Run Your Hospital Well Inside the Global Budget.

Why Maryland hospitals need specialized help

The Health Services Cost Review Commission (HSCRC) is an independent Maryland state agency that regulates hospital rates.^[1] Under Global Budget Revenue, each hospital has an annual revenue target, set from a historical base period rather than from the volume of services it delivers. The base is adjusted for inflation updates, population-driven volume changes, performance in quality-based and efficiency-based programs, changes in payer mix and changes in uncompensated care. Revenue may also change with shifts in service levels, market share or services moving to unregulated settings.^[2]

That changes the strategic questions. Success depends less on how many services are delivered and more on understanding what moves the approved budget, how the hospital performs in the quality programs, and how to run the organization well within it. Hospitals that read the rules correctly can plan with confidence. Those that do not can miss adjustments or misjudge their margin.

What we help with

• Global budget revenue strategy. We help leadership understand how the hospital’s approved revenue is built, what moves it from year to year, and how to plan, forecast and run the organization inside it.
• Volume, market-shift and service-line analysis. Under a global budget, the questions change. We analyze population-driven volume, market share shifts and services moving to unregulated settings, and which service lines to grow, hold or restructure.
• Quality and efficiency program performance. We review results in the HSCRC programs that affect hospital revenue, such as the Maryland Hospital Acquired Conditions program, the Readmission Reduction Incentive Program, Quality Based Reimbursement and the GBR-PAU Efficiency Adjustment, and identify where improvement matters most.
• Rate setting and rate-center analysis. We analyze volume and revenue by rate center, unit rates and the annual update to rates, so you can see how your hospital compares and what is driving change.
• Uncompensated care and payer-mix analysis. We examine changes in payer mix and uncompensated care, both of which feed into the annual adjustments to a hospital’s revenue.
• Scenario modeling and budget planning. We build simple models that show how changes in volume, inflation updates, quality results or service changes could affect revenue and margin.
• AHEAD Model readiness and policy monitoring. We track Commission meetings and policy proposals, translate them into plain English for executives and boards, and help prepare written comments where a hospital wants to respond.
• Executive and board briefings. We explain global budgets, rate setting and the AHEAD Model to leadership teams and boards, with practical examples from the hospital’s own numbers.
• Public Maryland hospital data analysis. We compare hospitals using HSCRC’s published financial and hospital data, with the limits of that data stated.

Not on the list? If your question involves the HSCRC, global budgets or the AHEAD Model, ask us. Tell us what you are trying to decide and we will say whether and how we can help.

How it works

1. Understand. We start with your approved budget, your recent results and the decision in front of you.
2. Gather. We bring together HSCRC publications, your own financial and volume data and relevant public information.
3. Analyze and investigate. We look for what is driving revenue, volume, quality results and cost, and we state what the evidence does and does not establish.
4. Evaluate. We compare options and scenarios, including their trade-offs under the global budget.
5. Recommend. We translate the findings into clear priorities and next steps.

What you receive

A written summary of what we found, the evidence behind each finding and prioritized recommendations. Depending on what you need, we can also provide models, dashboards, presentations or implementation plans.

Learn how the HSCRC and global budgets work

Our plain-English guides explain each part of Maryland’s system, with sources. To see what is changing and what is still a draft, use our HSCRC Policy Tracker.

• What Is the HSCRC? Maryland’s Hospital Rate-Setting Commission Explained
• What Is Global Budget Revenue (GBR)? How Maryland Hospitals Are Paid
• The History of Maryland’s All-Payer Hospital System: From 1971 to the AHEAD Model
• How the HSCRC Sets Hospital Rates: Unit Rates, Rate Orders and the Annual Update Factor
• How Maryland Hospital Global Budgets Are Adjusted Each Year: Volume, Market Shift and More
• HSCRC Quality Programs Explained: MHAC, QBR and RRIP
• Potentially Avoidable Utilization (PAU) in Maryland: How the Savings Policy and GBR-PAU Adjustment Work
• How Maryland Pays for Uncompensated Care: The HSCRC UCC Policy Explained
• The AHEAD Model in Maryland: What It Is and What It Means for Hospitals
• What Changes for Maryland Hospitals in 2028 and 2029 Under the AHEAD Model
• The HSCRC Bridge Adjustment Explained: How Maryland Will Smooth the Move to CMS Medicare Global Budgets
• HSCRC Glossary: The Maryland Hospital Finance Terms Every Executive Should Know
• How to Manage a Hospital Under a Global Budget: A Practical Guide for Maryland Executives

Explore our free Maryland tools

These interactive reports use public Maryland hospital data and show the kind of analysis we do.

• Financial Reports: Statewide HSCRC hospital financial condition data.
• Hospital Profiles: Maryland hospital profiles built from public data.
• Maryland Medicare Inpatient: Maryland Medicare inpatient data, explored interactively.
• HSCRC Intelligence Report: Summaries of HSCRC Commission meetings.
• Annual Experience Report: Volume and revenue by rate center, compared across years.
• Ask About the HSCRC: Plain-English answers about the HSCRC and the AHEAD Model.

Frequently asked questions