Orthopedics. 2022 Jan-Feb;45(1):e11-e16. doi: 10.3928/01477447-20211124-03. Epub 2021 Dec 2.
In 2014, Maryland implemented an experimental reimbursement model, Global Budget Revenue (GBR). This model provided hospitals with a capitated annual budget each fiscal year to use toward all services, regardless of payer. Goals of GBR include reductions in cost, improvements in care quality, and increased access for patients to high-volume procedures, such as total knee arthroplasty (TKA). We assessed demographics and outcomes among patients with low incomes and patients of racial minority groups in Maryland who underwent TKA before and after GBR implementation. Patients undergoing TKAs from 2011 to 2016 were queried from the Maryland State Inpatient Database, resulting in 71,066 patients. There were 13,722 patients with low incomes and 19,846 patients of racial minority groups. The chi-square test was used for sex, income, insurance, Charlson Comorbidity Index, and morbid obesity, with the Student's test being reserved for age before and after GBR. The proportion of patients with low incomes decreased the year before GBR but increased with GBR and maintained (<.001). The proportion of patients of racial minority groups increased the year before GBR implementation, decreased slightly, and then maintained (<.001). Mean cost decreased for both cohorts of patients (both <.001). Discharges to home increased for both cohorts (<.001), while length of stay decreased (both <.001). Global Budget Revenue decreased cost while improving outcomes for TKA patients post-GBR. Patients with low incomes have not increased their use of TKA, contrary to patients of racial minority groups. This suggests that barriers remain. Further follow-up of GBR performance in subsequent years will increase understanding of the sustainability of this trend and the degree to which any increase in access is dependent on the implementation of the Affordable Care Act. [. 2022;45(1):e11-e16.].
2014 年，马里兰州实施了一项实验性的报销模式，即全球预算收入（GBR）。该模式为每家医院在每个财政年度提供一个用于支付所有服务的年度预算，无论支付方是谁。GBR 的目标包括降低成本、提高护理质量以及增加患者接受高容量手术（如全膝关节置换术，TKA）的机会。我们评估了马里兰州在实施 GBR 前后低收入患者和少数族裔患者 TKA 的人口统计学和结果。从马里兰州住院患者数据库中查询了 2011 年至 2016 年接受 TKA 的患者，共 71066 例。其中低收入患者 13722 例，少数族裔患者 19846 例。使用卡方检验比较性别、收入、保险、Charlson 合并症指数和病态肥胖，使用学生 t 检验比较 GBR 前后的年龄。在 GBR 之前，低收入患者的比例下降，但随着 GBR 的实施而增加并保持不变（<.001）。少数族裔患者的比例在 GBR 实施前增加，略有下降，然后保持不变（<.001）。两组患者的平均费用都有所下降（均<.001）。两组患者出院回家的比例均有所增加（均<.001），而住院时间则有所缩短（均<.001）。GBR 降低了 TKA 患者的成本，同时改善了术后结果。低收入患者并没有增加 TKA 的使用，与少数族裔患者相反。这表明仍存在障碍。对 GBR 在随后几年的表现进行进一步跟踪，将有助于了解这种趋势的可持续性，以及增加获得机会在多大程度上取决于《平价医疗法案》的实施。[2022；45（1）：e11-e16.]。
