scholarly journals Understanding the impact of ‘cost’ under MACRA: a neurointerventional imperative!

2018 ◽  
Vol 10 (10) ◽  
pp. 1005-1011 ◽  
Author(s):  
Gabriela Spilberg ◽  
Gregory N Nicola ◽  
Andrew B Rosenkrantz ◽  
Ezequiel Silva III ◽  
Clemens M Schirmer ◽  
...  
Keyword(s):  
United States ◽  
Affordable Care Act ◽  
Service System ◽  
The United States ◽  
Cost Curve ◽  
Fee For Service ◽  
Performance Category ◽  
The Cost ◽  
The Impact ◽  
Incentive Payments

The cost of providing healthcare in the United States continues to rise. The Affordable Care Act created systems to test value-based alternative payments models. Traditionally, procedure-based specialists such as neurointerventionalists have largely functioned in, and are thus familiar with, the traditional Fee for Service system. Administrative charge data would suggest that neurointerventional surgery is an expensive specialty. The Medicare Access and CHIP Reauthorization Act consolidated pre-existing federal performance programs in the Merit-based Incentive Payments System (MIPS), including a performance category called ‘cost’. Understanding cost as a dimension that contributes to the value of care delivered is critical for succeeding in MIPS and offers a meaningful route for favorably bending the cost curve.

The Impact of Regional Differences in Prices and Wages on Economic Growth: The United States in 1890

1979 ◽  
Vol 39 (1) ◽  
pp. 69-85 ◽  
Author(s):  
Philip R. P. Coelho ◽  
James F. Shepherd
Keyword(s):  
United States ◽  
Well Being ◽  
The United States ◽  
City Size ◽  
Cost Of Living ◽  
Real Wages ◽  
Industrial Growth ◽  
Wage Earners ◽  
The Cost ◽  
The Impact

Differences in regional prices and wages are examined for the United States in 1890, together with the relationship between the cost of living and city size, and the determinants of regional industrial growth. Results indicate that regional cost-of-liying differences were sufficiently large so that money wages cannot be used for purposes of comparing the economic well-being of wage earners across regions. Except for the South, money wages and the cost of living were positively correlated. The relative differences in money wages, however, were greater; consequently real wages in high wage-price areas were generally higher.

Association of Medicaid expansion under the Affordable Care Act with access to elective spine surgical care

2021 ◽  
pp. 1-9
Author(s):  
Jacob K. Greenberg ◽  
Derek S. Brown ◽  
Margaret A. Olsen ◽  
Wilson Z. Ray
Keyword(s):  
United States ◽  
Spine Surgery ◽  
Surgical Procedures ◽  
Affordable Care Act ◽  
Surgical Care ◽  
The United States ◽  
Medicaid Expansion ◽  
Percentage Points ◽  
The Affordable Care Act ◽  
The Impact

OBJECTIVE The Affordable Care Act expanded Medicaid eligibility in many states, improving access to some forms of elective healthcare in the United States. Whether this effort increased access to elective spine surgical care is unknown. This study’s objective was to evaluate the impact of Medicaid expansion under the Affordable Care Act on the volume and payer mix of elective spine surgery in the United States. METHODS This study evaluated elective spine surgical procedures performed from 2011 to 2016 and included in the all-payer State Inpatient Databases of 10 states that expanded Medicaid access in 2014, as well as 4 states that did not expand Medicaid access. Adult patients aged 18–64 years who underwent elective spine surgery were included. The authors used a quasi-experimental difference-in-difference design to evaluate the impact of Medicaid expansion on hospital procedure volume and payer mix, independent of time-dependent trends. Subgroup analysis was conducted that stratified results according to cervical fusion, thoracolumbar fusion, and noninstrumented surgery. RESULTS The authors identified 218,648 surgical procedures performed in 10 Medicaid expansion states and 118,693 procedures performed in 4 nonexpansion states. Medicaid expansion was associated with a 17% (95% CI 2%–35%, p = 0.03) increase in mean hospital spine surgical volume and a 23% (95% CI −0.3% to 52%, p = 0.054) increase in Medicaid volume. Privately insured surgical volumes did not change significantly (incidence rate ratio 1.13, 95% CI −5% to 34%, p = 0.18). The increase in Medicaid volume led to a shift in payer mix, with the proportion of Medicaid patients increasing by 6.0 percentage points (95% CI 4.1–7.0, p < 0.001) and the proportion of private payers decreasing by 6.7 percentage points (95% CI 4.5–8.8, p < 0.001). Although the magnitude of effects varied, these trends were similar across procedure subgroups. CONCLUSIONS Medicaid expansion under the Affordable Care Act was associated with an economically and statistically significant increase in spine surgery volume and the proportion of surgical patients with Medicaid insurance, indicating improved access to care.

scholarly journals Economic Cascades and the Costs of a Business-as-Usual Approach to COVID-19

2021 ◽  
Author(s):  
Peter Roopnarine ◽  
David Goodwin ◽  
Maricela Abarca ◽  
Joseph Russack
Keyword(s):  
United States ◽  
Economic Model ◽  
The United States ◽  
Industrial Sector ◽  
Economic Losses ◽  
Economic Systems ◽  
Usual Approach ◽  
The Cost ◽  
Business As Usual ◽  
The Impact

Shelter-in-place policies and the closure of non-essential workplaces intended to disrupt transmission of the SARS-COV-2 virus are effective approaches to combating COVID-19. They have, however, caused record levels of unemployment in the United States, raising questions of whether mitigation is more societally damaging than the disease. Here we use a coupled epidemiological-economic model to estimate the impact on employment of an unmitigated, business-as-usual approach to the pandemic. We compared unemployment between March-August 2020 in ten Californian socio-economic systems (SESs) to unemployment forecast by a model of industrial sector inter-dependencies subjected to unmitigated outbreaks of COVID-19. We found that economic losses are unavoidable because disease-driven losses propagate economically through SESs, amplifying losses to the disease. While model forecasts are generally lower than actual unemployment, jobs savings would come at the cost of greatly increased worker mortality. The costs would also be disproportionately greater among smaller and inland SESs.

Waste-to-Energy Project Economics and Financing: A Look Into the Factors Influencing the Future

2006 ◽  
Author(s):  
Jeffrey F. Clunie
Keyword(s):  
United States ◽  
The United States ◽  
Fuel Oil ◽  
Waste To Energy ◽  
Recent Analysis ◽  
Economic Factors ◽  
The Future ◽  
The Cost ◽  
The Impact

This paper focuses on significant changes in the overall economics of waste-to-energy (WTE) during the last 30 years. The WTE industry in this country has seen several different business cycles occur since 1975, as different market drivers have caused the industry to rise and fall. This paper compares: (1) those economic factors that were in play in 1975, when the first WTE facility in the United States was built, and the industry was in its infancy; (2) the factors at play when the WTE industry was at its height in 1990; and (3) some of the factors that caused the industry’s steep downward trend since 1994, when the last greenfield WTE facility in the United States was built. The paper will identify changes that have occurred with regard to the pricing of electricity and the ability of public sectors to charge non-market-based tipping fees. The paper discusses the drivers of 2006 and focuses on completed economic factors to be considered when comparing WTE with other waste disposal means. The paper discusses the drivers of 2006 and whether the industry is finally poised to begin an upward turn in the cycle. The paper focuses on the impact of the cost of diesel fuel oil on the overall economics of long-haul transfer, and how that is likely to impact the future development of WTE facilities. The paper also presents a case study of a recent analysis that was undertaken for two counties that were evaluating the financial viability of WTE as compared to other disposal options.

scholarly journals The impact of the Patient Protection and Affordable Care Act on insurance coverage and cancer‐directed treatment in HIV‐infected patients with cancer in the United States

Cancer ◽  
2019 ◽  
Vol 126 (3) ◽  
pp. 559-566 ◽  
Author(s):  
Kelsey L. Corrigan ◽  
Leticia Nogueira ◽  
K. Robin Yabroff ◽  
Chun Chieh Lin ◽  
Xuesong Han ◽  
...  
Keyword(s):  
United States ◽  
Affordable Care Act ◽  
Insurance Coverage ◽  
The United States ◽  
Patients With Cancer ◽  
Patient Protection ◽  
The Impact

The Cost of the First World War to the United States

2018 ◽  
Author(s):  
Kristen Tannas
Keyword(s):  
United States ◽  
Economic Growth ◽  
Indirect Cost ◽  
The United States ◽  
First World War ◽  
World War ◽  
The First World War ◽  
The Cost ◽  
The Impact ◽  
First World

In this paper, a calculation of cost of the First World War to the United States is performed with the aim of evaluating the impact of the War on the American economy. The method used to make this calculation is based on the work of economic historians Claudia Goldin and Frank Lewis, who studied the cost of the American Civil War. This method involves the calculation first of the “direct cost” of the war, which represents the value of economic losses made up of war expenditures, casualties and the opportunity cost of drafted soldiers. The “indirect cost” of the War is also calculated to measure the impact of the War on American economic growth by projecting economic growth in a hypothetical world where the First World War did not occur and comparing it to the economic growth actually experienced in the United States. This calculation is meant to capture any positive effects that the War may have had. For the calculations, data was drawn from a number of primary sources including censuses and government documents. The results of both of these calculations show that the First World War had a negative impact on American growth and represented a massive drain of economic resources. In particular, the indirect cost calculation shows that American growth slowed considerably in the decade following the War. This result is significant as it contradicts the common view of the postwar period prior to the Great Depression as being one of great prosperity in the United States.

scholarly journals The Impact of Structural Genomics: Expectations and Outcomes

Science ◽  
2006 ◽  
Vol 311 (5759) ◽  
pp. 347-351 ◽  
Author(s):  
John-Marc Chandonia ◽  
Steven E. Brenner
Keyword(s):  
United States ◽  
Structural Biology ◽  
Structural Genomics ◽  
Structure Determination ◽  
The United States ◽  
Structural Knowledge ◽  
Biological Macromolecules ◽  
Current Impact ◽  
The Cost ◽  
The Impact

Structural genomics (SG) projects aim to expand our structural knowledge of biological macromolecules while lowering the average costs of structure determination. We quantitatively analyzed the novelty, cost, and impact of structures solved by SG centers, and we contrast these results with traditional structural biology. The first structure identified in a protein family enables inference of the fold and of ancient relationships to other proteins; in the year ending 31 January 2005, about half of such structures were solved at a SG center rather than in a traditional laboratory. Furthermore, the cost of solving a structure at the most efficient SG center in the United States has dropped to one-quarter of the estimated cost of solving a structure by traditional methods. However, the efficiency of the top structural biology laboratories—even though they work on very challenging structures—is comparable to that of SG centers; moreover, traditional structural biology papers are cited significantly more often, suggesting greater current impact.

scholarly journals Evolution of Physician-Centric Business Models Under the Patient Protection and Affordable Care Act

2016 ◽  
Vol 15 (1) ◽  
Author(s):  
Tanya Nix ◽  
Lynn Szostek
Keyword(s):  
United States ◽  
Medical Care ◽  
Affordable Care Act ◽  
Business Models ◽  
Healthcare Delivery ◽  
The United States ◽  
New Paradigm ◽  
Medical Specialties ◽  
Patient Protection ◽  
The Cost

For decades, the cost of medical care in the United States has increased exponentially. United States citizens spend twice as much as their European counterparts on medical care. Congress enacted the Patient Protection and Affordable Care Act (PPACA) to ensure affordable healthcare to the citizens of the United States. PPACA legislation is creating a new paradigm in healthcare delivery and provider business models. The purpose of this case study was to explore physicians’ perspectives regarding physician-centric business models evolving under the requirements of the PPACA legislation. Data were gathered through semistructured interviews and questionnaires with a purposive sample of 75 participants across 20 medical specialties within the United States. Three universal themes emerged including (a) use of midlevel practitioners, (b) changes to provider practices, and (c) enhanced business education. Healthcare leaders may use the findings to advance the evolution of physician business models that meet the needs of healthcare stakeholders.

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