Citation: Academic Emergency Medicine. 2018 Jun 22.Journal: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.Published: 2018ISSN: 1069-6563.Full author list: Galarraga JE; Frohna WJ; Pines JM.UI/PMID: 29931705.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Health Research Institute | MedStar Washington Hospital CenterDepartment(s): Emergency MedicineActivity type: Journal Article.Medline article type(s): Journal ArticleDigital Object Identifier: https://dx.doi.org/10.1111/acem.13507 (Click here)Abbreviated citation: Acad Emerg Med. 2018 Jun 22.Local Holdings: Available online from MWHC library: 1997 - present, Available in print through MWHC library:2005-2007.Abstract: BACKGROUND: In 2014, the state of Maryland moved away from fee-for-service payments and into a global budget revenue (GBR) structure where hospitals have a fixed revenue target, independent of patient volume or services provided. We assess the effects of GBR adoption on emergency department (ED) admission decisions among adult encounters.Abstract: METHODS: We used hospital medical record and billing data from adult ED encounters from January 1, 2011 through December 31, 2015, with four Maryland (MD) hospitals and two District of Columbia (DC) hospitals within the same health system. We performed difference-in-differences analysis (DID) and calculated the effects of the GBR model on ED admission rates (inpatient and observation) using hospital-fixed effect regression adjusted for patient, hospital, and community factors. We also examined changes in the distribution of acuity among ED admissions with GBR adoption.Abstract: RESULTS: The study sample included 1,492,953 ED encounters with a mean ED admission rate of 20.5%. The ED admission rate difference pre- and post-GBR was -1.14% (95% CI: -0.89, -1.40) for MD hospitals and -0.04% (95% CI: -0.24, 0.32) for DC hospitals with a DID of -1.10% (95% CI: -1.34, -0.86). This change was attributable to a -3.3% (95% CI: -3.54, -3.08) decline in inpatient admissions and 2.7% (95% CI: 2.53, 2.79) increase in observation admissions. Declines in admissions were observed primarily among mild-to-moderate severity of illness encounters with a low risk of mortality.Abstract: CONCLUSIONS: Within the same health system, implementation of global budgeting in MD hospitals was associated with a decline in ED admissions - particularly lower acuity admissions - compared to DC hospitals that remained under fee-for-service payments. This article is protected by copyright. All rights reserved.Abstract: Copyright This article is protected by copyright. All rights reserved.