Ge Bai

Higher Hospital Spending on Occupational Therapy Is Associated With Lower Readmission Rates.

Hospital executives are under continual pressure to control spending and improve quality. While prior studies have focused on the relationship between overall hospital spending and quality, the relationship between spending on specific services and quality has received minimal attention. The literature thus provides executives limited guidance regarding how they should allocate scarce resources. Using Medicare claims and cost report data, we examined the association between hospital spending for specific services and 30-day readmission rates for heart failure, pneumonia, and acute myocardial infarction. We found that occupational therapy is the only spending category where additional spending has a statistically significant association with lower readmission rates for all three medical conditions. One possible explanation is that occupational therapy places a unique and immediate focus on patients’ functional and social needs, which can be important drivers of readmission if left unaddressed.

Do Hospitals Without Physicians on the Board Deliver Lower Quality of Care

This study examines whether hospitals without physician participation on their boards of directors deliver lower quality of care. Using data from California nonprofit hospitals from 2004 to 2008, the authors document that the absence of physicians on the board is associated with a decrease of 3 to 5 percentage points in 3 of 4 measures of care quality. This result was obtained using regression analysis, which controls for various hospital characteristics. The authors also identify factors that influence quality of care in hospitals. Specifically, hospital size, church affiliation, urban location, and system affiliation are positively associated with quality of care; proportion of Medicaid patient revenue and poverty level of the county in which the hospital is located are negatively associated with quality of care. These results highlight the importance of physician participation in hospital governance and indicate areas for hospitals and policy makers to focus on to enhance medical quality management.

US Hospitals Are Still Using Chargemaster Markups To Maximize Revenues.

Many hospital executives and economists have suggested that since Medicare adopted a hospital prospective payment system in 1985, prices on the hospital chargemaster (an exhaustive list of the prices for all hospital procedures and supplies) have become irrelevant. However, using 2013 nationally representative hospital data from Medicare, we found that a one-unit increase in the charge-to-cost ratio (chargemaster price divided by Medicare-allowable cost) was associated with

Variation in the Ratio of Physician Charges to Medicare Payments by Specialty and Region

64 higher patient care revenue per adjusted discharge. Furthermore, hospitals appeared to systematically adjust their charge-to-cost ratios: The average ratio ranged between 1.8 and 28.5 across patient care departments, and for-profit hospitals were associated with a 2.30 and a 2.07 higher charge-to-cost ratio than government and nonprofit hospitals, respectively. We also found correlation between the proportion of uninsured patients, a hospitals system affiliation, and its regional power with the charge-to-cost ratio. These findings suggest that hospitals still consider the chargemaster price to be an important way to enhance revenue. Policy makers might consider developing additional policy tools that improve markup transparency to protect patients from unexpectedly high charges for specific services.

California’s Hospital Fair Pricing Act Reduced The Prices Actually Paid By Uninsured Patients

Variation in the Ratio of Physician Charges to Medicare Payments by Specialty and Region Nearly all physicians charge more than the Medicare program actually pays (herein referred to as “excess charges”), with complete discretion to determine the amount charged. High excess charges can impose financial burdens on uninsured patients and privately insured patients using out-of-network physicians.1,2 Although some out-of-network physicians may offer discounts from their full charges, many patients receive unexpected medical bills.3 A national study was conducted to understand the extent and variation of physician excess charges.

Accounting Performance and Capacity Investment Decisions: Evidence from California Hospitals

Californias Hospital Fair Pricing Act, passed in 2006, aims to protect uninsured patients from paying hospital gross charges: the full, undiscounted prices based on each hospitals chargemaster. In this study I examined how the law affects the net price actually paid by uninsured patients--a question critical for evaluating the laws impact. I found that from 2004 to 2012 the net price actually paid by uninsured patients shrank from 6 percent higher than Medicare prices to 68 percent lower than Medicare prices; the adjusted collection ratio, essentially the amount the hospital actually collected for every dollar in gross price charged, for uninsured patients dropped from 32 percent to 11 percent; and although hospitals have been increasingly less able to generate revenues from uninsured patients, they have raised the proportion of services provided to them in relation to total services provided to all patients. The substantial protection provided to uninsured patients by the California Hospital Fair Pricing Act has important implications for federal and state policy makers seeking to achieve a similar goal. States or Congress could legislate criteria determining the eligibility for discounted charges, mandate a lower price ceiling, and regulate for-profit hospitals in regard to uninsured patients.

Addressing Generic-Drug Market Failures — The Case for Establishing a Nonprofit Manufacturer

Capacity decisions involve tradeoffs between the cost of capacity and the opportunity costs of lost sales. Accounting researchers posit that accounting performance provides sufficient information about these tradeoffs and thus can be used to formulate simple rules to assist capacity decisions. Empirical research has not examined the role of accounting information in capacity investment decisions at the department level in a multi-product firm in the presence of social costs. Empirical analyses using department-level data from California hospitals for the period 1998-2005 show that hospitals are more likely to make capacity investments in departments with high accounting performance. However, in the presence of demand variability, the association between accounting performance and capacity investment is attenuated because of the resulting increase in noise in accounting performance measures. Thus the weight on accounting performance as a decision tool for capital investments reduces when there is demand variability. Another factor that reduces the weight on accounting performance is capacity utilization. Higher capacity utilization can lead to turning away or rerouting of patients to other hospitals and negatively impacts reputation and quality of care, which increases the hospital’s social costs. Hence, hospitals do not require high accounting performance before investing in a department with high capacity utilization. This empirical evidence of the role of accounting performance in capacity investment decisions fills a gap in the capacity investment literature and furthers our understanding of the interactions between accounting performance and the operational determinants of firms’ capacity investment behavior.

Increasing Frequency and Share of Dermatologic Procedures Billed by Non-Physician Clinicians from 2012-2016

Addressing Generic-Drug Market Failures One market-based solution to stimulating competition in generic-drug markets is to establish a nonprofit manufacturer with the explicit mission of producing affordable versions of essential drugs and ensuring a stable supply of such products.

The Need for Better Data Breach Statistics—Reply

No serious adverse events or adverse effects directly related to the study drug were reported during this study. None of the subjects discontinued participation secondary to side effects. There are several limitations to this study, including the small population size, predominance of males, lack of a placebo control, cost of onabotulinumtoxinA, and variance in body site of target plaque and average ENF and neuropeptide densities by body site. In conclusion, the findings from this study support the idea that neurocutaneous pathways are altered in psoriasis and that onabotulinumtoxinA could be a potential treatment for recalcitrant, localized, psoriatic plaques. Its clinical effect of decreasing plaque severity may be mediated by decreasing SPand CGRP-immunoreactive nerve expression and increasing ENF density. These injections were well tolerated by subjects. Future investigations evaluating the effect of onabotulinumtoxinA in a larger number of patients with recalcitrant plaque psoriasis are needed to confirm clinical efficacy and safety.

Physician Charges and Medicare Payments

Hospital, New Taipei City, Taiwan (Tsai, Wu); Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tsai, Chien, Wu); Department of Marketing and Distribution Management, Oriental Institute of Technology, New Taipei City, Taiwan (Tsai); Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan (Chien, Wu); Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan (Wu).