The introduction of a global budget model in Pennsylvania rural hospitals failed to improve short-term outcomes for cancer surgery patients.

• Among over 17,000 cancer surgery admissions, the model did not change rates of 30-day or 90-day mortality, readmission, or other composite outcomes.
• Results were consistent across multiple cancer types and patient cohorts.

Surgeons should consider that financial models like PARHM may not effectively enhance surgical care quality or outcomes in rural settings, prompting a reevaluation of strategies to improve surgical oncology results.