Cancer Surgery Outcomes After Implementation of a Global Budget Model in Rural Hospitals

To evaluate the association between the implementation of the Pennsylvania Rural Health Model (PARHM), a global budget program for rural hospitals, and short-term outcomes for rural residents undergoing cancer surgery.

Rural hospitals play a critical role in delivering surgical care but face ongoing financial instability. Global budget models aim to stabilize hospitals and preserve access to care. While designed to stabilize finances and improve population health, its impact on quality of care for complex surgical services remains unknown.

We conducted a repeated cross-sectional study using a stacked difference-in-differences design to compare outcomes before and after the implementation of PARHM. Linked Pennsylvania inpatient discharge and cancer registry data (2016-2023) were used to identify patients undergoing inpatient surgery for 11 cancer types. Patients residing in hospital service areas (HSAs) with PARHM-participating hospitals were compared with those in PARHM-eligible nonparticipating HSAs. Models adjusted for patient and area characteristics and included HSA and year fixed effects.

Among 17,048 cancer surgery admissions, 3537 occurred in PARHM HSAs and 13,511 in comparison HSAs. Baseline patient and area characteristics were broadly similar across groups. PARHM implementation was not associated with changes in 30- or 90-day mortality, readmission, or composite outcomes. Findings were generally consistent across adoption cohorts and cancer types, with no evidence of systematic improvement or deterioration in outcomes following implementation.

Implementation of PARHM was not associated with changes in short-term cancer surgery outcomes among rural residents in Pennsylvania. Alternative strategies may be needed to improve short-term surgical oncology outcomes in rural hospitals.