OBJECTIVES: Under the mandatory Medicare Comprehensive Care for Joint Replacement (CJR) program beginning April 1, 2016, hospitals will receive a bundled payment for all covered services from the time of admission until 90 days after discharge for THA, a common and increasingly prevalent surgery. The goal of this study was to examine the impact of using BLIS to manage postsurgical pain on total hospitalization costs in Medicare patients undergoing THA. METHODS: Using Premier Perspective chargemaster data, this analysis included Medicare patients undergoing primary THA (ICD-9 code 81.51) at the five hospitals with the highest BLIS use from 7/1/2013 to 3/31/2015; patients not receiving BLIS were used as controls. The primary outcomes were total hospital costs (estimated by Premier using proprietary charge to cost ratios). Generalized linear mixed models (GLMM) were used to examine the association between BLIS use, hospital, patient factors, and outcomes; patients with $0 costs were excluded. RESULTS: The hospitals included in this analysis were mainly urban (n=4) and non-academic (n=4), with two in the South, two in the Northeast, and one in the West; each hospital 187-465 THA patients who received BLIS (total 1,534) and 353-585 controls (total 2,295). Gender and Charlson Comorbidity Index (CCI) were similar but the BLIS group had more whites (82.5% vs. 57.3%) and was younger (72.0 vs. 73.1). In univariate analyses, total hospital costs were $552 lower ($16,268 vs. $16,820; p<0.001) with BLIS. In GLMM using hospital for random effects as well as age, gender, race, and CCI, total hospital costs were estimated to be $919 lower (p<0.001) in the BLIS group. CONCLUSIONS: Total hospital costs for THA were significantly lower when using BLIS to manage postsurgical pain in Medicare patients. Use of BLIS could contribute to reducing total hospital costs under the new CJR program starting 4/1/2016.