• Ronald E Delanois, Chukwuweike U Gwam, Jeffrey J Cherian, Jennifer I Etcheson, Iciar M Dávila Castrodad, Kurt P Spindler, and Michael A Mont.
• Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD.
• J Arthroplasty. 2019 Feb 1; 34 (2): 201-205.

BackgroundMaryland is the only state utilizing the Global Budget Revenue (GBR) model to reduce costs. The purpose of this study is to evaluate whether the GBR payment model effectively reduced the following: (1) costs of inpatient hospital stays; (2) post-acute care costs; (3) lengths of stay (LOS); (4) readmission rates; and (5) discharge disposition in patients who underwent primary total hip and knee arthroplasty (THA and TKA).MethodsWe evaluated the Maryland Centers for Medicare & Medicaid Service database for THAs and TKAs performed at 6 hospitals 1 year prior to (2012) and after the initiation of GBR (2015). We compared differences in costs for each inpatient care episode, post-acute care periods (total costs, acute rehabilitation, short-term nursing facility, home health, durable medical equipment), readmissions, LOS, and discharge disposition.ResultsHospitals had a significant reduction in mean inpatient care costs for THA and TKA (P < .0001). There was a significant reduction in total post-acute care costs following THA (P < .001). Home healthcare had a significant increase in cost following THA and TKA (P < .0001). There was a significant reduction in durable medical equipment costs for THA (P < .0001). There was a significant decrease in LOS for THA and TKA (P < .0001). There was a significant increase in patients discharged home (THA, P = .0262; TKA, P = .0058).ConclusionThe Maryland healthcare model may be associated with a reduction in inpatient and post-acute care costs. Furthermore, implementation of GBR may result in reductions in LOS and readmission rates.Copyright © 2018 Elsevier Inc. All rights reserved.

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