Global Budgets


Completed Agreements under the All-Payer Model

Global Budget Revenue Overview Presentation

Global Budget Revenue (“GBR”) methodology is central to achieving the three part aim set forth in the All-Payer Model of promoting better care, better health, and lower cost for all Maryland patients. In contrast to the previous Medicare waiver that focused on controlling increases in Medicare inpatient payments per case, the new All-Payer Model focuses on controlling increases in total hospital revenue per capita. GBR methodology is an extension of TPR methodology, which encourages hospitals to focus on population-based health management by prospectively establishing a fixed annual revenue cap for each GBR hospital.

The Total Patient Revenue System (“TPR”) is a revenue constraint system available to sole community provider hospitals and hospitals operating in regions of the State characterized by an absence of densely overlapping service areas. The TPR system provides hospitals with a financial incentive to manage their resources efficiently and effectively in order to slow the rate of increase in the cost of health care. The TPR also is consistent with the Hospital’s mission to provide the highest value of care possible to the community it serves.

Under GBR and TPR contracts, each hospital’s total annual revenue is known at the beginning of each fiscal year. Annual revenue is determined from an historical base period that is adjusted to account for inflation updates, infrastructure requirements, population driven volume increases, performance in quality-based or efficiency-based programs, changes in payer mix and changes in levels of UCC. Annual revenue may also be modified for changes in services levels, market share shifts, or shifts of services to unregulated settings.

*Please Note: The GBR contracts utilize the same contract template and differ only in section XII D entitled “Other Provisions Relative to the Hospital.” They also have a table of contents page that is linked to the specific sections and page numbers for ease of navigation.​


Global Budget Revenue (“GBR”)


Total Patient Revenue (“TPR”)