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Background: Earlier reports have documented growth of United States emergency department (ED) visits since the early 1990s.Objective: In this report, we describe recent trends in ED utilization and inpatient admissions in Maryland and District of Columbia hospitals from 2011 to 2013.Methods: We analyzed monthly ED visit and inpatient admission volumes from 53 acute care hospitals in Maryland and the District of Columbia from 2011 to 2013. Fixed-effect regression was used to assess the relationship between community-level demographics, hospital insurance mix, urgent care/retail clinic density, and hospitals participating in Maryland's Total Patient Revenue (TPR) pilot-a global payment program-and changes in ED visit and hospital admission volume from 2012 to 2013.Results: Across 53 Maryland and District of Columbia hospitals, ED visits grew 2.8% between 2011 and 2012. From 2012 to 2013, ED visits declined by 3.5%. Admissions declined by 3.3% from 2011 to 2012, then declined again 3.6% from 2012 to 2013. Community demographic or hospital insurance-mix variable and density of urgent care centers were not associated with lower ED visits. Inpatient admissions fell significantly more in hospitals participating in Maryland's TPR global payment pilot program.Conclusions: In 2013, ED visits in fell in Maryland and District of Columbia hospitals, and inpatient admission volumes fell from 2011 to 2013. This is a reversal of decades-long trends in higher health care utilization. These trends were not explained by demographics, insurance, or ED alternatives, however, falling admission rates were more pronounced in Maryland hospitals participating in global payment programs. [ABSTRACT FROM AUTHOR]