Maryland Total Patient Revenue
What They’re Doing: Global hospital budget arrangements that cover all inpatient and outpatient services provided by participating hospitals with incentives to ensure that patients receive care in the most appropriate setting.
Innovation Type: Total Patient Revenue
Supportive Financing Mechanism: Total Patient Revenue is a Health Services Cost Review Commission (HSCRC) approved three-year program designed to implement a voluntary alternative hospital financing strategy for Maryland hospitals that have defined service areas (primarily rural hospitals). Participating hospitals receive a global budget that covers all inpatient and outpatient services provided by the hospital. A global budget is based on the hospital's revenue from the prior fiscal year. The approved revenue is adjusted by the Commission’s approved annual rate update factor and relative performance on specific quality (both process and outcome) measures. This global budget is the annual revenue target under which a participating hospital can charge all payers (including Medicare, Medicaid and private insurers) for services. If the hospital can increase efficiency, contain costs, and/or reduce avoidable admissions and readmissions, it will achieve financial savings. If costs increase beyond the global budget amount, then the hospital bears the financial risk.
Evaluation type: Quasi-Experimental
Evaluation Plan: HSCRC will review any market share shifts; the number of hospital admissions, outpatient visits, and readmissions; as well as how hospitals score on various quality measures (both on process and outcome before and after the program. Additionally, hospitals must submit to the Commission interventional plans implemented to achieve the desired outcomes and savings.
Outcomes: Not available at this time. 3-year arrangement results expected end of 2013.
Target Population: Rural Hospitals in Maryland (10 hospitals currently participating)
Date of Implementation : July 2010
Contact: Steve Ports at the Maryland Health Services Cost Review Commission (HSCRC) firstname.lastname@example.org.
Where to learn more: Pending