship between total number of surgeries performed and each quality measure.(#br)Results(#br)Over the 3-year period spanning 2013-2015, hospitals in New York State performed an average of 1136.59 total joint replacement surgeries (standard deviation [SD] = 1484.740) and achieved a mean readmission penalty of 0.005909 (SD = 0.0038539), VBP penalty of 0.001089 (SD = 0.0021137), and a HAC score of 5.832 (SD = 1.736). The Pearson correlation coefficients between total joint replacement surgeries and performance on VBP, readmission penalty, and HAC score were 0.303, 0.168, and 0.160, respectively. The correlation coefficient between surgery volume and combined performance score was 0.277. Of these correlations, surgery volume and VBP performance, and surgery volume and combined performance showed statistical significance ( P < .01).(#br)Conclusion(#br)Our study demonstrates that there is a positive association between joint replacement volumes and overall hospital quality, as well as joint replacement volumes and VBP performance, specifically. These findings are consistent with previously reported associations between patient outcomes and procedure volumes. However, a relationship between joint replacement volume and HAC scores or readmission penalties could not be demonstrated. These inconsistencies could be due to the fact that these CMS pay-for-performance programs consider patient outcomes across all specialties. Additionally, the data from the Affordable Care Act is in its infancy, as reporting had only begun in 2013, and hospitals are still at the beginning of their learning curves. Analysis in the coming years may further elucidate the relationship between surgery volume and these individual CMS quality measures.