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Revisions to the Sixth Update of the Geographic Practice Cost Index

November 11, 2011 in Medicaid/Medicare, Medicare, My Papers, Physician Compensation | No comments

How does Medicare adjust payments to physician practices to account for regional differences in input costs such as employee wages, office rent, malpractice insurance and other expenses?  I recently co-authored a report in support of the CMS final rule which explains how CMS will make these adjustments for 2012.  Among the key revisions are an expansion of the number of occupations included in the employee wage index and the creation of a purchased services index which takes into account regional variation in the price of services that physicians frequently contract (e.g., accounting and legal services).

You can read the full report here.

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Operating on commission: Analyzing how physician financial incentives affect surgery rates

April 9, 2010 in My Papers | 1 comment

My paper on how physician compensation affects surgery rates is being published in the May 2010 edition of Health Economics.  The abstract from the article is below:

“This paper employs a nationally representative, household-based dataset in order to test how the compensation method of both the specialists and the primary care providers affects surgery rates. After controlling for adverse selection, I find that when specialists are paid through a fee-for-system scheme rather than on a capitation basis, surgery rates increase 78%. The impact of primary care physician compensation on surgery rates depends on whether or not referral restrictions are present.“

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Women with a Partner Gain Weight

January 21, 2010 in My Papers, Obesity | 1 comment

Most women gain weight after marriage.  However, this may not just be do to having a child.

The New York Times reports on a recent study by Annette Dobson in the American Journal of Preventive Medicine.  They find that “[a]fter adjusting for other variables, the 10-year weight gain for an average 140-pound woman was 20 pounds if she had a baby and a partner, 15 if she had a partner but no baby, and only 11 pounds if she was childless with no partner. The number of women with a baby but no partner was too small to draw statistically significant conclusions.”

The study does a good job of documenting the weight gain, but does not fully explain why this is occurring.  One of my previous studies looks at just this question.  My co-author and I hypothesize that married individuals have less of an incentive to maintain their weight, because they are not in the dating market.  In fact, the study finds evidence that women who begin cohabitating with their mate gain less weight than if they had gotten married.   Since in both cases the women live with their partner, the weight gain cannot be due to simply moving in with one’s significant other.  We find evidence that the probability a couple will separate (based on marital status and other factors), directly affects weight.  Women in more stable relationships gain more weight then women in less stable relationships, likely because the women in less stable relationships know they may soon re-enter the dating market.

However, the effect of the “dating market” on weight is only 2.4 kg (about 5 lb).  Thus, this effect doesn’t cause one to be obese, but can explain some of the weight gain after marriage.  Marriage does have many other salubrious effects, and one should not avoid marriage simply to avoid a minimal weight gain.

Delivering Vaccines: A Case Study of the Distribution System of Vaccines for Children

October 13, 2009 in My Papers, Vaccinations | No comments

A paper written by John Fontanesi and myself was recently published in the October 2009 edition of the American Journal of Managed Care. The paper is titled “Delivering Vaccines: A Case Study of the Distribution System of Vaccines for Children.” The abstract of the paper is below:

Objective: To evaluate the efficacy of the central- 
ization by the Centers for Disease Control and 
Prevention of their pediatric vaccine distribution 
system. 
Study Design: In March 2007, the Centers for 
Disease Control and Prevention began a pilot 
program to reform the Vaccines for Children  
(VFC) program. All California VFC providers  
were required to place vaccine orders under  
the centralized logistic system of the Vaccine  
Management Business Improvement Project 
(VMBIP). For this study, VFC ordering, use, 
and delivery data were collected from 2 large 
southern California healthcare providers that 
collectively served more than 200,000 children. 
Data collection occurred between January 2005 
and June 2008. 
Methods: This case study measures the change 
in the mean VFC delivery times before and after 
the VMBIP.  The data underwent simulation to 
estimate the number of days per year a provider 
would have zero VFC inventory before and after 
the VMBIP. 
Results: After the VMBIP was implemented, 
delivery times increased from 1.6 to 12.3 business 
days (P <.001). The probability that VFC deliveries 
took longer than 1 week increased from 7%  
before the VMBIP to 89% afterward. Our simulation 
demonstrates that for 7 of 11 vaccines investigat- 
ed there was a statistically significant increase in 
the number of days a provider would be without 
VFC (P <.01). 
Conclusion: Although the VMBIP was implement- 
ed to save costs, this study finds that during the 
VMBIP’s initial implementation timeline, providers 
experienced longer delivery delays and a higher 
probability of a VFC stockout. 
(Am J Manag Care. 2009;15(10)751-754)
  • Objective: To evaluate the efficacy of the centralization by the Centers for Disease Control and Prevention of their pediatric vaccine distribution system. 
  • Study Design: In March 2007, the Centers for Disease Control and Prevention began a pilot program to reform the Vaccines for Children  (VFC) program. All California VFC providers  were required to place vaccine orders under  the centralized logistic system of the Vaccine  Management Business Improvement Project (VMBIP). For this study, VFC ordering, use, and delivery data were collected from 2 large southern California healthcare providers that collectively served more than 200,000 children. Data collection occurred between January 2005 and June 2008. 
  • Methods: This case study measures the change in the mean VFC delivery times before and after the VMBIP.  The data underwent simulation to estimate the number of days per year a provider would have zero VFC inventory before and after the VMBIP. 
  • Results: After the VMBIP was implemented, delivery times increased from 1.6 to 12.3 business days (P <.001). The probability that VFC deliveries took longer than 1 week increased from 7%  before the VMBIP to 89% afterward. Our simulation demonstrates that for 7 of 11 vaccines investigated there was a statistically significant increase in the number of days a provider would be without VFC (P <.01). 
  • Conclusion: Although the VMBIP was implemented to save costs, this study finds that during the VMBIP’s initial implementation timeline, providers experienced longer delivery delays and a higher probability of a VFC stockout. 

(Am J Manag Care. 2009;15(10)751-754)

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Marriage makes you fat

September 24, 2009 in My Papers | 1 comment

Researches at UNC found that marriage may make you happy and healthy but fat as well.  If you’ve been a loyal reader of the Healthcare Economist, however, you knew that already.

Jason Shafrin’s research on marriage and weight gain already showed that marriage leads to increased weight gain.  In fact, the research demonstrated that one reason marriage causes weight gain is that individual who get married experience a decreased incentive to maintain their weight in order to attract a significant other (read the paper).  These findings were also presented at the Western Economic Association International (WEAI) conference in Vancouver this June.  Below is an abstract of the paper:

Married individuals weigh more on average than non-married individuals. We suggest that exiting the dating market decreases ones incentive to maintain their appearance and leads to an increase in body weight. We hypothesize that it is most difficult for individuals to exit a traditional marriage, and easiest for individuals to exit if the couple is cohabitating but not legally married. Using a 14-year panel data set, we test whether or not the ease of exiting a domestic relationship affects weight gain. For men, we find that the type of domestic relationship has little impact on weight gain. For women, however, marriage leads to a 2.4 kg weight gain compared to cohabitating.

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WEAI, Vancouver

June 30, 2009 in Economics - General, My Papers | 1 comment

This week I’ll be in Vancouver for the Western Economic Association International Conference.  

I’ll be presenting my paper on “Why Does Getting Married Make You Fat? Incentives and Appearance Maintenance.”

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Dr. Jason Shafrin

April 13, 2009 in My Papers | 8 comments

Today, April 13th, I successfully defended my dissertation.  I now officially have a Ph.D. in Economics from the University of California, San Diego.

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Help advance the science of economics and win a $25 Amazon gift card

March 6, 2009 in My Papers | 1 comment

Daniel Wiesen and Jason Shafrin ask you to participate in an economic survey.  By completing the survey, you will help advance the science of economics.  Further, if you complete the survey by March 20, you will be made eligible to win a $25 gift card to Amazon.   To take the survey click on this link or paste the following text into your Internet browser: http://webex.bonneconlab.uni-bonn.de/Prud_Prev/1a_reg.php

The survey contains 50 questions and will take about 20-30 minutes to complete.  By participating in the survey, you will help Daniel and Jason complete their dissertation research.  

If you have any questions, please feel free to email either Daniel Wiesen (daniel.wiesen@uni-bonn.de) or Jason Shafrin (jshafrin@ucsd.edu).

Help advance the science of economics and win a $25 Amazon gift card

March 4, 2009 in My Papers | No comments

Daniel Wiesen and Jason Shafrin ask you to participate in an economic survey.  By completing the survey, you will help advance the science of economics.  Further, if you complete the survey by March 20, you will be made eligible to win a $25 gift card to Amazon.   To take the survey click on this link or paste the following text into your Internet browser: http://webex.bonneconlab.uni-bonn.de/Prud_Prev/1a_reg.php

The survey contains 50 questions and will take about 20-30 minutes to complete.  By participating in the survey, you will help Daniel and Jason complete their dissertation research.  

If you have any questions, please feel free to email either Daniel Wiesen (daniel.wiesen@uni-bonn.de) or Jason Shafrin (jshafrin@ucsd.edu).

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WEAI

February 13, 2009 in Economics - General, My Papers | No comments

My paper titled “Why Does Getting Married Make You Fat? Incentives and Appearance Maintenance” was just accepted for presenatation at the Western Economic Association International (WEAI) conference.  This paper is co-authored with Uri Gneezy.  The conference will take place June 29-July 3, 2009 in Vancouver, Canada.

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