where will pathologic hip fractures go in a valuebased hip fracture bundle introduction there has been a burgeoning interest for implementing bundled payments for hip fractures being treated with hemiarthroplasty percutaneous pinning andor open reduction and internal fixation concerns exist about how hip fracture bundles may impede access to care for patients who require more resources such as those with pathologicneoplastic fracturesmethods the 2011 to 2017 american college of surgeonsnational surgical quality improvement program database was queried to identify patients undergoing percutaneous pinning hemiarthroplasty platescrew and intramedullary nail for hip fractures multivariate regression analyses were used to identify notable differences in 30day complications readmissions reoperations mortality length of stay and nonhome discharges between native and pathologicneoplastic hip fracturesresults a total of 67548 patients were includedof which 378 06 had a pathologicneoplastic hip fracture pathologic fractures versus native hip fractures had significantly higher odds of experiencing a prolonged length of stay 5 days odds ratio or 157 pulmonary embolism or 367 deep vein thrombosis or 203 30day readmissions or 143 and 30day mortality or 266discussion patients sustaining a pathologicneoplastic hip fracture have a worse adverse event profile risk adjustment based on facture etiology will be necessary to ensure that providers taking care of pathologicneoplastic fractures are appropriately reimbursed to minimize barriers to access of care for this vulnerable cohort