The impact of a statewide payment reform on transcatheter aortic valve replacement (TAVR) utilization and readmissions

Pooja S. Yesantharao, Eric W. Etchill, Alice L. Zhou, Chin Siang Ong, Thomas S. Metkus, Joseph K. Canner, Diane E. Alejo, Oluseyi Aliu, Matthew J. Czarny, Rani K. Hasan, Jon R. Resar, Stefano Schena

Research output: Contribution to journalArticlepeer-review


Background: Transcatheter aortic valve replacement (TAVR) is an increasingly used but relatively expensive procedure with substantial associated readmission rates. It is unknown how cost-constrictive payment reform measures, such as Maryland's All Payer Model, impact TAVR utilization given its relative expense. This study investigated the impact of Maryland's All Payer Model on TAVR utilization and readmissions among Maryland Medicare beneficiaries. Methods: This was a quasi-experimental investigation of Maryland Medicare patients undergoing TAVR between 2012 and 2018. New Jersey data were used for comparison. Longitudinal interrupted time series analyses were used to study TAVR utilization and difference-in-differences analyses were used to investigate post-TAVR readmissions. Results: During the first year of payment reform (2014), TAVR utilization among Maryland Medicare beneficiaries dropped by 8% (95% confidence interval [CI]: −9.2% to −7.1%; p < 0.001), with no concomitant change in TAVR utilization in New Jersey (0.2%, 95% CI: 0%–1%, p = 0.09). Longitudinally, however, the All Payer Model did not impact TAVR utilization in Maryland compared to New Jersey. Difference-in-differences analyses demonstrated that implementation of the All Payer Model was not associated with significantly greater declines in 30-day post-TAVR readmissions in Maryland versus New Jersey (−2.1%; 95% CI: −5.2% to 0.9%; p =0.1). Conclusions: Maryland's All Payer Model resulted in an immediate decline in TAVR utilization, likely a result of hospitals adjusting to global budgeting. However, beyond this transition period, this cost-constrictive reform measure did not limit Maryland TAVR utilization. In addition, the All Payer Model did not reduce post-TAVR 30-day readmissions. These findings may help inform expansion of globally budgeted healthcare payment structures.

Original languageEnglish (US)
Pages (from-to)1193-1202
Number of pages10
JournalCatheterization and Cardiovascular Interventions
Issue number7
StatePublished - Jun 1 2023


  • Maryland All Payer system
  • TAVR
  • global hospital budgets
  • payment reform
  • readmissions

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging


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