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Experiences With Maryland's All-Payer Model Among Surgeons.

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Summary

Surgeons know about Maryland's all-payer model (APM) but lack understanding and clear communication, impacting care delivery. Better clinician engagement and clearer strategies are needed for alternative payment models.

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Area of Science:

  • Health policy
  • Healthcare economics
  • Surgical practice

Background:

  • Hospital global budgets aim to control costs and improve patient outcomes.
  • Maryland's all-payer model (APM) is a full-risk payment reform initiative using global budgets.
  • Surgeon perspectives on APM implementation and impact remain largely unevaluated.

Purpose of the Study:

  • To investigate the experiences of surgeons operating under Maryland's APM.
  • To assess surgeon awareness, communication, practice changes, and perceived effects of the APM on care delivery.

Main Methods:

  • Convergent mixed-methods design utilizing surveys and semistructured interviews.
  • Surveys and interviews assessed surgeon experiences based on the Consolidated Framework for Implementation Research (CFIR).
  • Purposive and snowball sampling recruited surgeons from diverse practice settings; a nested sample underwent interviews.

Main Results:

  • High awareness (85.4%) of the APM among surveyed surgeons, but limited recall of institutional communication (38.8%).
  • Surgeons reported practice changes (63.6%) and centralization of complex care (59.1%), but doubted improvements in referral management or reduced hospital use.
  • Qualitative interviews revealed superficial understanding, reliance on peer communication, confusion over metrics, and concerns about resource strain due to financial incentives.

Conclusions:

  • Surgeons exhibit high awareness but limited operational understanding of Maryland's APM, with inconsistent institutional communication.
  • The APM has indirect effects on surgical practice, necessitating improved clinician engagement and clearer communication strategies.
  • Implementing alternative payment models requires deliberate stakeholder involvement and aligned clinical incentives for successful adoption and impact.