Maryland's Global Budget Revenue model associated with lower inpatient costs and 30-day readmissions in patients undergoing total hip arthroplasty

Abstract

Background:Maryland implemented the Global Budget Revenue (GBR) to reduce hospital costs, improvequality, and decrease readmissions. Studies assessing its impact on inpatient total hip arthroplasty (THA)procedures are lacking. This study compared before and after GBR changes in 1) patient characteristics;2) discharge dispositions and lengths of stay (LOS); 3) costs and charges of inpatient stays; and 4) 30-dayreadmission rates (RR) for THA recipients.Methods:The Maryland State Inpatient Database was queried for patients who underwent THA between2010 and 2016 utilizing the ICD-9 and ICD-10 procedure codes (n¼43,251). Pre- and post-GBR periodswere grouped as 2010 to 2013 and 2014 to 2016, respectively. Chi-square analyses were used to analyzepatient characteristics. Student's t-tests were utilized to compare ages, LOS, costs, charges, and RR.Results:There were no differences in the proportion of minorities undergoing THA between the pre- andpost-GBR periods (18.3% vs 19.4% African American, 1.2% vs 1.3% Hispanic;P¼.056). The number of THApatients with Medicaid insurances increased during post-GBR (4.0% vs 6.7%;P<.001). There was anincreased rate of home discharges during post-GBR (33.1% vs 40.9%;P<.001). We found lower LOS( 0.50 days; 95% CI: 0.458 to 0.533;P<.001), mean inpatient costs ( $1417.44; 95% CI $1143.76to $1150.32;P<.001), and mean inpatient charges ( $2196.50; 95% CI: $1980.10 to $2412.90;P<.001) during the post-GBR period. There were lower 30-day RR during the post-GBR period ( 0.9%;P<.001).Conclusions:Ourfindings suggest favorable preliminary results for patients undergoing THA under theGBR model.