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Association of a State-Wide Alternative Payment Model for Rural Hospitals With Bypass for Elective Surgeries
Donald S Bourne1, Zhaojun Sun1, Bruce L Jacobs2
1Department of Health Policy & Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA.
Health Services Research
|January 31, 2025
Summary
The Pennsylvania Rural Health Model (PARHM) did not significantly change overall rural hospital bypass rates for elective surgeries. However, PARHM participation was linked to increased bypass rates specifically for critical access hospitals.
Area of Science:
- Health Services Research
- Healthcare Policy
- Rural Health
Background:
- Rural hospital bypass, where patients seek care outside their local area, impacts healthcare access and financial stability.
- The Pennsylvania Rural Health Model (PARHM) introduced a global budget payment system to rural hospitals.
Purpose of the Study:
- To evaluate the impact of the Pennsylvania Rural Health Model (PARHM) on rural hospital bypass rates for 11 common elective surgeries.
- To analyze changes in bypass trends following the implementation of a global budget payment model in rural Pennsylvania.
Main Methods:
- A comparative interrupted time series analysis was employed, utilizing a natural experiment design.
- Pennsylvania all-payer inpatient discharge data from 2016-2022 (175,138 surgeries) were analyzed.
- Hospital service areas (HSAs) with PARHM-participating hospitals were compared to control HSAs not participating in PARHM.
Main Results:
- The average bypass rate for elective surgeries was 59.9%, showing an increasing trend over the study period.
- Overall, PARHM implementation did not lead to statistically significant differential changes in bypass rates between participating and control HSAs.
- A significant relative increase in bypass rates was observed for critical access hospitals (CAHs) participating in PARHM compared to controls, driven by stable rates in PARHM HSAs and decreased rates in control HSAs.
Conclusions:
- The study indicates that while PARHM did not broadly affect rural bypass rates, there is significant effect heterogeneity, particularly for critical access hospitals.
- The findings highlight a complex relationship between global budgets and hospital bypass, suggesting further investigation into patient outcomes is warranted.
- The differential impact on CAHs participating in PARHM warrants further research into the model's specific effects on rural healthcare utilization.
