Maryland’s global budget model led to a notable decrease in outpatient visits but no significant decline in inpatient visits to rural hospitals, according to a new study.
Researchers from Harvard and Johns Hopkins University tracked admission data from 2008 to 2013 and found that outpatient visits declined by 9% in that window, with a 15% decline in trips that weren’t to the emergency room.
Maryland launched the "Total Patient Revenue" budgets in 2010 for rural hospitals and expanded that to other facilities in 2014 in its "Global Budget Revenue" program.
Studies since then have highlighted some of the program’s shortcomings in achieving significant results. A recent study found declines in admissions that tracked with declines in patients not treated under the model, and another found that the model lowered costs but that that didn’t necessarily translate to better care.
The latest study, too, suggests that the impacts of the approach have been “rather limited,” the researchers wrote.
“One explanation for this may be that the incentives of the program are not strong enough to promote profound health delivery system transformation,” they said.
Eric Roberts, Ph.D., assistant professor of public health at the University of Pittsburgh Graduate School of Public Health, wrote in an accompanying article that the all-payers approach cannot be considered truly “global” as it only applied to hospitals—which could be the source of these concerns.
Maryland has since rolled out changes aimed at bringing physicians into the fold and aligning incentives more effectively, Roberts said: “[This] study, like the others the proceeded it, identified this misalignment of hospital and physician incentives as one reason why Maryland’s model might have more limited impacts on care patterns than policymakers intended.”
However, the changes to adjust these incentives may put it on the path to better coordination between hospitals and physicians, he said.
Maryland is currently the only state to try a global budget, which sets a rate all payers charge for hospital services.