Christopher S Brunt

Christopher S Brunt
Georgia Southern University | GSU · Department of Economics

Doctor of Philosophy

About

45
Publications
5,606
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
304
Citations
Additional affiliations
August 2017 - July 2021
Georgia Southern University
Position
  • Professor (Associate)
August 2012 - July 2017
Georgia Southern University
Position
  • Professor (Assistant)
August 2009 - August 2012
Lake Superior State University
Position
  • Professor (Assistant)

Publications

Publications (45)
Article
Nursing staff is a key component in providing high quality of care to nursing home (NH) residents, therefore, as of 2021, 39 states have minimum nursing staff regulations. In September of 2023, CMS announced a proposed rule for a first ever federal minimum nursing staff level, even though the effectiveness of these regulations at improving quality...
Article
Full-text available
For over 3 decades, the Centers for Medicare & Medicaid Services (CMS) has provided a bonus payment for outpatient physician services provided to beneficiaries under Medicare Part B in areas designated as Primary Care Health Professional Shortage Areas (HPSAs) during the previous calendar year. Despite the longstanding existence of the program, no...
Article
Before the COVID-19 pandemic, for-profit nursing homes' revenue generally covered their costs, whereas not-for-profit nursing homes often needed donations and other nonpatient revenue to cover expenses. The unprecedented challenges presented by the pandemic caused the industry to report operating losses that were larger among not-for-profits and fa...
Article
When nursing homes experience a shortage in directly employed nursing staff, they may rely on temporary workers from staffing agencies to fill this gap. This article examines trends in the use of staffing agencies among nursing homes during the prepandemic and COVID-19 pandemic era (2018-22). In 2018, 23 percent of nursing homes used agency nursing...
Article
Full-text available
Nursing homes face rapidly increasing wages and change their input mix as they face workforce shortfalls. For 15,959 freestanding NHs from 2017-2021, the proportion of hours worked by agency staff and the median wage cost per hour of agency and directly employed nursing staff were calculated from Medicare cost reports and Payroll-Based Journal data...
Preprint
Full-text available
For over three decades, the Centers for Medicare & Medicaid Services (CMS) has provided a bonus payment for outpatient physician services provided to beneficiaries under Medicare Part B in areas designated as Primary Care Health Professional Shortage Areas (HPSAs) during the previous calendar year. Despite the longstanding existence of the program,...
Article
Recently, the Centers for Medicare & Medicaid Services (CMS) introduced staffing measures related to staffing variability and turnover in the Nursing Home (NH) Care Compare Five-Star Quality Rating System. While the consensus within the literature is that reduced variability and turnover are associated with higher NH quality of care and life, no ex...
Article
To provide context for evaluating proposed nursing home staff regulations, we examined the proportion of facility revenues spent on nursing staff, as well as nursing staff levels in hours worked and paid per resident day, in 2019. Nationally, the median proportion of revenues spent on nursing staff was 33.9 percent, and median nursing staff levels...
Article
The Primary Care Incentive Payment Program (PCIP) provided a 10% bonus payment for Evaluation and Management (E&M) visits for eligible primary care providers (PCPs) from 2011 to 2015. Using a 2012 to 2017 sample of continuously eligible PCPs (the treatment group) and ineligible specialists with historically similar provision of billed services (the...
Article
Full-text available
Policymakers have historically attempted to influence quality in nursing homes through the imposition of minimum staffing standards and through the public dissemination of quality on websites like Care Compare. One current Federal standard necessitates a registered nurse (RN) on duty for at least eight consecutive hours each day. In 2018, the Cente...
Article
While a large and growing literature has examined the effects of the Affordable Care Act's Medicaid expansion on newly eligible Medicaid recipients, relatively few studies have explored whether increased Medicaid service utilization has had any negative spillover effects on the Medicare population. This study uses county-level data on Medicare fee-...
Article
Full-text available
Historically, Medicare has operated under the assumption that providers respond to reductions in reimbursement through increased provision of services in an effort to offset declining practice revenue; however, some recent empirical work examining fee reductions has found evidence of either small offsetting effects or reductions in the quantity sup...
Article
Using data on office visits for Medicare-treating physicians, this study examines the effects of several policy changes that reduced real reimbursement for some, but not all physicians, from 2012 to 2017. Using genetic propensity score weighted Difference-in-Differences (DID) models that include individual physician and county fixed-effects, this s...
Preprint
Full-text available
Using data on office visits for Medicare-treating physicians, this study examines the effects of several policy changes that reduced real reimbursement for some, but not all physicians, from 2012-2017. Using genetic propensity score weighted Difference-inDifferences (DID) models that include individual physician and county fixed-effects, this study...
Article
Full-text available
In this paper, we explore the effects of primary care physician (PCP) practice competition on five distinct quality metrics directly tied to screening, follow‐up care, and prescribing behavior under Medicare Part B and D. Controlling for physician, practice, and area characteristics as well as zip code fixed effects, we find strong evidence that PC...
Article
Full-text available
We examine the influence of favorable user-generated content on the demand for PC video games. As digital distribution has become the norm for video games, it has become relatively easy for independent developers to create and distribute games. The resulting increase in the variety of games being offered exacerbates the experience good nature of vi...
Article
Objective To evaluate physician characteristics associated with pharmaceutical industry transfers and prescribing behavior after public reporting under the Sunshine Act. Data Sources 2014‐2016 secondary data on industry transfers to physicians from the Open Payments Dataset supplemented with Medicare Part D prescription data, Medicare service data...
Article
Within the United States, a growing debate about special tax treatment and community benefits provided by not-for-profits (NFPs) has been occurring. While the nondistribution constraint of NFPs is often thought to incentivize higher quality and more charitable care, NFPs may also be used by contractors for personal gain. This study explores whether...
Article
This article examines the relationship between federal, state and municipal minimum wage laws, local cost-of-living (COL) and the unemployment rate. It finds a strong statistically significant positive relationship between minimum wages and unemployment once COL is taken into account. Our results suggest that federal minimum wage policy is likely t...
Article
This article explores the differentiated effects of health insurer market concentration on net compensation of employees across distinct firm sizes. Consistent with the existing literature evaluating insurer market concentration and the theory of compensating differentials, we find evidence of higher premiums and reduced net compensation for employ...
Article
Objective: To assess the impact of preferences, socioeconomic status (SES), and supplemental insurance (SI) on racial/ethnic disparities in the probability and use of services at physicians' offices, hospitals, and emergency departments among Medicare beneficiaries enrolled in Part B. Research design and subjects: This study includes black and w...
Article
Historically, Medicare has operated under the assumption that health care providers respond to reductions in reimbursement through increased provision of services to offset declines in practice revenue; however, recent empirical work has found either small offsetting effects or evidence supporting a traditional supply response. Using multiple ident...
Article
Typically, research on the effect of ownership has considered health care providers in isolation of competitive interaction from other firms. This analysis considers how the selection of Medicare reimbursement codes for skilled nursing facilities varies by ownership and is influenced by the competitive spillovers from market dominance of for-profit...
Article
In 1998, Medicare implemented the Prospective Payment System for post-acute care provided by skilled nursing facilities. This system paid a fixed price per day above the cost of care, creating an incentive to provide longer length of stays to increase revenues. In this paper, we examine whether there are systematic differences in length of stay for...
Article
Objective The objective of this study is to examine how nursing homes changed their use of antipsychotic and other psychoactive medications in response to Nursing Home Compare's initiation of publicly reporting antipsychotic use in July 2012.Research Design and SubjectsThe study includes all state recertification surveys (n = 40,415) for facilities...
Article
This paper analyses how health insurance market concentration impacts the market structure of primary care physicians. In more concentrated insurance markets, physicians are found to work in larger practices and their practices are more likely to have a hospital with an ownership interest. Physicians are also less likely to report being in a compet...
Article
Full-text available
Using 2008 physician survey data, we estimate the relationship between the generosity of fees paid to primary care physicians under Medicaid and Medicare and his/her willingness to accept new patients covered by Medicaid, Medicare, or both programs (i.e., dually enrolled patients). Findings reveal physicians are highly responsive to fee generosity...
Article
Medicare adjusts its payments to physicians for geographic differences in the cost of operating a medical practice, but the method it uses is imprecise. We measure the inaccuracy in its geographic adjustment factors and categorize beneficiaries by whether they live where Medicare's formula is favorable or unfavorable to physicians. Then, using the...
Article
Full-text available
Under Medicare Part B, adjustments to the fee schedule are made under the assumption that physicians and hospitals make up for fee reductions through increased service provision called ‘volume offsetting’. While historically, researchers have found evidence of volume offsetting, more recent studies have called into question its magnitude and existe...
Article
Full-text available
Within the last decade, there has been a growing push towards the use of electronic medical records and health information technology (IT) within primary care physician practices. Despite financial subsidies, smaller practices remain reluctant to adopt these information systems. Using a nationally representative survey of physicians, this study exp...
Article
Full-text available
All payments to physicians under Medicare Part B are adjusted to reflect geographic differences in practice costs. The methods used for this adjustment, and temporary price floors imposed by Congress, have created longstanding systematic under and overpayment across physicians, whereby some are routinely underpaid while others are routinely overpai...
Article
With the introduction of Medicare’s Prospective Payment Systems over the last three decades, there is a growing concern that services may be provided that are not clinically justified to increase revenues. In the case of post-acute care provided by skilled nursing facilities (SNFs), there are no standard treatment guidelines, reducing the ability o...
Article
Under Medicare Part B, adjustments to the fee schedule are made with the operating assumption that physicians “offset” fee reductions through increased service provision called “volume offset.” Using a nationally representative survey of Medicare beneficiaries, this study is the first to analyze the incentive for physicians and hospitals to increas...
Article
Consolidation of health insurers has generated significant concern that insurers are using monopsony power. This paper ascertains if monopsony power affects physician markets for primary care physicians. Physicians change having increased willingness to accept new Medicare patients, perception of Medicare reimbursement inadequacy and change volume...
Article
Full-text available
Post-acute care provided by skilled nursing facilities (SNFs) is reimbursed by Medicare under a Prospective Payment System using resource utilization groups (RUGs) that adjust payment intensity based on predefined ranges of weekly therapy minutes provided and the functionality of the patient. Individual RUGs account for differences in the intensity...
Article
Across numerous industries, firms have used subcontracting of services to flexibly meet the demands of consumers without making investments in developing the services in-house. The decision to subcontract and how subcontracting affects firms have largely focused on the manufacturing sector. In this paper, we study subcontracting of therapist staffi...
Article
Full-text available
Medicare Part B pays outpatient physicians according to the billed Current Procedural Terminology (CPT) codes, which differ in procedure and intensity. Since many performed services merely differ by intensity, physicians have an incentive to upcode services to increase profitability of a visit. Using nationally representative data from the 2001 to...
Article
Full-text available
The maximum amount physicians can charge Medicare patients for Part B services depends on Medicare reimbursement rates and on federal and state restrictions regarding balance billing. This study evaluates whether Part B payment rates, state restrictions on balance billing beyond the federal limit, and physician balance billing influence how benefic...
Article
Since the mid 1980's, individual states and the federal government have restricted the maximum amount that physicians can bill under Medicare Part B through what is known as balance billing restrictions. Physicians can effectively bill for no more than 1.09% of the Medicare approved rate for a particular service. Simultaneously, Medicare approved r...

Network

Cited By