Key result
Global budget payments linked to fewer 30-day AMI readmissions without increasing cardiovascular mortality.
Why the study?
Global budget payments effectively contain health care expenditures, but information on their impact on the quality of cardiovascular care is limited.
Does the implementation of Global Budget Payments impact utilization, outcomes, and costs for major cardiovascular conditions?
Observational
Yes
Does the implementation of Global Budget Payments impact utilization, outcomes, and costs for major cardiovascular conditions?
State-level adoption of Global Budget Payments may effectively contain costs without adversely impacting the quality of cardiovascular care or inpatient outcomes.
Background Global budget payments (GBP) are considered effective in containing health care expenditures; however, information on their impact on quality of cardiovascular care is limited. We aimed to evaluate the effects of GBP on utilization, outcomes, and costs for 3 major cardiovascular conditions. Methods We analyzed claims data of hospital admissions in Maryland from fiscal year 2013 to 2018. Using segmented regression, we evaluated temporal trends in hospitalizations, length of stay, percutaneous coronary intervention and coronary artery bypass grafting volumes, case mix-adjusted 30-day readmission rates, risk-standardized mortality rates, and hospitalization charges in patients with principal diagnosis of heart failure, acute ischemic stroke, and acute myocardial infarction (AMI) in relation to GBP implementation. Trends in global cardiovascular procedure charges/volumes were also studied. Results Hospitalization rates for congestive heart failure and AMI remained unaffected by GBP, while the gradient of ischemic stroke admissions decreased ( P trend <0.0001). Length of stay slightly increased for patients with congestive heart failure ( P trend =0.03). Inpatient coronary artery bypass grafting surgeries decreased ( P trend <0.0001). We observed a significant decrease in casemix-adjusted 30-day readmission rate in the AMI cohort beyond the prepolicy trend ( P trend =0.0069). There were no significant changes in mortality for any of the 3 conditions. Hospitalization charges increased for ischemic stroke ( P trend <0.0001), remained constant for congestive heart failure ( P trend =0.1), and decreased for AMI ( P trend =0.0005). We observed a significant increase in electrocardiography rate charges ( P trend <0.0001), coincidentally with a reduction in volumes ( P trend =0.0003). Conclusions Introducing GBP in Maryland had no perceivable adverse effects on inpatient outcomes and quality indicators for 3 major cardiovascular conditions. Savings were observed in the AMI cohort, possibly due to reduced unnecessary readmissions, efficiency improvements, or shifts to outpatient care. Reduced cardiovascular procedure volumes were counterbalanced by a proportional rise in charges. State-level adoption of GBP with pay-for-performance incentives may be effective for cost containment without adversely impacting quality of cardiovascular care.
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Viganego et al. (2021) conducted an observational in Heart failure, acute ischemic stroke, and acute myocardial infarction. Global budget payments vs. Pre-policy trend was evaluated on Temporal trends in hospitalizations, length of stay, procedure volumes, 30-day readmission rates, mortality rates, and hospitalization charges. Global budget payments in Maryland had no adverse effects on mortality for major cardiovascular conditions, and significantly decreased 30-day readmissions for acute myocardial infarction (P=0.0069).
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