Key result
Maryland's All Payer Model caused an initial 8% drop in TAVR utilization (p<0.001) but did not significantly reduce 30-day post-TAVR readmissions compared to New Jersey (DiD -2.1%, p=0.1).
Why the study?
It is unknown how cost-constrictive payment reform measures, such as Maryland's All Payer Model, impact TAVR utilization and associated readmissions given the procedure's relative expense.
Does Maryland's All Payer Model impact TAVR utilization and 30-day readmissions in Medicare beneficiaries?
Observational
Yes
Does Maryland's All Payer Model impact TAVR utilization and 30-day readmissions in Medicare beneficiaries?
Mean Difference: -2.1 (95% CI -5.2–0.9)
p-value: p=0.1
A statewide cost-constrictive payment reform (Maryland's All Payer Model) caused a temporary decline in TAVR utilization but did not limit long-term utilization or reduce 30-day readmissions.
Maryland's All-Payer Model showed no TAVR utilization or readmission effect; leaves open payment reform impacts on procedural care.
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is an increasingly used but relatively expensive procedure with substantial associated readmission rates. It is unknown how cost-constrictive payment reform measures, such as Maryland's All Payer Model, impact TAVR utilization given its relative expense. This study investigated the impact of Maryland's All Payer Model on TAVR utilization and readmissions among Maryland Medicare beneficiaries. METHODS: This was a quasi-experimental investigation of Maryland Medicare patients undergoing TAVR between 2012 and 2018. New Jersey data were used for comparison. Longitudinal interrupted time series analyses were used to study TAVR utilization and difference-in-differences analyses were used to investigate post-TAVR readmissions. RESULTS: During the first year of payment reform (2014), TAVR utilization among Maryland Medicare beneficiaries dropped by 8% (95% confidence interval [CI]: -9.2% to -7.1%; p < 0.001), with no concomitant change in TAVR utilization in New Jersey (0.2%, 95% CI: 0%-1%, p = 0.09). Longitudinally, however, the All Payer Model did not impact TAVR utilization in Maryland compared to New Jersey. Difference-in-differences analyses demonstrated that implementation of the All Payer Model was not associated with significantly greater declines in 30-day post-TAVR readmissions in Maryland versus New Jersey (-2.1%; 95% CI: -5.2% to 0.9%; p =0.1). CONCLUSIONS: Maryland's All Payer Model resulted in an immediate decline in TAVR utilization, likely a result of hospitals adjusting to global budgeting. However, beyond this transition period, this cost-constrictive reform measure did not limit Maryland TAVR utilization. In addition, the All Payer Model did not reduce post-TAVR 30-day readmissions. These findings may help inform expansion of globally budgeted healthcare payment structures.
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Yesantharao et al. (2023) conducted an observational in Medicare patients undergoing TAVR. Maryland's All Payer Model vs. New Jersey (no payment reform) was evaluated on 30-day post-TAVR readmissions (Difference-in-differences -2.1%, 95% CI -5.2 to 0.9, p=0.1). Maryland's All Payer Model caused an initial 8% drop in TAVR utilization (p<0.001) but did not significantly reduce 30-day post-TAVR readmissions compared to New Jersey (DiD -2.1%, p=0.1).
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