Assessment of Costs and Care Quality Associated With Major Surgical Procedures After Implementation of Maryland’s Capitated Budget Model

Abstract

IMPORTANCEIn 2014, Maryland implemented the all-payer model, a distinct hospital funding policy that applied caps on annual hospital expenditures and mandated reductions in avoidable complications. Expansion of this model to other states is currently being considered; therefore, it is important to evaluate whether Maryland's all-payer model is achieving the desired goals among surgical patients, who are an at-risk population for most potentially preventable complications.OBJECTIVE To examine the association between the implementation of Maryland's all-payer model and the incidence of avoidable complications and resource use among adult surgical patients. DESIGN, SETTING, AND PARTICIPANTSThis comparative effectiveness study used hospital discharge records from the Healthcare Cost and Utilization Project state inpatient databases to conduct a difference-in-differences analysis comparing the incidence of avoidable complications and the intensity of health resource use before and after implementation of the all-payer model in Maryland. The analytical sample included 2 983 411 adult patients who received coronary artery bypass grafting (CABG), carotid endarterectomy (CEA), spinal fusion, hip or knee arthroplasty,

Implementation of the Maryland Global Budget Revenue Model and Variation in the Expenditures and Outcomes of Surgical Care

“…Furthermore, the Centers for Medicare and Medicaid Services has signaled intent to accelerate movement toward APMs that incentive a reorganization of care relationships around accountability for the total cost of care (TCOC), that is, population-based payments 7. Thus, it is critical that we investigate whether these broad-based payment models achieve their stated goals of enhancing value (ie, maximizing outcomes per unit cost) for surgical patients 8…”

Evaluation of Length of Stay, Care Volume, In-Hospital Mortality, and Emergency Readmission Rate Associated With Use of Diagnosis-Related Groups for Internal Resource Allocation in Public Hospitals in Hong Kong

“…First, because any meaningful change to clinical practice in response to the new payment model would require time to develop, we excluded observations made immediately after the date of the policy implementation. 22 Second, we calculated volume of care at the mega-cluster level, combining Hong Kong’s 18 districts into 3 geographic groups—Hong Kong Island, Kowloon, and New Territories—to mitigate the cross-district movement of patients. Third, we checked the sensitivity of our results to different measurements of disease burden first by calculating the CCI using patients’ primary and secondary diagnoses and then by replacing the index with a binary variable indicating whether the patient had a chronic disease.…”

Analyzing Trends in Urethral Suspension Procedures After Changes in Medicare Payment Policy

“…Initial analyses of the Maryland All-Payer Model, a global payment plan, demonstrated a substantial decrease in hospital-acquired conditions (ranging from 0.4% for knee arthroplasty to 11.3% for coronary artery bypass grafting) and a parallel reduction in hospital costs. 6 Nonetheless, some worry that alternative forms of payment can have unintended consequences, particularly when incentives are misaligned with quality. Common criticisms of these new models include avoidance of patients with higher risk for disease, which is potentially evident in some contexts in the Maryland All-Payer Model, 6 and withholding appropriate care to reduce spending.…”

“…6 Nonetheless, some worry that alternative forms of payment can have unintended consequences, particularly when incentives are misaligned with quality. Common criticisms of these new models include avoidance of patients with higher risk for disease, which is potentially evident in some contexts in the Maryland All-Payer Model, 6 and withholding appropriate care to reduce spending. The Hospital Readmissions Reduction Program (HRRP) is a CMS pay-for-performance initiative that financially incentivized a reduction in hospital readmissions for several conditions, including heart failure.…”