Rather than let volumes control revenue, HSCRC sets an annual revenue target (GBR) that each hospital must meet.
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 the Total Patient Revenue (TPR) methodology, which was established prior to 2014 for sole community providers to encourage hospitals to focus on population-based health management by prospectively establishing a fixed annual revenue cap for each hospital.
Under GBR 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, population driven volume changes, 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.