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

Abstract

Objective: To assess the effect of the Global Budget Revenue (GBR) program on outcomes after surgery. Background: There is limited data summarizing the effect of the GBR program on surgical outcomes as compared with traditional fee-forservice systems. Methods: The Medline, Embase, Scopus, and Web of Science databases were used to conduct a systematic literature search on April 5, 2022. We identified full-length reports of comparative studies involving patients who underwent surgery in Maryland after implementation of the GBR program. A random effects model calculated the overall pooled estimate for each outcome which included complications, rates of readmission and mortality, length of stay, and costs. Results: Fourteen studies were included in the qualitative synthesis, with 8 unique studies included in the meta-analysis. Our analytical sample was comprised of 170,011 Maryland patients, 78,171 patients in the pre-GBR group, and 91,840 patients in the post-GBR group. The pooled analysis identified modest reductions in costs [standardized mean difference (SMD) −0.

Association of Neighborhood Socioeconomic Deprivation with Utilization and Costs of Anterior Cervical Discectomy and Fusion

“…We hypothesize that patients in Maryland with higher socioeconomic burden may be at less disadvantage compared with patients in other states in terms of accessing surgical care. A recent systematic review by Shammas et al 36 An additional important finding of our study is that increasing neighborhood deprivation was associated with greater perioperative costs. This was true both in the inpatient setting as well as the outpatient setting.…”

Transforming Specialty Care Delivery and Payment Under Global Budgets—Insights from the Provision of Surgical Services in Maryland

“…A recent meta-analysis examined 8 eligible studies of orthopedic, vascular, and general surgical procedures in Maryland. 6 The GBR model was consistently associated with small but statistically significant reductions in index hospitalization spending compared with other states, along with modest improvements on several measures of quality, including complication rates, inpatient mortality, and readmission rates.…”

“…With 69.4% of surgical expenditures occurring in the inpatient setting and elective surgery accounting for 43% of total gross hospital revenue, surgical care has substantial potential for savings under the GBR model. A recent meta-analysis examined 8 eligible studies of orthopedic, vascular, and general surgical procedures in Maryland . The GBR model was consistently associated with small but statistically significant reductions in index hospitalization spending compared with other states, along with modest improvements on several measures of quality, including complication rates, inpatient mortality, and readmission rates.…”

Maryland’s Global Budget Revenue Model

“…Shammas et al4 perform a meta-analysis of the impact of the GBR program on outcomes after surgery. The study demonstrates modest but consistent improvement in quality and reduction in costs among Maryland patients who underwent surgical procedures after the GBR program implementation from 2014 to 2018.…”

“…Maryland’s GBR system, in contrast, places a cap on total hospital expenditures for all patients across all care sites. In this issue of “Annals of Surgery”, 2 reports (Shammas et al4 and Offodile et al5) draw attention to the potential impact of a global capitation payment model like the Maryland GBR on the delivery and outcomes of surgical care.…”