Effects of Maryland's All-Payer Model on elective joint replacement surgery

Area of Science:

• Health Services Research
• Orthopedic Surgery Outcomes
• Healthcare Policy Analysis

Background:

• The Maryland All-Payer Model aimed to control healthcare costs while maintaining quality.
• Understanding the model's effect on elective procedures like major joint replacement is crucial.
• Previous research has not fully elucidated the impact on surgical rates within this specific model.

Purpose of the Study:

• To evaluate the Maryland All-Payer Model's influence on the rate of elective major joint replacement surgeries.
• To compare the changes in major joint replacement rates with those of hip fracture repair.
• To investigate variations in surgical rates based on hospital affiliations.

Main Methods:

• Retrospective cohort study of Medicare fee-for-service patients in Maryland (2011-2018).
• Utilized a difference-in-difference framework comparing elective major joint replacement to hip fracture repair.
• Employed generalized linear models to estimate the All-Payer Model's association with surgical rates.

Main Results:

• Elective major joint replacement surgery rates increased more significantly than hip fracture repair rates under the All-Payer Model (aRR, 1.31).
• Hospitals with affiliates in adjacent states experienced slower growth in major joint replacement rates compared to Maryland-only hospitals (aRR, 0.87).
• Major joint replacement rates for Maryland residents at affiliated out-of-state hospitals increased post-intervention.

Conclusions:

• The Maryland All-Payer Model was associated with a more rapid rise in population-based elective major joint replacement surgery rates than hip fracture repair.
• While Maryland hospitals with out-of-state affiliates showed slower growth, elective major joint replacement rates increased for Maryland residents at these affiliated out-of-state facilities.