Effects of Maryland's global budget revenue model on emergency department utilization and revisits. Effects of Maryland's Global Budget Revenue Model on Emergency Department Utilization and Revisits.
Citation: Academic Emergency Medicine. 29(1):83-94, 2022 01.PMID: 34288254Institution: MedStar Health Research Institute | MedStar Institute for Innovation | MedStar Washington Hospital CenterDepartment: Emergency MedicineForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Emergency Service, Hospital | *Medicare | Aged | Hospitalization | Humans | Maryland/ep [Epidemiology] | Medically Uninsured | United StatesYear: 2022Local holdings: Available online from MWHC library: 1997 - present, Available in print through MWHC library:2005-2007Abstract: BACKGROUND: In 2014, Maryland (MD) implemented a "global budget revenue" (GBR) program that prospectively sets hospital budgets. This program introduced incentives for hospitals to tightly control volume and meet budget targets. We examine GBR's effects on emergency department (ED) visits, admissions, and returns.CONCLUSIONS: GBR adoption was associated with lower ED utilization and admissions. ED returns and admissions among returns also decreased, while mortality and ICU stays among returns remained stable, suggesting that GBR has not led to adverse patient outcomes from fewer admissions. However, changes in ED return disparities varied by subgroup, indicating that improvements in care transitions may be uneven across patient populations. Copyright This article is protected by copyright. All rights reserved.METHODS: We performed an interrupted time series analysis with difference-in-differences (DiD) comparisons using 2012 to 2015 Healthcare Cost Utilization and Project data from MD, New York (NY), and New Jersey (NJ). We examined GBR's effects on ED visits/1,000 population, admissions from the ED, and ED returns at 72-hours and 9-days. We also examined rates of admission, intensive care unit (ICU) stay, and in-hospital mortality among returns. To evaluate racial/ethnic and payer outcome disparities among ED returns, we performed a triple differences analysis.RESULTS: ED visits decreased with GBR adoption in MD relative to NY and NJ, by 5 and 6 visits/1,000 population respectively. ED admissions declined relative to NY and NJ, by 0.6% and 1.8% respectively. There was also a post-GBR decline in ED returns by 0.7%. Admissions among returns declined by 2%, while ICU and in-hospital mortality among returns remained relatively stable. ED return outcomes varied by racial/ethnic and payer group. Non-Hispanic whites and non-Hispanic blacks experienced a similar decline in returns, while returns remained unchanged among Hispanics/Latinos, widening the disparity gap. Payer group disparities between privately insured and Medicare, Medicaid, and uninsured individuals improved, with the disparity reduction most pronounced among the uninsured.Originally published: Academic Emergency Medicine. 2021 Jul 20Fiscal year: FY2022Digital Object Identifier: ORCID:- Galarraga, Jessica E Huang, Jim:
- https://orcid.org/0000-0003-3654-9436 https://orcid.org/0000-0002-7461-4369 https://orcid.org/0000-0003-3654-9436 https://orcid.org/0000-0002-7461-4369 Galarraga, Jessica E Huang, Jim:
- https://orcid.org/0000-0003-3654-9436 https://orcid.org/0000-0002-7461-4369 https://orcid.org/0000-0003-3654-9436 https://orcid.org/0000-0002-7461-4369
| Item type | Current library | Collection | Call number | Status | Date due | Barcode |
|---|---|---|---|---|---|---|
| Journal Article | MedStar Authors Catalog | Article | 34288254 | Available | 34288254 |
Available online from MWHC library: 1997 - present, Available in print through MWHC library:2005-2007
BACKGROUND: In 2014, Maryland (MD) implemented a "global budget revenue" (GBR) program that prospectively sets hospital budgets. This program introduced incentives for hospitals to tightly control volume and meet budget targets. We examine GBR's effects on emergency department (ED) visits, admissions, and returns.
CONCLUSIONS: GBR adoption was associated with lower ED utilization and admissions. ED returns and admissions among returns also decreased, while mortality and ICU stays among returns remained stable, suggesting that GBR has not led to adverse patient outcomes from fewer admissions. However, changes in ED return disparities varied by subgroup, indicating that improvements in care transitions may be uneven across patient populations. Copyright This article is protected by copyright. All rights reserved.
METHODS: We performed an interrupted time series analysis with difference-in-differences (DiD) comparisons using 2012 to 2015 Healthcare Cost Utilization and Project data from MD, New York (NY), and New Jersey (NJ). We examined GBR's effects on ED visits/1,000 population, admissions from the ED, and ED returns at 72-hours and 9-days. We also examined rates of admission, intensive care unit (ICU) stay, and in-hospital mortality among returns. To evaluate racial/ethnic and payer outcome disparities among ED returns, we performed a triple differences analysis.
RESULTS: ED visits decreased with GBR adoption in MD relative to NY and NJ, by 5 and 6 visits/1,000 population respectively. ED admissions declined relative to NY and NJ, by 0.6% and 1.8% respectively. There was also a post-GBR decline in ED returns by 0.7%. Admissions among returns declined by 2%, while ICU and in-hospital mortality among returns remained relatively stable. ED return outcomes varied by racial/ethnic and payer group. Non-Hispanic whites and non-Hispanic blacks experienced a similar decline in returns, while returns remained unchanged among Hispanics/Latinos, widening the disparity gap. Payer group disparities between privately insured and Medicare, Medicaid, and uninsured individuals improved, with the disparity reduction most pronounced among the uninsured.
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