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These two volumes contain the findings of the final, extended evaluation of the five year Medicare Participating Heart Bypass Center Demonstration which paid a single, negotiated global amount to hospitals covering all Part A and B inpatient services. Volume I (420 pages) contains Chapters 1-7 of the report and Volume II (272 pages) contains Chapters 8-15. This report supplements the first evaluation covering the first three years of the demonstration. It presents an overview of the demonstration design and site selection process, the national trends in Medicare bypass surgery between 1990 and 1996, shifts in market shares of demonstration hospitals, Medicare and beneficiary program savings, hospital cost savings, changes in patient in-hospital and post-discharge outcomes, lengths of stay, complications, changes in appropriateness for surgery, and the satisfaction survey of patients and referring physicians, plus six chapters of case study findings regarding changes in patient care and hospital management, hospital competition and marketing, payments to physicians, achievement of participant goals, and reimbursement difficulties. A separate Volume III of appendices includes the update calculation method, data collection forms, statistical tables, appropriateness rating sheets, survey forms and interview protocols, the comparative angiographic study, the appropriateness study, and other background information.