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<ul class="summary-list"><li>Health facilities were already in fiscal straits before COVID-19 - except in Maryland. </li><li>The state uses a data-determined annual budget for each hospital instead of fee-for-service pricing.</li></ul>The way the United States typically finances hospitals isn't working. The coronavirus laid this bare, along with many other long-standing societal problems.Before COVID-19, most hospitals were operating on a standard "fee-for-service" model, in which the more procedures they do, the more they get paid. This worked for some hospitals, but it incentivized them to increase the number of procedures to make more money, which is not always in patients' best interests. And the fee-for-service model wasn't working for all hospitals, particularly those in rural areas or those that served low-income patients, where procedure volume and income are limited by sparse population and lower reimbursements from government payers, respectively. Before the <keyword id="11896136" type="UNKNOWN" weightage="60" keywordseo="pandemic" source="Orion">pandemic</keyword>, half of US hospitals had a profit margin of 3.5% or less. Between 2010 and the beginning of 2020, 120 rural hospitals were forced to close their doors.<keyword id="8764262" type="UNKNOWN" weightage="60" keywordseo="covid" source="Orion">COVID</keyword> has revealed the deeper vulnerabilities of the fee-for-service model. When the pandemic hit in early 2020, many hospitals had to postpone all non-urgent surgeries - their main source of revenue. This affected even facilities that had been in relatively good shape: From March to June 2020, the American Hospital Association (AHA) estimates that US hospitals lost more than $50 billion per month.Things aren't looking much better now: In a <a href="https://www.aha.org/guidesreports/2021-09-21-financial-effects-covid-19-hospital-outlook-remainder-2021">recent report</a> prepared for the AHA, experts predict that hospital income still won't have recovered to pre-pandemic levels by the end of 2021, and could remain as much as 80% lower.But in one state, the financial future for hospitals seems somewhat less bleak.In Maryland, outpatient hospital revenue between January and July 2020 was only 14.6% lower than the same period in 2019; for inpatients, revenue fell by only 1.6%.The reason Maryland hospitals fared better than those in other states during COVID is that the state long ago eschewed the traditional fee-for-service model, and instead adopted an entirely different payment system designed to keep costs down and facilities financially stable. This system proved itself to be particularly useful during the greatest financial threat ever to hit US hospitals and health systems. It protected Maryland's hospitals, keeping them functioning and financially solvent.We believe other states could learn lessons from Maryland's experience.How did Maryland end up with such a different system to pay for hospital care? In 2014, an independent commission in Maryland, with input from payers and hospitals, agreed to a specific annual budget for each hospital, determined by the number of patients and procedures in 2013, plus annual adjustments based on inflation and population growth. This created a system of fixed revenue, or a global budget, paid by all insurers (public and private), so hospitals could anticipate their yearly income, and plan accordingly.The budget is not dependent on patient volume: If a hospital needed to treat more patients than it had anticipated, the reimbursement rate per patient fell; if fewer patients showed up, the rate rose. (The system continues to monitor hospitals to ensure they don't use the payment scheme as a reason to not treat patients, or to discharge them sooner than they should.)Any savings that hospitals get from skipping unnecessary procedures - which come with costs such as supplies and additional staff - are channeled back into programs designed to keep patients healthy and prevent hospital readmissions. Many hospitals began by focusing on reducing readmissions; others are now working with partners in their communities to <a href="https://www.umms.org/ummc/news/2020/ummc-hopkins-team-up-tackle-diabetes-baltimore">redesign care to reduce diabetes and other chronic diseases</a>.Another major benefit of Maryland's financing system is that it keeps hospital budgets relatively stable, even if patient volume drops off. So during COVID, as other hospitals fell into crises when elective procedures were canceled, Maryland hospitals stayed afloat, which gave them the stability to face the unknown and support frontline workers. A recent paper in the Journal of the American Medical Association estimated that under the usual fee-for-service pricing system, Maryland hospitals would have lost an additional $450 million between March and July 2020.The system is working not just for hospitals. Every year, the cost of paying for health care grows, but in Maryland, that increase is smaller than in other states. Within the first five years of their new payment system, Maryland hospitals <a href="https://hscrc.maryland.gov/Documents/Updated%20APM%20results%20through%20PY5.pdf">saved Medicare $1.4 billion</a> by limiting the rise in per-capita spending, compared with the rest of the country. What's more, the quality of care doesn't appear to be suffering - in fact, the <a href="https://www.nejm.org/doi/full/10.1056/NEJMp1508037">rates of preventable hospital-acquired conditions such as pulmonary embolism, renal failure and venous thrombosis fell among patients.</a>We're not saying the Maryland hospital financing model would be possible everywhere - some states may not be able to get all interested parties on the same page. But it is well worth a try, and some states agree. In Pennsylvania, for instance, rural hospitals have moved to a global budget system similar to Maryland's. Other states such as Massachusetts are considering <a href="https://www.milbank.org/focus-areas/total-cost-of-care/peterson-milbank/">their version of global budgets.</a>Whether they succeed remains to be seen. But one thing is certain: Something needs to change. COVID has shown, in a stark way, that the current system of fee-for-service pricing in hospitals is bad in good times, and worse in crises. US hospitals - and their patients - deserve better.

The fee-for-service model is hurting hospitals across the country - here's what Maryland is doing differently

<div class="KonaFilter image-container display-table"><div><div class="image on-image">Manny Hernandez/Getty ImagesJack Nicklaus and Donald Trump at the unveiling of the Jack Nicklaus Villa at Trump Doral at Trump National Doral on February 20, 2015 in Doral, Florida.</div></div></div><ul class="summary-list"><li>President Donald Trump's federal budget proposal earmarks $20 million for a hospital project backed by professional golfer and Trump's close friend Jack Nicklaus, Politico reported Tuesday.</li><li>Politico said that Nicklaus personally lobbied Trump on the golf course for the federal budget to allocate the funding for a mobile children's hospital program he's supported. </li><li>Trump and Nicklaus are long-time friends and golfing partners. In February, Trump posted a photo of him playing a round with Nicklaus and Tiger Woods at the Trump National Golf Club in Jupiter, Florida</li></ul>President Donald Trump's recently-introduced federal budget proposal allocates $20 million for a hospital project backed by professional golfer and Trump's close friend Jack Nicklaus, <a href="https://www.politico.com/story/2019/03/11/trump-jack-nicklaus-1259949" target="_blank" rel="noopener">Politico reported Tuesday.</a>Citing sources familiar with the matter, Politico said that Nicklaus <a href="https://news.fiu.edu/2018/07/the-golden-bear-meets-panthers-on-the-hill/124390">personally lobbied</a> Health and Human Services Secretary Alex Azar, Office of Management and Budget Director Mick Mulvaney, and Trump himself on the golf course for the federal budget to allocate the money for a mobile children's hospital program Sources told Politico that a designation in the budget that would allocate funding to "continue support for the pediatric disaster care pilot initiative" would go to Nicklaus' project. Nicklaus' program aims to provide mobile hospital and medical services for children in vulnerable situations, including children whose lives have been disrupted by natural disasters such as hurricanes. His namesake children's hospital currently provides some mobile dental care for children, Politico said. Trump and Nicklaus are long-time friends and golfing partners. In February, Trump posted a photo of him <a href="https://www.golfchannel.com/news/president-donald-trump-plays-golf-jack-nicklaus-tiger-woods-jupiter" target="_blank" rel="noopener">playing a round with Nicklaus and Tiger Woods</a> at the Trump National Golf Club in Jupiter, Florida. Its 18-hole course was even <a href="https://www.apnews.com/2525c4c8b47c4892adcd2e8d7700a81e">designed by Nicklaus</a>. He had previously golfed with Nicklaus around the Thanksgiving holidays. Read more: <a href="https://www.businessinsider.com/ap-trump-on-course-with-pro-golfers-jack-nicklaus-tiger-woods-2019-2">Trump golfs with Tiger Woods and Jack Nicklaus in first Florida outing since government shutdown</a>When Trump was running for president in 2016, Nicklaus praised Trump as "terrific" and said "he didn't get to where he's at because he's dumb.""He's turning America upside-down, he's awakening the country," <a href="https://www.golfdigest.com/story/jack-nicklaus-on-donald-trump-hes-turning-america-upside-down-hes-awakening-the-country" target="_blank" rel="noopener">he said in an interview with CBS' Tim Axelrod</a>. "We need a lot of that."Nicklaus, dubbed "The Golden Bear" in the golf world, retired from the sport in 2005 after <a href="https://www.businessinsider.com/tiger-woods-missed-chance-to-break-jack-nicklaus-record-2018-8" target="_blank" rel="noopener">winning a career record </a>18 major tournaments including six wins at the Masters. <div class="margin-top"> <h3>NOW WATCH: <a href="https://www.businessinsider.com/alexandria-ocasio-cortez-praised-questioning-michael-cohen-hearing-trump-2019-2">Alexandria Ocasio-Cortez is being praised for her line of questioning at Michael Cohen's hearing - watch it here</a></h3> <div> </div> </div>

Golfer Jack Nicklaus reportedly succeeded in lobbying Trump to include $20 million for a mobile children's hospital program in the federal budget

<a href="http://www.businessinsider.in/searchresult.cms?query=Finance+Minister+Arun+Jaitley&amp;sortorder=effectivedate">Finance Minister Arun </a><a href="http://www.businessinsider.in/searchresult.cms?query=Finance+Minister+Arun+Jaitley&amp;sortorder=effectivedate">Jaitley</a>’s <a href="http://www.businessinsider.in/searchresult.cms?query=Budget+2017+&amp;sortorder=effectivedate">Budget 2017 </a>got some good news for the <a href="http://www.businessinsider.in/searchresult.cms?query=healthcare+sector&amp;sortorder=effectivedate">healthcare sector</a>. The government has prepared an action plan for health, especially for poor. Jaitley announced the target was to eliminate tuberculosis by 2025. Under various proposals made during the <keyword id="6358021" type="PERSON" weightage="20" keywordseo="budget">Budget</keyword>, 1.5 lakh health sub-centres will be transformed into health and wellness centres. Two new <a href="http://www.businessinsider.in/searchresult.cms?query=AIIMS&amp;sortorder=effectivedate">AIIMS</a> hospitals were proposed, to be set up in <a href="http://www.businessinsider.in/searchresult.cms?query=Gujarat&amp;sortorder=effectivedate">Gujarat</a> and <a href="http://www.businessinsider.in/searchresult.cms?query=Jharkhand&amp;sortorder=effectivedate">Jharkhand</a>. 
 
Also, to increase the number of doctors in secondary and tertiary care, the government is making structural reforms in medical education and practice. Jaitley also stated that they will encourage several reputed hospitals across the country to start courses. 
 
There were mixed reactions when it came to healthcare in budget but mostly people are happy. Here’s what experts have to say

Experts are happy with focus on healthcare

The tour and travel industry has sought for exemption on service tax on foreign exchange earned on inbound tours in the upcoming <a href="http://www.businessinsider.in/searchresult.cms?query=budget+2017&amp;sortorder=effectivedate">Budget 2017</a>. 
 
The industry wants <a href="http://www.businessinsider.in/searchresult.cms?query=arun+jaitley&amp;sortorder=effectivedate">Arun Jaitley</a> to announce lower tax rate and fix the <a href="http://www.businessinsider.in/searchresult.cms?query=GST&amp;sortorder=effectivedate">GST </a>rates for the sector. 
 
"Travel and tourism is one of the highest foreign exchange earners for the country. The industry is expecting that there will be exemption of service tax on foreign exchange earned by tour operators for inbound tours," Cox &amp; Kings Ltd CFO Anil Khandelwal told PTI. 
 
He further said paying of double tax on outbound tours must be also ended. 
 
Currently, an Indian customer pays double tax on outbound holidays for the overseas part of the trip due to service tax in India and also local GST/VAT of the visiting country, he said. 
 
"The service tax/GST should be levied only on the Indian component of the tour," Khandelwal said. 
 
Thomas Cook India Group Chairman and Managing Director Madhavan Menon said: "Strengthening 'Incredible India' brand through the creation of tourist circuits, key infrastructure and rail-roadways, is mission critical." 
 
Effective marketing to position India as a top leisure and MICE destination is also of prime importance, he added. 
 
"The tourism industry is one of the largest and most dynamic sectors globally, accounting for more than a third of the total services trade.... Keeping this in mind, we are hopeful that the upcoming Union Budget will provide a vital and much needed boost to the sector," Menon said. 
 
<a href="http://www.businessinsider.in/searchresult.cms?query=oyo&amp;sortorder=effectivedate">OYO</a> Founder and CEO Ritesh Agarwal said considering the government's focus on speedy implementation of digitalisation for long-term economic growth, "all eyes are now on the Union Budget for clarity on <keyword id="6383566" type="PERSON" weightage="20" keywordseo="Taxation">taxation</keyword> policy and regulatory issues, and fixing norms for the credit guarantee scheme. We hope to see supportive policies for the travel and tourism sector." 
 
He said additional incentives should be provided for infrastructure investments in the travel and tourism sector to accelerate growth. 
 
"A lower tax rate for hospitality business and lower rate of interest for real-estate development will ensure opening up of more supply for the nascent branded budget hospitality sector," Agarwal added.

Tour operators want Arun Jaitley to exempt service tax on foreign exchange during inbound trips

Mike Segar/ReutersNew York Gov. Andrew Cuomo speaks at a news conference on Monday, March 23.<ul class="summary-list"><li>562 people have died from the <a href="https://www.businessinsider.com/coronavirus-live-updates-latest-news">coronavirus</a> in New York over the past 24 hours, the single deadliest day since the outbreak began, Gov. Andrew Cuomo said on Friday.</li><li>Cuomo said he's signing an executive order that will allow the state to take ventilators and other much-needed medical equipment from private companies and hospitals and redistribute it to hospitals in need.</li><li>He also said New York managed to pass a budget, albeit not the one he had outlined in his January budget address, as fighting the pandemic has sucked up so much of the state's resources. </li><li><a href="https://www.businessinsider.com/?hprecirc-bullet">Visit Business Insider's homepage for more stories</a>.</li></ul>New York had its the single deadliest 24-hour period since the <a href="https://www.businessinsider.com/coronavirus-live-updates-latest-news">coronavirus outbreak</a> began in the state.Since March 1, when the first confirmed coronavirus case was recorded in the state, 2,935 New Yorkers have died. There were 562 deaths over the past 24 hours, the biggest single-day increase so far, Gov. Andrew Cuomo said in a Friday morning <a href="https://www.businessinsider.com/inside-gov-andrew-cuomos-daily-coronavirus-press-briefings-2020-4">press conference in Albany</a>.There are now over 102,000 confirmed cases statewide, with 14,810 people hospitalized, Cuomo said, with more than half of those concentrated in New York City, now the <a href="https://www.businessinsider.com/coronavirus-us-has-worlds-biggest-outbreak-topping-china-2020-3">global epicenter of the pandemic</a>. "It's hard to go through this all day and then it's hard to stay up all night, watching those numbers come in and the number of deaths tick up," Cuomo said. There are <a href="https://www.businessinsider.com/coronavirus-cases-worldwide-pass-1-million-mark-2020-4">over 1 million confirmed cases of coronavirus globally</a>, and over 250,000 of those cases are in the US, per Johns Hopkins University. <h2>Here are the other biggest takeaways from Cuomo's daily update:</h2><ul><li>Cuomo said he's signing an executive order to address the <a href="https://www.businessinsider.com/fema-100k-coronavirus-ventilators-not-until-june-2020-4">ongoing ventilator shortage</a>. The order will allow the state to take ventilators and other protective equipment from private hospitals and other companies and "redistribute" them to hospitals in need. The National Guard will be mobilized to assist in this process.</li><li>Cuomo said he's been in contact with Alibaba's Jack Ma and Mike Evans to help source medical equipment and protective gear from China. "Alibaba's been very helpful to us," Cuomo said. </li><li>New York's budget passed on Friday, but it wasn't the budget Cuomo had hoped for in his January 21 budget address. While the budget did address the "child vaping scourge," but <a href="https://www.businessinsider.com/cuomo-legal-marijuana-likely-wont-be-included-new-york-budget-2020-3">did not pass recreational marijuana legalization</a>.</li><li>New York Health Commissioner Howard Zucker said there's no direct evidence that masks, or face-covering bandanas and the like, can help protect people from coronavirus, but that those with symptoms or confirmed cases should wear them - as with medical workers. Vice President Mike Pence said on Thursday that the Center for Disease Control (CDC) <a href="https://www.businessinsider.com/white-house-may-recommend-wearing-masks-to-prevent-coronavirus-spread-2020-4">is going to be coming out with new guidance on mask-wearing</a> in "in the next several days."</li><li>Cuomo added, "the masks couldn't hurt, unless they gave a wearer a false sense of security." </li></ul><a href="/intelligence/digital-health?IR=T&amp;itm_source=businessinsider&amp;itm_medium=ctgr_bii&amp;itm_term=ctgr_subscription&amp;itm_content=health&amp;itm_campaign=digital-health"></a> Featured Health Articles: - <a href="/telehealth-industry-explained">Telehealth Industry Explained</a> - <a href="/value-based-care-pay-for-performance-healthcare-model">Value-Based Care Explained</a> - <a href="/senior-care-market-trends">Senior Care &amp; Assisted Living Market</a> - <a href="/wearable-technology-healthcare-medical-devices">Smart Medical Devices &amp; Wearable Tech</a> - <a href="/artificial-intelligence-healthcare">AI in Healthcare</a> - <a href="/remote-patient-monitoring-industry-explained">Remote Patient Monitoring Explained</a>- <a href="/ai-medical-diagnosis-report">AI in Medical Diagnosis Systems</a> <h3>NOW WATCH: <a href="https://www.businessinsider.com/how-to-prep-for-self-quarantine-coronavirus-preppers-network-2020-3">Head of NYC Prepper's Network explains how to prepare for a self-quarantine</a></h3>

New York just had its deadliest day yet of the coronavirus outbreak, Cuomo says

The budget of 2016, presented by <keyword id="42575" type="PERSON" weightage="20" keywordseo="Arun-Jaitley">Arun Jaitley</keyword> was much of euphoria for tourism industry. The tourism ministry got 70 % hike in the budget with an allocation of Rs 1,590 crore, to focus on infrastructure development and promotion and publicity initiatives. Under <keyword id="2964753" type="UNKNOWN" weightage="20" keywordseo="Swadesh-Darshan">Swadesh Darshan</keyword> scheme, theme-based tourism circuits have been identified for infrastructure development across the country, while PRASAD's (national mission on pilgrimage rejuvenation and spiritual augmentation drive) objective is to augment religious and spiritual tourism in the country. 
 The spread looked delicious and the major players were too happy to believe. But on the fateful night of 8th November last year, the debacle happened. PM Modi demonetized Rs 500 and Rs 1000 notes and tourism industry among many others was badly hit. While the government had the logic of digital transaction, foreign tourists coming to India inspired by ‘Atithi devo bhava’ were taken aback. November being Thanks Giving month for most people in the West became quite thankless to the foreign tourists. With too much limitations on withdrawal and exchange, an online travel portal on condition of anonymity told <keyword id="824043" type="COMPANY" weightage="20" keywordseo="Business-Insider">Business Insider</keyword>, they experienced 15% cancelation of pre-booked trips. 
 
So does the upcoming budget look like a silver lining? 
 
Let’s hear it from the experts: 
 Chander K. Baljee, Royal Orchid <keyword id="6368036" type="PERSON" weightage="20" keywordseo="Hotels">Hotels</keyword> told Business Insider, “I believe the tourism and hotel industry could gain tremendous support if the budget supports a lot of things. The list would include extension of e-tourist visa from 30 days to 180 days, need for multiple entry e-toursit visa instead of the existing single entry, promotion on Medical Toursim. 
 
The industry is still saddled with multiple layers of tax include VAT, service tax, luxury tax etc. and ranges from 20% - 30%. Lowering the threshold of infrastructure status for hotel projects to Rs. 25 Cr. would also do well. Some of the aspects which can be considered are: special incentives like tax-free bonds and income tax exceptions on profits used in re-investment in the tourism sector, development of tourism infrastructure at heritage site, setting up centres for adventure activities and experiential zones. More support to drive job creation in this industry will help improve the poverty alleviation in the country.” 
 
Talking about building of infrastructure, Ritesh Agarwal, Founder &amp; CEO, OYO said, “Infrastructure development is a pre-requisite to provide the much-needed impetus for the industry’s growth. Additional incentives should be provided for infrastructure investments in the travel and tourism sector to accelerate growth. A lower tax rate for hospitality business and the lower rate of interest for real-estate development will ensure opening up of more supply for the nascent branded budget hospitality sector. This will be in line with supporting small owner-friendly policies, such as the exemption of service tax in the sub-Rs. 1000 hotel room category.” 
 
Not just Indian entrepreneurs, even tourism boards of various countries are equally excited about the budget on Februray 1. Hanneli Slabber, Country Manager, South African Tourism India said, “Positive taxation of course will help propel domestic tourism forward. We look forward to positive taxation on airline tickets and airport services to make the proposition of flying domestically and internationally more accessible to all Indians.”

You Searched For "budget hospitality" and got 6 results

The fee-for-service model is hurting hospitals across the country - here's what Maryland is doing differently

John Colmers and Sherry Glied

Golfer Jack Nicklaus reportedly succeeded in lobbying Trump to include $20 million for a mobile children's hospital program in the federal budget

Grace Panetta

Experts are happy with focus on healthcare

HASAN BABAR

Tour operators want Arun Jaitley to exempt service tax on foreign exchange during inbound trips

BI India Bureau

New York just had its deadliest day yet of the coronavirus outbreak, Cuomo says

Jeremy Berke

Here’s how Budget 2017 will be a game changer in tourism industry

Suchayan Mandal

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