Related Experiment Video
Updated: Jan 1, 2026
Mouse Heterotopic Cervical Cardiac Transplantation Utilizing Vascular Cuffs
Published on: June 23, 2022
Maryland's Global Budget Revenue Program and Coronary Artery Bypass Surgery
Michael A Mazzeffi1, James S Gammie2, Kenichi Tanaka1
1Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland.
Insights
Maryland's global budget revenue (GBR) program reduced potentially preventable complications (PPCs) for coronary artery bypass grafting (CABG) patients but did not significantly impact readmissions. The initiative showed minimal charge growth.
Area of Science:
- Health Services Research
- Healthcare Policy
- Cardiovascular Surgery
Background:
- Maryland implemented a global budget revenue (GBR) program in 2014, assigning fixed annual budgets to hospitals.
- The study investigated the GBR program's impact on coronary artery bypass grafting (CABG) patient outcomes and costs.
Purpose of the Study:
- To evaluate the association of Maryland's GBR program with changes in CABG patient risk profiles.
- To assess reductions in potentially preventable complications (PPCs) and 30-day hospital readmissions post-GBR implementation.
- To analyze annual per-patient charge growth in CABG cases under the GBR program.
Main Methods:
- Analysis of isolated CABG patient data in Maryland from fiscal years 2013 to 2017.
- Comparison of patient characteristics, severity of illness, PPCs, readmissions, and hospital charges.
- Interrupted time series analysis to evaluate the GBR program's effect on PPCs and readmissions.
Main Results:
- A significant increase in patient severity of illness was observed (34.6% in 2013 vs. 46.1% in 2017).
- A significant reduction in mean PPC incidence of -22.8% was found after GBR implementation.
- No significant reduction in 30-day hospital readmissions was observed (-2.7%).
- Annual per-patient charge growth remained between -1.4% and 2.6% without adjusting for inflation.
Conclusions:
- Maryland's GBR program was associated with significant reductions in PPCs for CABG patients.
- The program demonstrated minimal per-patient charge growth during the initial 14 fiscal quarters.
- The GBR initiative did not significantly alter 30-day hospital readmissions for CABG patients, indicating partial achievement of its goals.
Background:
In 2014 Maryland began a global budget revenue (GBR) program where hospitals were assigned a global budget for each year. We hypothesized that this program would be associated with changes in coronary artery bypass grafting (CABG) patient risk profile, reductions in potentially preventable complications (PPCs) and 30-day hospital readmissions, and low annual per patient charge growth.
Methods:
Patients having isolated CABG surgery in Maryland between fiscal years 2013 and 2017 were included. Patient characteristics, admission all-payer refined severity of illness, PPCs, 30-day hospital readmissions, and per patient hospital charges were compared between years. The impact of Maryland's GBR program on PPCs and 30-day hospital readmissions was evaluated using interrupted time series analysis.
Results:
During the study period 11,070 patients had CABG surgery. The percentage of patients with major or extreme severity of illness at admission differed significantly between years (34.6% in 2013 vs 46.1% in 2017, P < .001). There was a significant reduction in mean PPC incidence of -22.8% (95% confidence interval, -29.8% to -15.8%) after GBR implementation but no significant reduction in 30-day hospital readmissions (-2.7%; 95% confidence interval, -6.0% to 0.6%). Without adjusting for inflation the annual per patient charge growth remained between -1.4% and 2.6% from 2013 to 2017.
Conclusions:
Maryland's GBR program was associated with significant PPC reductions, minimal charge growth, and no significant change in 30-day hospital readmissions during its first 14 fiscal quarters. These findings suggest that Maryland's GBR program achieved some but not all of its predefined goals in CABG patients.
