The Impact of Maryland’s Capitated Hospital Payment Model on Hospital-Based and Ambulatory Surgical Center Care 

Grant: #73780

Grantee Institution: George Washington University

Principal Investigator: Jesse Pines, M.D.

Grant Period: September 1, 2016 - February 28, 2017

Budget: $79,184

This project is funded as part of the Robert Wood Johnson Foundation’s solicitation “Policy-Relevant Insurance Studies” (PRIS), which supports studies that evaluate or predict the effects of policies or policy changes related to health insurance coverage. The purpose of this project is to explore the impact of Maryland hospitals’ Total Patient Revenue (TPR) program, a pilot program in Maryland that was an alternative payment model where hospitals shifted from fee-for-service to global budgeting. Using 2005-2013 inpatient, emergency department (ED), and ambulatory surgery patient-level data, the researchers will examine the effect of the program on patterns of ED and inpatient care, specifically focusing on case-mix and decisions for hospital admission and procedural care, and shifts toward outpatient care in settings that are outside of the capitation net, particularly ambulatory surgical centers.

Publications

Maryland’s Experiment With Capitated Payments For Rural Hospitals: Large Reductions In Hospital-Based Care
Health Affairs | April 2019