Maryland's Global Hospital Budgets — Preliminary Results from an All-Payer Model

Patel, Ankit; Rajkumar, Rahul; Colmers, John M.; Kinzer, Donna; Conway, Patrick H.; Sharfstein, Joshua M.

doi:10.1056/nejmp1508037

Cited by 55 publications

(44 citation statements)

References 4 publications

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“…These reforms leveraged the state's preexisting unique all‐payer hospital rate‐setting system and the federal government's State Innovation Models (SIM) Initiative . Previous studies have shown little early impact on inpatient readmission rates in TPR's rural hospitals and on either potentially preventable complications or inpatient utilization after GBR's statewide expansion . (See Appendix for more details.…”

Section: Introductionmentioning

confidence: 99%

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The effects of global budget payments on hospital utilization in rural Maryland

Done

Herring

2019

Health Services Research

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Objective To assess the effect of Maryland's 2010 Total Patient Revenue (TPR) global budget reform in eight rural hospitals on population‐level hospital rates of utilization three years after implementation. Data Sources/Study Setting Data on all inpatient discharges and outpatient department visits from the Health Services Cost Review Commission, population data from Claritas Demographic Reports, and county‐level data from the Area Health Resource File. Study Design We use a difference‐in‐differences approach to compare changes in utilization rates over time in the reform areas comprising 125 Zip Code Tabulation Areas (ZCTAs) and in two control hospital areas (66 ZCTAs and 327 ZCTAs, respectively). We examine several inpatient and outpatient measures and distinguish between relatively discretionary and nondiscretionary utilization. Data Collection Admissions data are hospital‐reported discharge abstracts of all encounters in Maryland during 2008‐2013. Population data are derived from the US Census. Principal Findings We find no statistically significant changes in admissions, either overall or discretionary. We find a statistically significant 8.9 percent (95%CI = [1.8, 16.0]) reduction in outpatient visits, with a statistically significant reduction of 14.8 percent (95%CI = [5.3, 24.3]) visits not to the Emergency Department. Conclusions We find that the TPR reform decreased outpatient utilization but did not affect inpatient utilization.

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Section: Introductionmentioning

confidence: 99%

“…7 Previous studies have shown little early impact on inpatient readmission rates in TPR's rural hospitals 8 and on either potentially preventable complications or inpatient utilization after GBR's statewide expansion. [9][10][11][12] (See Appendix S1 for more details. )…”

mentioning

confidence: 99%

The effects of global budget payments on hospital utilization in rural Maryland

Done

Herring

2019

Health Services Research

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“…In the first year alone, Maryland saved Medicare $116 million while reducing the rate of potentially preventable conditions by 26.3%. 19 In Rhode Island, a policy change created a mandated increase in primary care expenditures to 10% of total health care expenditures, leading to a savings of over $100 million in its first 4 years. 20 Rather than simply increasing fee-forservice rates for primary care services, payers were required to instead invest in other primary care There is currently no streamlined, organized system of payment for healthcare.…”

Section: ) Payment: Breaking Down Vertical Silos Of Care Creating Gmentioning

confidence: 99%

"A Paradox Persists When the Paradigm Is Wrong": Pisacano Scholars' Reflections from the Inaugural Starfield Summit

Doohan

Coutinho

Lochner

et al. 2016

The Journal of the American Board of Family Medicine

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“…More specifically, the case demonstrates how a calculative tool (hospital budgeting) facilitates the aims of reducing utilisation and costs while motivating both cooperation and quality improvement. In 2014, the US state of Maryland applied the “Global Budget” approach to implement extensive changes in hospital treatment practices (Patel et al., ). The policy aimed to replace a volume‐based reimbursement system with a global budget, with the twin goals of improving the quality of healthcare and controlling costs (Evans & Meyer, ; Patel et al., ) .…”

Section: Introductionmentioning

confidence: 99%

“…In 2014, the US state of Maryland applied the “Global Budget” approach to implement extensive changes in hospital treatment practices (Patel et al., ). The policy aimed to replace a volume‐based reimbursement system with a global budget, with the twin goals of improving the quality of healthcare and controlling costs (Evans & Meyer, ; Patel et al., ) . The global budget in Maryland represents an unconventional shift in behavioural motivations towards quality of care, moving away from the traditional focus on volume.…”

Section: Introductionmentioning

confidence: 99%

Accounting facilitating sociopolitical aims: The case of Maryland hospitals

Malmmose

Fouladi

2019

Financ Acc Manag

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In 2014, the State of Maryland in the United States implemented a substantial change to their hospital payment approach in the form of "Global Budgets". This strategy for financing garnered significant attention because acute care hospitals in the state transitioned from a fee-for-service hospital payment system to a prospective framebased budget. Applying the conceptual framework of Miller and Power [Academy of Management Annals, 7(1), 557-605], we emphasise how calculative practices actively influence organisational structure decision-making. The study investigates the reciprocal role of accounting practices in the facilitation of hospital policies. Findings demonstrate that accounting practices recursively constitute and reshape the organisation of hospitals. The policy change to GlobalBudgets has influenced accounting practices, which likewise have promoted large organisational changes that increase engagement with external stakeholders. The consequences of the Global Budget policy have been significant, leading to highly complex administrative practices while also necessitating a cost shifting in order to subsidise physician costs, due to the separation of hospitals and physician organisations. However, we also witness how Global Budgets and the combination of centralised monitoring with decentralised managerial freedom substantiate remarkable holistic quality initiatives.

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Maryland's Global Hospital Budgets — Preliminary Results from an All-Payer Model

Abstract: In the first year of Maryland's experiment in setting all-payer rates for hospital services, costs were contained and the quality of care improved, though the state still has high rates of hospital admissions and per capita spending for Medicare patients.

Cited by 55 publications

References 4 publications

The effects of global budget payments on hospital utilization in rural Maryland

The effects of global budget payments on hospital utilization in rural Maryland

"A Paradox Persists When the Paradigm Is Wrong": Pisacano Scholars' Reflections from the Inaugural Starfield Summit

Accounting facilitating sociopolitical aims: The case of Maryland hospitals

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