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VOLUME 54 | NUMBER 3 | JUNE 2019

Response to "The effects of global budget payments on hospital utilization in rural Maryland"

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Over the last decade, the push toward payment reform in the United States has led to the proliferation of alternative models to feeforservice payment. A common feature of alternative payment models (APMs) is the use of spending benchmarks (budgets), which provide incentives for providers to be more efficient, tied to payforperformance incentives, which reward quality improvement and discourage stinting on care.1-4 Maryland's hospital global budget program follows this basic structure, but with characteristics that differentiate it from other APMs. Unlike APMs such as accountable care organizations and bundled payment models, Maryland's global budget model focuses on a specific site of care (hospitals); places hospitals—but not physicians—at risk for spending and outcomes; and includes all payers.5 These unique features have generated interest in whether Maryland's approach to payment reform holds the potential to improve hospital care and—by discouraging the use of potentially avoidable, highcost hospital services—catalyze broader changes in the way hospitals address the health needs of populations they serve

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