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

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.