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{
    "pk": 12643,
    "title": "Impact of Global Budget Revenue Policy on Emergency Department Efficiency in the State of Maryland",
    "subtitle": null,
    "abstract": "Introduction:\n On January 1, 2014, the State of Maryland implemented the Global Budget Revenue (GBR) program. We investigate the impact of GBR on length of stay (LOS) for inpatients in emergency departments (ED) in Maryland.\nMethods:\n We used the Hospital Compare data reports from the Centers for Medicare and Medicaid Services (CMS) and CMS Cost Reports Hospital Form 2552-10 from January 1, 2012–March 31, 2016, with GBR hospitals from Maryland and hospitals from West Virginia (WV), Delaware (DE), and Rhode Island (RI). We implemented difference-in-differences analysis and investigated the impact of GBR implementation on the LOS or ED1b scores of Maryland hospitals using a mixed-effects model with a state-level fixed effect, a hospital-level random effect, and state-level heterogeneity.\nResults:\n The GBR impact estimator was 9.47 (95% confidence interval [CI], 7.06 to 11.87, p-value<0.001) for Maryland GBR hospitals, which implies, on average, that GBR implementation added 9.47 minutes per year to the time that hospital inpatients spent in the ED in the first two years after GBR implementation. The effect of the total number of hospital beds was 0.21 (95% CI, 0.089 to 0.330, p-value = 0 .001), which suggests that the bigger the hospital, the longer the ED1b score. The state-level fixed effects for WV were -106.96 (95% CI, -175.06 to -38.86, p-value = 0.002), for DE it was 6.51 (95% CI, -8.80 to 21.82, p-value=0.405), and for RI it was -54.48 (95% CI, -82.85 to -26.10, p-value<0.001).\nConclusion:\n Our results indicate that GBR implementation has had a statistically significant negative impact on the efficiency measure ED1b of Maryland hospital EDs from January 2014 to April 2016. We also found that the significant state-level fixed effect implies that the same inpatient might experience different ED processing times in each of the four states that we studied. [West J Emerg Med.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Emergency Department Efficiency"
        },
        {
            "word": "Global Budgeting"
        },
        {
            "word": "Global Budget Revenue"
        },
        {
            "word": "Difference-in-Difference"
        },
        {
            "word": "Healthcare Policy Impact"
        }
    ],
    "section": "Health Policy Analysis",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/6xg3733b",
    "frozenauthors": [
        {
            "first_name": "Ai",
            "middle_name": "",
            "last_name": "Ren",
            "name_suffix": "",
            "institution": "University of Maryland, Robert H. Smith School of Business, Decision, Operations, and Information Technologies, College Park, Maryland",
            "department": "None"
        },
        {
            "first_name": "Bruce",
            "middle_name": "",
            "last_name": "Golden",
            "name_suffix": "",
            "institution": "University of Maryland, Robert H. Smith School of Business, Decision, Operations, and\nInformation Technologies, College Park, Maryland",
            "department": "None"
        },
        {
            "first_name": "Frank",
            "middle_name": "",
            "last_name": "Alt",
            "name_suffix": "",
            "institution": "University of Maryland, Robert H. Smith School of Business, Decision, Operations, and Information Technologies, College Park, Maryland",
            "department": "None"
        },
        {
            "first_name": "Edward",
            "middle_name": "",
            "last_name": "Wasil",
            "name_suffix": "",
            "institution": "American University, Kogod School of Business, Department of Information Technology and Analytics, Washington, District of Colombia",
            "department": "None"
        },
        {
            "first_name": "Margret",
            "middle_name": "",
            "last_name": "Bjarnadottir",
            "name_suffix": "",
            "institution": "University of Maryland, Robert H. Smith School of Business, Decision, Operations, and Information Technologies, College Park, Maryland",
            "department": "None"
        },
        {
            "first_name": "Jon Mark",
            "middle_name": "",
            "last_name": "Hirshon",
            "name_suffix": "",
            "institution": "University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland",
            "department": "None"
        },
        {
            "first_name": "Laura",
            "middle_name": "",
            "last_name": "Pimentel",
            "name_suffix": "",
            "institution": "University of Maryland, Robert H. Smith School of Business, Decision, Operations, and Information Technologies, College Park, Maryland",
            "department": "None"
        }
    ],
    "date_submitted": "2019-03-26T04:58:40Z",
    "date_accepted": "2019-03-26T04:58:40Z",
    "date_published": "2019-10-14T21:26:58Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/12643/galley/6689/download/"
        }
    ]
}