About
300
Publications
35,441
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
17,413
Citations
Introduction
Skills and Expertise
Publications
Publications (300)
Applied economists often transform a dependent variable that is non‐negative and skewed with the natural log transformation, the inverse hyperbolic sine transformation, or power function. We show that these transformations separate the zeros from the positives such that the estimated parameters are related to those from a scaled linear probability...
Importance
Estimating the effects of dementia on care use and financial outcomes is timely, as the population with dementia will more than double in the next few decades.
Objective
To determine the incremental changes associated with dementia in regard to older adults’ care use and assess financial consequences for individuals, families, and socie...
Importance
Robotic-assisted cholecystectomy is rapidly being adopted into practice, partly based on the belief that it offers specific technical and safety advantages over traditional laparoscopic surgery. Whether robotic-assisted cholecystectomy is safer than laparoscopic cholecystectomy remains unclear.
Objective
To determine the uptake of robot...
Objective:
Our statewide thoracic quality collaborative has implemented multiple quality improvement initiatives to improve lung cancer nodal staging. We subsequently implemented a value-based reimbursement initiative to further incentivize quality improvement. We compare the impact of these programs to steer future quality improvement initiatives...
Objectives:
To evaluate hospital performance and behaviors in the first 2 years of a statewide commercial insurance episode-based incentive pay-for-performance (P4P) program.
Study design:
Retrospective cohort study of price- and risk-standardized episode-of-care spending from the Michigan Value Collaborative claims data registry.
Methods:
Cha...
Objective:
To test the effect of hospital-physician integration on primary care physicians' (PCP) clinical volume in traditional Medicare.
Data sources and study setting:
Nationwide retrospective longitudinal study using Medicare claims and other data sources from 2010 to 2016.
Study design:
We identified 70,000 PCPs, some of whom remained non...
Background:
Accountable Care Organizations (ACOs) and the employment of nurse practitioners (NP) in place of physicians are strategies that aim to reduce the cost and improve the quality of routine care delivered in skilled nursing facilities (SNF). The recent expansion of ACOs and nurse practitioners into SNF settings in the United States may be...
Health is strongly and positively correlated with education, which is one of many reasons to better understand the determinants of education. In this paper, we test for a specific type of family influence on education: genetic nurture. Specifically, we test whether a person's educational attainment is correlated with their sibling's polygenic score...
Background:
Health care claims have an inherent limitation in that noncovered services are unreported. This limitation is particularly problematic when researchers wish to study the effects of changes in the insurance coverage of a service. In prior work, we studied the change in the use of in vitro fertilization (IVF) after an employer added cove...
According to the World Health Organization, obesity is one of the greatest public-health challenges of the 21st century. Body weight is also known to affect individuals’ self-esteem and interpersonal relationships, including romantic ones. We estimate the “utility-maximizing” Body Mass Index (BMI) and calculate the implied monetary value of changes...
This research is to assess the impact of dementia on healthcare use and economic status over the course of dementia. We used a nationally representative, longitudinal study of older adults, specifying two propensity-score matched samples: 1) 3,476 adults aged 55+ at baseline who would have dementia in two years (hereafter “dementia group”), and 2)...
Vitamin D deficiency has long been associated with reduced immune function that can lead to viral infection. Several studies have shown that Vitamin D deficiency is associated with increases the risk of infection with COVID-19. However, it is unknown if treatment with Vitamin D can reduce the associated risk of COVID-19 infection, which is the focu...
In this article, I show how to calculate consistent marginal effects on the original scale of the outcome variable in Stata after estimating a linear regression with a dependent variable that has been transformed by the inverse hyperbolic sine function. The method uses a nonparametric retransformation of the error term and accounts for any scaling...
Importance
Nonadherence to buprenorphine may increase patient risk of opioid overdose and increase health care spending. Quantifying the impacts of nonadherence can help inform clinician practice and policy.
Objective
To estimate the association between buprenorphine treatment gaps, opioid overdose, and health care spending.
Design, Setting, and...
Importance:
Instrumental variables can control for selection bias in observational research. However, valid instruments are challenging to identify.
Objective:
To evaluate regional variation in sleeve gastrectomy following insurance coverage implementation as an instrumental variable in comparative effectiveness research.
Design, setting, and p...
Hospital‐physician integration has surged in recent years. Integration may allow hospitals to share resources and management practices with their integrated physicians that increase the reported diagnostic severity of their patients. Greater diagnostic severity will increase practices' payment under risk‐based arrangements. We offer the first analy...
Importance:
Medicare accountable care organizations (ACOs) that disproportionately care for patients of racial and ethnic minority groups deliver lower quality care than those that do not, potentially owing to differences in out-of-network primary care among them.
Objective:
To examine how organizational quality is associated with out-of-network...
Objectives:
Alternative payment models (APMs) encouraging provider collaboration may help small practices overcome the participation challenges that they face in APMs. We aimed to determine whether small practices in accountable care organizations (ACOs) reduced their beneficiaries' spending more than large practices in ACOs.
Study design:
Retro...
Background:
Spousal death is associated with elevated mortality in the surviving partner; less is known about how healthcare costs and use change following spousal death.
Objectives:
To examine the causal impact of spousal death on Medicare costs and use over time.
Design:
Longitudinal cohort study with an event study design.
Setting:
Nation...
The dynamics between formal and informal care among persons with a disability may substantially differ over the course of their cognitive decline.
Based on a nationally representative study of older adults, the analysis sample included 3,685 individuals who had at least one activity of daily living (ADL) limitation. We estimated probabilities of us...
Background:
The dynamics between formal and informal care among persons with an activity limitation may substantially differ over the course of their cognitive decline.
Method:
Based on a nationally representative study of older adults, the sample included 3,685 adults (11,856 year-persons) who had at least one activity of daily living (ADL) lim...
Context: COVID-19 has a high case fatality rate in high-risk populations and can cause severe morbidity and high healthcare resource use. Nursing home residents are a high-risk population; they live in congregate settings, often with shared rooms, and require hands-on care.Objectives: To assess state responses to the coronavirus pandemic related to...
Despite the important role that family members can play in dementia care, little is known about the association between the availability of family members and the type of care, informal (unpaid) or formal (paid), that is actually delivered to older adults with dementia in the US. Using data about older adults with dementia from the Health and Retir...
Employment is one of the most critical determinants of health and health behaviors for adults. This study focuses on Ukraine and measures how an involuntary job loss – defined as job loss due to business closures, reorganizations, bankruptcies, or privatization – affects BMI, being overweight or obese, smoking, alcohol consumption, and physical act...
Background
For the >40,000 US children undergoing congenital heart surgery annually, the relationship between hospital quality and costs remains unclear. Prior studies report conflicting results and clinical outcomes have continued to improve over time. We examined a large contemporary cohort, aiming to better inform ongoing initiatives seeking to...
Medicare’s Hospital Value-Based Purchasing Program (HVBP) is the first national pay-for-performance program to combine measures of quality of care with a measure of episode spending. We estimated the implicit tradeoffs between mortality reduction and spending reduction. To earn points in HVBP, a hospital can either lower mortality or reduce spendin...
Background:
Prospective payment models have incentivized reductions in length of stay after surgery. The benefits of abbreviated postoperative hospitalization could be undermined by increased readmissions or postacute care use, particularly for older adults or those with comorbid conditions.
Objective:
The purpose of this study was to determine...
Background:
Understanding the impact of comorbidities and competing risks of death when caring for older adults with thyroid cancer is key for personalized management. The objective of this study was to determine whether older adults with thyroid cancer are more likely to die from thyroid cancer or other etiologies and determine patient factors as...
Background
A urinary biomarker sensitive to glomerular functional or structural changes in diabetic kidney disease is required. This study examined whether urinary C-megalin reflects renal function or albuminuria in diabetes.
Methods
This was a cross-sectional study involving 1576 patients with type 1 or 2 diabetes. The exposure variables were es...
Objective
To determine the relationship between Medicare's site‐based outpatient billing policy and hospital‐physician integration.
Data sources
National Medicare claims data from 2010 to 2016.
Study Design
For each physician‐year, we calculated the disparity between Medicare reimbursement under hospital ownership and under physician ownership. U...
Objective:
To evaluate real-world effects of enhanced recovery protocol (ERP) dissemination on clinical and economic outcomes after colectomy.
Summary background data:
Hospitals aiming to accelerate discharge and reduce spending after surgery are increasingly adopting perioperative ERPs. Despite their efficacy in specialty institutions, most stu...
Background
Hurricanes Katrina and Sandy were two of the most significant disasters of the 21 st century that critically impacted communities and the health of their residents. Despite the assumption that disasters affect access to healthcare, to our knowledge prior studies have not rigorously examined availability of healthcare providers following...
Background: Neoadjuvant therapy (NAT) is increasingly being used in the management of patients with resectable pancreatic ductal adenocarcinoma (PDAC); however, there is a lack of evidence regarding the benefit among these patients.
Objective: The aim of this study was to evaluate overall survival (OS) in PDAC patients with resectable disease trea...
Background
Postacute care is a major driver of cardiac surgical episode spending, but the sources of variation in spending have not been explored. The objective of this study was to identify sources of variation in postacute care spending within 90-days of discharge following coronary artery bypass grafting (CABG) and aortic valve replacement (AVR)...
Background
Over 180 000 coronary artery bypass grafting (CABG) procedures are performed annually, accounting for $7 to $10 billion in episode expenditures. Assessing tradeoffs between spending and quality contributing to value during 90-day episodes has not been conducted but is essential for success in bundled reimbursement models. We, therefore,...
Background:
Obesity is a growing public health problem worldwide. We evaluated the mediators and association between changes in obesity metrics and renal outcomes in the general population.
Methods:
Using the Japanese nationwide health check-based cohort from April 2011 to March 2019, we selected individuals aged 40-74 years, with a baseline est...
Background:
Extended care facility use is a primary driver of variation in hospitalization-associated health care payments and is increasingly a focus for savings under episode-based payment. However, concerns remain that extended care facility limits could incur rising readmissions, emergency department use, or other costs. We analyzed the effect...
Background:
Alternative payment models, including Accountable Care Organizations and fully capitated models, change incentives for treatment over fee-for-service models and are widely used in a variety of settings. The level of payment may affect the assignment to a payment category, but to date the upcoding literature has been motivated largely i...
Background
Our objective was to investigate why early studies regarding adoption of the 21-gene recurrence score (RS) assay did not show an initial reduction in the number of breast cancer patients receiving real-world chemotherapy.
Materials and Methods
We address two sources of confounding suspected in previous studies: (1) the early time frame...
Background:
Controversy exists over whether there has been a true increase in the occurrence of thyroid cancer or overdiagnosis secondary to imaging practices. Because cancer overdiagnosis is associated with detection of indolent disease, overdiagnosis can be associated with perceived improvement in survival.
Materials and methods:
Surveillance,...
Background:
Optimal methods to assess resource utilization in congenital heart surgery remain unclear. We compared traditional cost-to-charge ratio methods with newer standardized cost methods which aim to more directly assess resources consumed.
Methods:
Clinical data from the STS Database were linked with resource use data from the Pediatric H...
Background:
The quality of care received by a growing number of older patients with chronic kidney disease (CKD) has not been adequately examined.
Objective:
The objective of this study was to assess the quality of CKD care among older patients and to clarify its association with the incidence of end-stage renal disease (ESRD).
Research design:...
Introduction:
This study sought to empirically evaluate whether the Medicaid expansion under the Affordable Care Act increased smoking cessation among low-income childless adult smokers.
Methods:
The effects of the Medicaid expansion on smoking quit attempts and the probability of 30- and 90-day smoking cessation were evaluated using logistic re...
Background
Although the Medicare Shared Savings Program (MSSP) created new incentives for organizations to improve healthcare value, Accountable Care Organizations (ACOs) have achieved only modest reductions in the use of low-value care.
Objective
To assess ACO engagement of clinicians and whether engagement was associated with clinicians’ reporte...
Chronic pain clearly lowers utility, but valuing the reduction in utility is empirically challenging. Here, we use improvements over prior applications of the subjective well-being method to estimate the implied trade-off between pain and income using four waves of the Health and Retirement Study (2008-2014), a nationally representative survey on i...
Importance
The use of robotic surgery for common operations like colectomy is increasing rapidly in the United States, but evidence for its effectiveness is limited and may not reflect real-world practice.
Objective
To evaluate outcomes of and trends in the use of robotic, laparoscopic, and open colectomy across diverse practice settings.
Design,...
Background:
There is increased focus on the value of surgical care. Postoperative complications decrease value, but it is unknown whether high-value hospitals spend less than low-value hospitals in cases without complications. Previous studies have not evaluated both expenditures and validated outcomes in the same patients, limiting the understand...
Postacute care costs are the primary determinant of episode spending around hospitalization. Yet there is little evidence that greater spending on postacute care improves readmission rates or functional recovery. Recent Medicare payment reform evaluations have suggested that postacute care spending is responsive to episode-based incentives. However...
A large literature has documented strong positive correlations among siblings in health, including body mass index (BMI) and obesity. This paper tests whether that is explained by a specific type of peer effect in obesity: genetic nurture. Specifically, we test whether an individual's weight is affected by the genes of their sibling, controlling fo...
Background:
Accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) are associated with modest savings. However, prior research may overstate this effect if high-cost clinicians exit ACOs.
Objective:
To evaluate the effect of the MSSP on spending and quality while accounting for clinicians' nonrandom exit.
Design:
S...
Marginal effects can be used to express how the predicted probability of a binary outcome changes with a change in a risk factor. For example, how does 1-year mortality risk change with a 1-year increase in age or for a patient with diabetes compared with a patient without diabetes? This approach can make the results more easily understood. Margina...
The Medicare Shared Savings Program (MSSP) adjusts savings benchmarks by beneficiaries' baseline risk scores. To discourage increased coding intensity, the benchmark is not adjusted upward if beneficiaries' risk scores rise while in the MSSP. As a result, accountable care organizations (ACOs) have an incentive to avoid increasingly sick or expensiv...
In Reply We agree with Dr Sonis that ORs have one distinct advantage over RRs when reporting the association between a binary outcome and a risk factor. If the original OR was computed for the occurrence of an outcome, then the OR for the nonoccurrence of the outcome is the inverse of the original OR. There is no such convenient transformation for...
Report cards are intended to improve consumer decision-making and foster a market for quality. However, inadequate risk adjustment of report card measures often biases comparisons across firms. We test whether skilled nursing facility (SNF) star ratings causally predict the quality-related outcomes that are important to patients and providers. We e...
Context
Thyroid cancer incidence increased with the greatest change in adults aged ≥ 65.
Objective
To determine the relationship between area-level use of imaging and thyroid cancer incidence over time
Design, Setting and Participants
Longitudinal imaging patterns in Medicare patients aged ≥ 65 years residing in Surveillance, Epidemiology, and En...
Background:
There is widespread interest in reducing use of postacute care (ie, care after hospital discharge) following major surgery, provided that such reductions do not worsen quality outcomes such as readmission rates.
Objectives:
To describe the association between changes in skilled nursing facility (SNF) use and changes in readmission ra...
Odds ratios frequently are used to present strength of association between risk factors and outcomes in the clinical literature. Odds and odds ratios are related to the probability of a binary outcome (an outcome that is either present or absent, such as mortality). The odds are the ratio of the probability that an outcome occurs to the probability...
The profound economic and political changes of the 1990s had detrimental social effects in many domains of life in post-socialist countries, including diminishing life expectancy and growing unhappiness. Despite economic improvements in the second decade of transition, research has documented that happiness lagged behind. We test whether past unemp...
BACKGROUND
Accountable care organizations (ACOs) have been shown to reduce prostate cancer treatment among men unlikely to benefit because of competing risks (ie, potential overtreatment). This study assessed whether the level of engagement in ACOs by urologists affected rates of treatment, overtreatment, and spending.
METHODS
A 20% sample of nati...
The profound economic and political changes of the 1990s had detrimental social effects in many domains of life in post-socialist countries, including diminishing life expectancy and growing unhappiness. Despite economic improvements in the second decade of transition, research has documented that happiness lagged behind. We test whether past unemp...
Health care expenditures and use are challenging to model because these dependent variables typically have distributions that are skewed with a large mass at zero. In this article, we describe estimation and interpretation of the effects of a natural experiment using two classes of nonlinear statistical models: one for health care expenditures and...
Introduction:
Changes in national PSA screening recommendations for prostate cancer have reduced screening. Accountable Care Organizations (ACOs) have the potential to accelerate the impact of these screening recommendations. The extent to which physicians in ACOs translate policy into real world practice is uncertain.
Methods:
We performed a re...
Objective:
Our objective was to understand the reliability of profiling surgeons on average health care spending.
Summary of background data:
Under its Merit-based Incentive Payment System (MIPS), Medicare will measure surgeon spending and tie performance to payments. Although the intent of this cost-profiling is to reward low-cost surgeons, it...
Objective:
To evaluate the effect of Medicare Shared Savings Program accountable care organizations (ACOs) on hospital readmission after common surgical procedures.
Summary background data:
Hospital readmissions following surgery lead to worse patient outcomes and wasteful spending. ACOs, and their associated hospitals, have strong incentives to...
Purpose:
Policy reforms in the Affordable Care Act encourage health care integration to improve quality and lower costs. We examined the association between system-level integration and longitudinal costs of cancer care.
Methods:
We used linked SEER-Medicare data to identify patients age 66 to 99 years diagnosed with prostate, bladder, esophagea...
Importance
Readmissions after surgery lead to poor patient outcomes and increased costs. The Hospital Readmissions Reduction Program (HRRP) penalizes hospitals with excess readmissions after specified medical and surgical discharges.
Objective
To evaluate the association of the HRRP with readmissions after major joint surgery (targeted) and proced...
Pay-for-performance programs are gradually spreading across Asia. This paper builds on the longer experience in the United States to offer lessons for Asia. The Center for Medicare and Medicaid Services has introduced several pay-for-performance programs since 2012 to encourage hospitals to improve quality of care and reduce costs. Some state Medic...
The quality and cost of care in nursing homes depend critically on the number and types of nurses. Recent research suggests that the nursing supply adjusts to macroeconomic conditions. However, prior work has failed to consider the effect of macroeconomic conditions on demand for nurses through the effect on revenues. We test how county-level unemp...
Background:
Accountable care organizations (ACOs) can improve prostate cancer care by decreasing treatment variations (ie, avoidance of treatment in low-value settings). Herein, the authors performed a study to understand the effect of Medicare Shared Savings Program ACOs on prostate cancer care.
Methods:
Using a 20% Medicare sample, the authors...
This study explores whether for-profit home health agencies responded differently from non-profit agencies to financial incentives embedded in the Medicare prospective payment system. Agencies were able to receive higher reimbursement per patient under the prospective payment system if they adjusted the number of therapy visits or the type of visit...
Importance:
Coronary artery bypass grafting (CABG) is scheduled to become a mandatory Medicare bundled payment program in January 2018. A contemporary understanding of 90-day CABG episode payments and their drivers is necessary to inform health policy, hospital strategy, and clinical quality improvement activities. Furthermore, insight into curren...
Recent tobacco regulations proposed by the Food and Drug Administration have raised a thorny question: how should the cost-benefit analysis accompanying such policies value foregone consumer surplus associated with regulation-induced reductions in smoking? In a model with rational and fully informed consumers, this question is straightforward. Ther...
US policymakers place high priority on tying Medicare payments to the value of care delivered. A critical part of this effort is the Hospital Value-based Purchasing Program (HVBP), which rewards or penalizes hospitals based on their quality and episode-based costs of care and incentivizes integration between hospitals and post-acute care providers....
Objective:
We sought to assess hospital cost variation for elective inpatient surgical procedures within small geographic areas.
Summary background data:
Previous studies have documented cost variation for inpatient surgical procedures on a national basis, suggesting opportunities for savings. Cost variation within small geographic areas is more...
Background:
The burden of diabetes-related chronic kidney disease (CKD) on individuals and society is increasing, shifting attention toward improving the quality of care for patients with CKD and diabetes. We assessed the quality of CKD care and its association with long-term dialysis, acute kidney injury (AKI), and death.
Study design:
Retrospe...
Background:
Both the Centers for Medicare and Medicaid Services' (CMS) Hospital Compare star rating and surgical case volume have been publicized as metrics that can help patients to identify high-quality hospitals for complex care such as cancer surgery. The current study evaluates the relationship between the CMS' star rating, surgical volume, a...