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In 2014, Maryland expanded its all-payer hospital rate-setting model into a population-based global budget revenue model, which replaced fee-for-service hospital payments and introduced quality pay-for performance incentives for acute-care hospitals. The model has incentivized a shift towards non-hospital care and reduced hospital admissions. The research team conducted a total of 25 semi-structured interviews across 18 different hospital emergency departments with emergency department physician leadership (n = 14) and care coordination staff (n = 11) to examine emergency department care coordination processes and understand the focus of care coordination efforts. The interviews assessed the perceived efficacy of care coordination and identified barriers to success, as well as the influence of Maryland’s payment reform model on emergency department care coordination strategies.
The results showed that across all emergency departments, there was significant variation in the hours and types of care coordination staff coverage and the number of initiatives implemented to improve care coordination. Most participants perceived Maryland’s reform with global budgeting as having a mixed impact on emergency department care coordination and overall emergency department care. Participants perceived emergency department care coordination as effective in facilitating safer discharges, improving outpatient follow-up and addressing social determinants of health; however, adequate access to outpatient providers was a significant barrier. Emergency department physician leaders identified improved care transitions and patient care but experienced increased workloads to avoid admissions and support safe transitions among their discharged patients.
Although the observed care coordination initiatives were perceived to produce positive results, Maryland's global budgeting policies were also perceived to produce barriers to improving emergency department care. Further research is needed to determine the association of the different strategies to improve emergency department care coordination with patient outcomes to inform practice leaders and policymakers on the efficacy of the various approaches. This research was led by Dr. Jessica Galarraga, a MedStar Health economics investigator and emergency medicine physician.
American Journal of Emergency Medicine, 2021. DOI: 1016/j.ajem.2020.12.048