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. 2022 Apr 6;157(6):e220135. doi: 10.1001/jamasurg.2022.0135

Table 3. Association of Maryland Global Budget Revenue Program With Total Medicare Payments, Readmissions, Emergency Department Visits, and Mortality Through 30 Days After Discharge.

Pre-GBR period Post-GBR period DID estimatesa
Maryland Control states Maryland Control states DID estimate (95% CI), pp P value
All surgeries
Total Medicare payments, mean (SD), $ 31 720 (36 494) 20 676 (26 467) 28 312 (31 123) 16 583 (21 087) 646 (−208 to 1542) .14
Any all-cause readmission, % 13.5 8.9 10.4 7.6 −2.2 (−4.3 to −0.1) .04
Any ED visit, % 16.1 13.9 14.6 12.6 −1.0 (−3.4 to 1.4) .42
Death, % 2.5 2.1 1.6 1.3 −0.4 (−1.4 to 0.5) .36
Major cancer surgeries
Total Medicare payments, mean (SD), $ 47 137 (42 465) 34 923 (35 789) 41 955 (36 313) 28 179 (29 048) 1471 (−1140.86 to 4307.42) .28
Any all-cause readmission, % 20.1 15.6 17.4 13.2 −0.6 (−5.1 to 4.0) .80
Any ED visit, % 22.1 20.4 22.1 18.9 1.3 (−3.6 to 6.2) .59
Death, % 4.6 3.8 2.8 2.8 −1.3 (−3.5 to 0.9) .24
Discharged to SNF or IRF, %b 14.3 17.2 13.7 14.3 2.1 (−2.1 to 6.3) .33

Abbreviations: DID, difference-in-differences; ED, emergency department; GBR, global budget revenue; IRF, inpatient rehabilitation facility; pp, percentage points; SNF, skilled nursing facility.

a

Models for all surgeries were adjusted for hospital fixed effect, year fixed effect, and patient characteristics, including race and ethnicity, dual eligibility at surgery month, cancer type, surgery setting (inpatient or outpatient), and chronic obstructive pulmonary disease. Models for major cancer surgeries were adjusted for hospital fixed effect, year fixed effect, race and ethnicity, dual eligibility at surgery month, surgery type, and chronic obstructive pulmonary disease.

b

Patients who were not discharged home, to SNF, or to IRF were excluded, leaving 8054 patients (6431 from Maryland; 1623 from control hospitals) in the analysis. Excluded patients were those who died (n = 148) or were discharged to another hospital (short-term, long-term, federal, critical access hospital, n = 248), hospice (n = 34), or other care facilities (intermediate care facility, Medicaid certified nursing home, other health care institution, n = 41). We additionally excluded 19 patients to ensure Maryland hospitals and their matched controls had data from the same years.