• Nicolae Done, Bradley Herring, and Tim Xu.
• Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
• Health Serv Res. 2019 Jun 1; 54 (3): 526-536.

ObjectiveTo assess the effect of Maryland's 2010 Total Patient Revenue (TPR) global budget reform in eight rural hospitals on population-level hospital rates of utilization three years after implementation.Data Sources/Study SettingData on all inpatient discharges and outpatient department visits from the Health Services Cost Review Commission, population data from Claritas Demographic Reports, and county-level data from the Area Health Resource File.Study DesignWe use a difference-in-differences approach to compare changes in utilization rates over time in the reform areas comprising 125 Zip Code Tabulation Areas (ZCTAs) and in two control hospital areas (66 ZCTAs and 327 ZCTAs, respectively). We examine several inpatient and outpatient measures and distinguish between relatively discretionary and nondiscretionary utilization.Data CollectionAdmissions data are hospital-reported discharge abstracts of all encounters in Maryland during 2008-2013. Population data are derived from the US Census.Principal FindingsWe find no statistically significant changes in admissions, either overall or discretionary. We find a statistically significant 8.9 percent (95%CI = [1.8, 16.0]) reduction in outpatient visits, with a statistically significant reduction of 14.8 percent (95%CI = [5.3, 24.3]) visits not to the Emergency Department.ConclusionsWe find that the TPR reform decreased outpatient utilization but did not affect inpatient utilization.© Health Research and Educational Trust.

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