The state of Maryland has implemented\u00a0 a payment\u00a0 model for hospitals which caps revenue and attempts to regulate volume. The initial attraction was,\u00a0 if\u00a0 hospitals knew what there operating budget would be and if there were able to reduce cost, than the difference would be profit that could be reallocated for improvements, personel, or overall growth.\u00a0 Now approximately 5 % was assigned to quality metrics The regulatory body,HSCRC, also has the ability to readjust\u00a0 based on inflation, volume shift and failure to meet quality metrics.\u00a0 To note, if a hospital exceeds its volume threshold than that excess is paid at 50% which, for\u00a0 most hospital, is below cost.\u00a0 The other issue is that most hospitals are part of a system but are viewed by HSCRC independently. Now as hospitals will shift volume for a variety\u00a0 of reasons, i.e. too complicated, too costly, the receiving hospital is potentially exceeding budget and volume and the sending hospital may or may not be with in their financial corridor. Now, you may ask yourself, why doesn’t HSCRC realize this. The answer is the transfer is\u00a0 defended by the institutions as the right thing for the patient.\u00a0 So now let me explain the conundrum.\u00a0 Since the introduction of this payment model, most hospitals have figured out the game and volume is not your friend. Most hospitals continue to struggle with controlling volume especially tertiary hospitals.\u00a0 So, the response by these facilities is to use elective volume as its flux. They will ask surgeons to shift volume when a hospital is at risk for too much volume or if a hospital, within its system, needs volume. \u00a0As you can imagine, this is very disruptive to patients and employees.\u00a0 When volume is needed at a sister hospital, the hospital that is above threshold is asked to close ORs ( this lowers expense) and the employees and doctors are asked to shift to the other hospital to provide volume.\u00a0 As you can imagine, this is not what the doctors or employees signed up for.\u00a0 So as ask for your help is solving this conundrum.<\/p>\n","protected":false},"excerpt":{"rendered":"
The Maryland Global budget model has created an volume conundrum. I would love to here your thoughts.<\/p>\n","protected":false},"author":12197,"featured_media":0,"comment_status":"open","ping_status":"closed","template":"","categories":[442,441],"class_list":["post-551","hck-submission","type-hck-submission","status-publish","hentry","category-access-issues","category-global-budget","hck-taxonomy-organization-hospitals","hck-taxonomy-country-united-states"],"connected_submission_link":"https:\/\/d3.harvard.edu\/platform-mhcdsolutions\/conversation\/mhcd-solutions\/","yoast_head":"\n