Stephen Parente | University of Minnesota - Twin Cities (original) (raw)

Papers by Stephen Parente

Inquiry, Feb 1, 2007

This study examined three-year spending and utilization trends associated with enrollment in a co... more This study examined three-year spending and utilization trends associated with enrollment in a consumer-directed health plan (CDHP) offered by a large employer alongside a preferred provider organization (PPO) and a point-of-service (POS) plan. The CDHP cohort spent considerably more money on hospital care than the POS cohort. Results found evidence of pent-up demand in the CDHP, but not enough to explain the spending trend. Lower prescription drug spending—where the CDHP modestly controlled allowable costs—was associated with less hospital and emergency room use in following periods. Findings suggest the CDHP had too little out-of-pocket cost-sharing to control medical spending.

International Journal of Technology Assessment in Health Care, Jul 1, 2008

Journal of Advanced Nursing, Sep 26, 2016

Aims. The aim of this study was to answer the overall question: Does primary care diabetes manage... more Aims. The aim of this study was to answer the overall question: Does primary care diabetes management for Medicare patients differ in scope and outcomes by provider type (physician or nurse practitioner)? Background. In the USA as well as globally, there is a pressing need to address high healthcare costs while improving healthcare outcomes. Primary health care is one area where healthcare reform has received considerable attention, in part because of continued projections of primary care physician shortages. Many argue that nurse practitioners are one solution to ease the consequences of the projected shortage of primary care physicians in the USA as well as other developed countries. Design. Cross-sectional quantitative analysis of 2012 Medicare claims data. Methods. A 5% Standard Analytic File of 2012 Medicare claims data for beneficiaries with Type 2 diabetes were analysed. A medical productivity index was used to stratify patients as healthiest and least healthy who were seen by either nurse practitioners only or primary care physicians exclusively. Included in the analyses were health services utilization, health outcomes and healthcare cost variables. Results. The patients in the nurse practitioner only group, overall and stratified by medical productivity index status, had significantly improved outcomes compared with all primary care physician provider groups regarding healthcare services utilization, patient health outcomes and healthcare costs. Conclusions. These findings inform current healthcare workforce conversations regarding healthcare quality, outcomes and costs. Our results suggest nurse practitioner engagement in chronic care patient management in primary care settings is associated with lower cost and better quality health care.

Health Affairs, Mar 1, 2009

Health information technology (HIT) has changed the way clinicians work, and brought some advanta... more Health information technology (HIT) has changed the way clinicians work, and brought some advantages and disadvantages to clinical practice. In this special focus issue of JAMIA, our guest associate editors (p. 244) introduce three articles on the effects of HIT for patient safety (p. 246, p. 261, p. 268). Additional articles report on algorithms to measure patient safety (p. 310), and an interactive tool for cross-over analyses of EHRs for patient safety (p. 323). Prescription of medications is an area in which the effects of HIT for patient safety are well studied. Articles reporting on the analyses of medication errors (p. 316), computerized prescriber order entry (CPOE) system-related patient safety reports (p. 316), variation in high priority drug-drug interaction alerts across institutions (p. 331), clinician response to electronic health record (EHR) prompts (p. 275), and alert override analysis (p. 409) are directly connected to topics in this special focus issue. This issue also includes articles on a tool for automated screening for medication errors (p. 281), an approach for automated identification of antibiotic overdoses and adverse events (p. 295), and the impact of CPOE on the length of stay and mortality rate in an academic medical center (p. 303), and an intensive care unit (p. 413). Completing the set of articles focused on HIT and patient safety are two systematic reviews-one on automation bias (p. 423) and another on types and causes of prescribing errors generated from CPOE systems (p. 432), a brief communication on changes in the quality of care due to Meaningful Use implementation (p. 394), approaches to leverage EHRs for failure mode and effects analysis on a cardiology unit (p. 288), and approaches to leverage EHRs to identify complex atrial fibrillation patients for targeted intervention (p. 339).

Health Affairs, Nov 1, 2005

DOAJ (DOAJ: Directory of Open Access Journals), Aug 1, 2013

Comparing the sensitivity of models predicting health status: a critical look at an OECD Report o... more Comparing the sensitivity of models predicting health status: a critical look at an OECD Report on the efficiency of health system. Insurance Markets and Companies, 4(1) RELEASED ON Wednesday,

Disease Management & Health Outcomes, 2007

with chronic illnesses has been questioned, but little information exists regarding the experienc... more with chronic illnesses has been questioned, but little information exists regarding the experience of chronically ill individuals in CDHPs. To contribute to a better understanding of the experience of people with chronic illnesses in CDHPs, this study analyzed survey and medical claims data from a large public employer that offered a CDHP as well as other benefit options. Methods: An analysis of a combined survey, administrative records, and medical claims data was conducted for a sample of employees participating in a large public employer's health benefits plan. The main outcome measures were plan enrollment decision, use of information, plan rating, and spending patterns. Results: Employees with chronic illness are equally likely as other employees to join a CDHP, to understand key plan coverage features, and to report having a particularly positive or negative experience with their plan. However, CDHP enrollees with chronic illnesses assign higher ratings to their plan than do other CDHP enrollees (p < 0.07). They are more likely than other CDHP enrollees to use informational tools (p < 0.05), more likely to anticipate spending all of their savings account dollars (p < 0.05), and more likely actually to spend more than the deductible (particularly for prescription drug expenditures [p < 0.05]((Author: ok?))). Compared with other CDHP enrollees whose spending exceeds the deductible, enrollees with chronic illnesses spend significantly more on prescription drugs. Conclusions: Even though the CDHP benefit design was generous, relatively few employees chose the CDHP, and the CDHP was no more attractive to employees with chronic illnesses than to other employees. Furthermore, although people with chronic illnesses who chose CDHPs had some understanding of how their HSAs would work, they tended to exhaust those accounts and also spend more than the plan's deductible. ((Author: these sentences have been added to provide concluding statements regarding some findings in this study.)). There is much more for employers to do if they want CHDP enrollees with chronic illnesses to 'manage' their conditions more effectively.

International Journal of Health Economics and Management, 2015

Concern abounds about whether the health care workforce is sufficient to meet changing demands sp... more Concern abounds about whether the health care workforce is sufficient to meet changing demands spurred by the Affordable Care Act (ACA). We project that by 2022 the health care industry needs three to four million additional workers, forty percent of which is related to demand growth under the ACA. We project faster job growth in the ambulatory care sector, especially in home health care. Given the current profile, we expect that the future health care workforce will be increasingly female, young, racially/ethnically diverse, not US-born, at or below the poverty level and at a low level of educational attainment.

Health Services Research, 2004

Objective. To assess the experience of enrollees in a consumer-driven health plan (CDHP). Data So... more Objective. To assess the experience of enrollees in a consumer-driven health plan (CDHP). Data Sources/Study Setting. Survey of University of Minnesota employees regarding their 2002 health benefits. Study Design. Comparison of regression-adjusted mean values for CDHP and other plan enrollees: customer service, plan paperwork, overall satisfaction, and plan switching. For CDHP enrollees only, use of plan features, willingness to recommend the plan to others, and reports of particularly negative or positive experiences. Principal Findings. There were significant differences in experiences of CDHP enrollees versus enrollees in other plans with customer service and paperwork, but similar levels of satisfaction (on a 10-point scale) with health plans. Eight percent of CDHP enrollees left their plan after one year, compared to 5 percent of enrollees leaving other plans. A minority of CDHP enrollees used online plan features, but enrollees generally were satisfied with the amount and quality of the information provided by the CDHP. Almost half reported a particularly positive experience, compared to a quarter reporting a particularly negative experience. Thirty percent said they would recommend the plan to others, while an additional 57 percent said they would recommend it depending on the situation. Conclusions. Much more work is needed to determine how consumer experience varies with the number and type of plan options available, the design of the CDHP, and the length of time in the CDHP. Research also is needed on the factors that affect consumer decisions to leave CDHPs.

Health Services Research, 2004

Objective. To compare medical care costs and utilization in a consumer-driven health plan (CDHP) ... more Objective. To compare medical care costs and utilization in a consumer-driven health plan (CDHP) to other health insurance plans. Study Design. We examine claims and employee demographic data from one large employer that adopted a CDHP in 2001. A quasi-experimental pre-post design is used to assign employees to three cohorts: (1) enrolled in a health maintenance organization (HMO) from 2000 to 2002, (2) enrolled in a preferred provider organization (PPO) from 2000 to 2002, or (3) enrolled in a CDHP in 2001 and 2002, after previously enrolling in either an HMO or PPO in 2000. Using this approach we estimate a differencein-difference regression model for expenditure and utilization measures to identify the impact of CDHP. Principal Findings. By 2002, the CDHP cohort experienced lower total expenditures than the PPO cohort but higher expenditures than the HMO cohort. Physician visits and pharmaceutical use and costs were lower in the CDHP cohort compared to the other groups. Hospital costs and admission rates for CDHP enrollees, as well as total physician expenditures, were significantly higher than for enrollees in the HMO and PPO plans. Conclusions. An early evaluation of CDHP expenditures and utilization reveals that the new health plan is a viable alternative to existing health plan designs. Enrollees in the CDHP have lower total expenditures than PPO enrollees, but higher utilization of resource-intensive hospital admissions after an initially favorable selection.

Health Services Research, 2004

Objective. To determine who chooses a Consumer‐Driven Health Plan (CDHP) in a multiplan, multipro... more Objective. To determine who chooses a Consumer‐Driven Health Plan (CDHP) in a multiplan, multiproduct setting, and, specifically, whether the CDHP attracts the sicker employees in a company's risk pool.Study Design. We estimated a health plan choice equation for employees of the University of Minnesota, who had a choice in 2002 of a CDHP and three other health plans—a traditional health maintenance organization (HMO), a preferred provider organization (PPO), and a tiered network product based on care systems. Data from an employee survey were matched to information from the university's payroll system.Principal Findings. Chronic illness of the employee or family members had no effect on choice of the CDHP, but such employees tended to choose the PPO. The employee's age was not related to CDHP choice. Higher‐income employees chose the CDHP, as well as those who preferred health plans with a national provider panel that includes their physician in the panel. Employees tend...

Routledge eBooks, Nov 13, 2017

This paper reports the results of a major study of the impact of international agricultural resea... more This paper reports the results of a major study of the impact of international agricultural research, covering eleven crops in all major regions of the developing world, over the period 1960-2000. Although much of the "common wisdom" concerning the Green Revolution suggests that gains from research were limited to rice and wheat in Asia and Latin America, we find evidence of far broader impacts, extending essentially to all crops and regions. There are important differences, however, in the extent of these impacts. We explore these differences and assess the overall impact of research-driven improvements in technology.

This paper examines the effect of agricultural policy on a country's development and growth. We f... more This paper examines the effect of agricultural policy on a country's development and growth. We find that low agricultural productivity can delay the start of industrialization in a country for a long period of time, causing a country's per capita income to fall far behind the industrial leader. Once industrialization begins, this trend is reversed. However, the extent to which a country catches up to the leader depends primarily on factors that affect productivity in non-agricultural activities. Agricultural policy, therefore, is largely irrelevant in the long run. But in the short run, a country that experiences large improvements in agricultural productivity, due to say a Green Revolution, will experience an increase in its income relative to the leaders.

Review of Economic Dynamics, 2004

Agriculture's share of economic activity is known to vary inversely with a country's level of dev... more Agriculture's share of economic activity is known to vary inversely with a country's level of development. This paper examines whether extensions of the neoclassical growth model can account for some important sectoral patterns observed in a current cross-section of countries and in the time series data for currently rich countries. We find that a straightforward agricultural extension of the neoclassical growth model restricted to match U.S. observations fails to account for important aspects of the crosscountry data. We then introduce a version of the growth model with home production, and we show that this model performs much better. We thank Lee Alston, Bob Evenson and Ed Prescott for their comments. We have also benefited from the comments of participants at the 1998 NEUDC meetings; the 1999 Econometric Society winter meetings; and the 1999 meetings of the Society for Economic Dynamics.

We examine the presence of deliberate diagnostic coding intensity for risk-based beneficiary pros... more We examine the presence of deliberate diagnostic coding intensity for risk-based beneficiary prospective payments in Medicare Advantage (MA) compared to traditional fee-for-service Medicare from 2010 through 2014. We find that risk ratings based on adjusted diagnostic groups (ADGs) and hierarchical condition categories (HCCs) are similar for the fee-for-service population, but the ADG risk adjustor significantly reduces risk scores in the Medicare Advantage population. Like the HCC system, ADGs are based on patients’ diagnoses, but they are not used for MA payment. Our results suggest that upcoding within the risk adjustment system may have over-stated risk differences in the fee-for-service and Medicare Advantage populations, leading to higher payments to Medicare Advantage plans.

Health Care Financing Review, 2006

This article examines the investment of patient care information technology (IT) systems by a nat... more This article examines the investment of patient care information technology (IT) systems by a nationwide sample of U.S. short-term acute care hospitals and the resulting impact these systems have in the productivity of institutions from 1990-1998. Of particular interest is the extent to which for-profit and not-for-profit hospitals obtain different results from the adoption of IT systems. We find that the marginal effect of IT on for-profit hospital productivity is to reduce the number of days supplied, while in not-for-profit hospitals the marginal effect of IT is to increase the quantity of services supplied. This resulting effect is consistent with the differing objectives of not-for-profit and for-profit hospitals and demonstrates the positive marginal value of IT as a sustainable and prudent investment.

Inquiry, Feb 1, 2007

This study examined three-year spending and utilization trends associated with enrollment in a co... more This study examined three-year spending and utilization trends associated with enrollment in a consumer-directed health plan (CDHP) offered by a large employer alongside a preferred provider organization (PPO) and a point-of-service (POS) plan. The CDHP cohort spent considerably more money on hospital care than the POS cohort. Results found evidence of pent-up demand in the CDHP, but not enough to explain the spending trend. Lower prescription drug spending—where the CDHP modestly controlled allowable costs—was associated with less hospital and emergency room use in following periods. Findings suggest the CDHP had too little out-of-pocket cost-sharing to control medical spending.

International Journal of Technology Assessment in Health Care, Jul 1, 2008

Journal of Advanced Nursing, Sep 26, 2016

Aims. The aim of this study was to answer the overall question: Does primary care diabetes manage... more Aims. The aim of this study was to answer the overall question: Does primary care diabetes management for Medicare patients differ in scope and outcomes by provider type (physician or nurse practitioner)? Background. In the USA as well as globally, there is a pressing need to address high healthcare costs while improving healthcare outcomes. Primary health care is one area where healthcare reform has received considerable attention, in part because of continued projections of primary care physician shortages. Many argue that nurse practitioners are one solution to ease the consequences of the projected shortage of primary care physicians in the USA as well as other developed countries. Design. Cross-sectional quantitative analysis of 2012 Medicare claims data. Methods. A 5% Standard Analytic File of 2012 Medicare claims data for beneficiaries with Type 2 diabetes were analysed. A medical productivity index was used to stratify patients as healthiest and least healthy who were seen by either nurse practitioners only or primary care physicians exclusively. Included in the analyses were health services utilization, health outcomes and healthcare cost variables. Results. The patients in the nurse practitioner only group, overall and stratified by medical productivity index status, had significantly improved outcomes compared with all primary care physician provider groups regarding healthcare services utilization, patient health outcomes and healthcare costs. Conclusions. These findings inform current healthcare workforce conversations regarding healthcare quality, outcomes and costs. Our results suggest nurse practitioner engagement in chronic care patient management in primary care settings is associated with lower cost and better quality health care.

Health Affairs, Mar 1, 2009

Health information technology (HIT) has changed the way clinicians work, and brought some advanta... more Health information technology (HIT) has changed the way clinicians work, and brought some advantages and disadvantages to clinical practice. In this special focus issue of JAMIA, our guest associate editors (p. 244) introduce three articles on the effects of HIT for patient safety (p. 246, p. 261, p. 268). Additional articles report on algorithms to measure patient safety (p. 310), and an interactive tool for cross-over analyses of EHRs for patient safety (p. 323). Prescription of medications is an area in which the effects of HIT for patient safety are well studied. Articles reporting on the analyses of medication errors (p. 316), computerized prescriber order entry (CPOE) system-related patient safety reports (p. 316), variation in high priority drug-drug interaction alerts across institutions (p. 331), clinician response to electronic health record (EHR) prompts (p. 275), and alert override analysis (p. 409) are directly connected to topics in this special focus issue. This issue also includes articles on a tool for automated screening for medication errors (p. 281), an approach for automated identification of antibiotic overdoses and adverse events (p. 295), and the impact of CPOE on the length of stay and mortality rate in an academic medical center (p. 303), and an intensive care unit (p. 413). Completing the set of articles focused on HIT and patient safety are two systematic reviews-one on automation bias (p. 423) and another on types and causes of prescribing errors generated from CPOE systems (p. 432), a brief communication on changes in the quality of care due to Meaningful Use implementation (p. 394), approaches to leverage EHRs for failure mode and effects analysis on a cardiology unit (p. 288), and approaches to leverage EHRs to identify complex atrial fibrillation patients for targeted intervention (p. 339).

Health Affairs, Nov 1, 2005

DOAJ (DOAJ: Directory of Open Access Journals), Aug 1, 2013

Comparing the sensitivity of models predicting health status: a critical look at an OECD Report o... more Comparing the sensitivity of models predicting health status: a critical look at an OECD Report on the efficiency of health system. Insurance Markets and Companies, 4(1) RELEASED ON Wednesday,

Disease Management & Health Outcomes, 2007

with chronic illnesses has been questioned, but little information exists regarding the experienc... more with chronic illnesses has been questioned, but little information exists regarding the experience of chronically ill individuals in CDHPs. To contribute to a better understanding of the experience of people with chronic illnesses in CDHPs, this study analyzed survey and medical claims data from a large public employer that offered a CDHP as well as other benefit options. Methods: An analysis of a combined survey, administrative records, and medical claims data was conducted for a sample of employees participating in a large public employer's health benefits plan. The main outcome measures were plan enrollment decision, use of information, plan rating, and spending patterns. Results: Employees with chronic illness are equally likely as other employees to join a CDHP, to understand key plan coverage features, and to report having a particularly positive or negative experience with their plan. However, CDHP enrollees with chronic illnesses assign higher ratings to their plan than do other CDHP enrollees (p < 0.07). They are more likely than other CDHP enrollees to use informational tools (p < 0.05), more likely to anticipate spending all of their savings account dollars (p < 0.05), and more likely actually to spend more than the deductible (particularly for prescription drug expenditures [p < 0.05]((Author: ok?))). Compared with other CDHP enrollees whose spending exceeds the deductible, enrollees with chronic illnesses spend significantly more on prescription drugs. Conclusions: Even though the CDHP benefit design was generous, relatively few employees chose the CDHP, and the CDHP was no more attractive to employees with chronic illnesses than to other employees. Furthermore, although people with chronic illnesses who chose CDHPs had some understanding of how their HSAs would work, they tended to exhaust those accounts and also spend more than the plan's deductible. ((Author: these sentences have been added to provide concluding statements regarding some findings in this study.)). There is much more for employers to do if they want CHDP enrollees with chronic illnesses to 'manage' their conditions more effectively.

International Journal of Health Economics and Management, 2015

Concern abounds about whether the health care workforce is sufficient to meet changing demands sp... more Concern abounds about whether the health care workforce is sufficient to meet changing demands spurred by the Affordable Care Act (ACA). We project that by 2022 the health care industry needs three to four million additional workers, forty percent of which is related to demand growth under the ACA. We project faster job growth in the ambulatory care sector, especially in home health care. Given the current profile, we expect that the future health care workforce will be increasingly female, young, racially/ethnically diverse, not US-born, at or below the poverty level and at a low level of educational attainment.

Health Services Research, 2004

Objective. To assess the experience of enrollees in a consumer-driven health plan (CDHP). Data So... more Objective. To assess the experience of enrollees in a consumer-driven health plan (CDHP). Data Sources/Study Setting. Survey of University of Minnesota employees regarding their 2002 health benefits. Study Design. Comparison of regression-adjusted mean values for CDHP and other plan enrollees: customer service, plan paperwork, overall satisfaction, and plan switching. For CDHP enrollees only, use of plan features, willingness to recommend the plan to others, and reports of particularly negative or positive experiences. Principal Findings. There were significant differences in experiences of CDHP enrollees versus enrollees in other plans with customer service and paperwork, but similar levels of satisfaction (on a 10-point scale) with health plans. Eight percent of CDHP enrollees left their plan after one year, compared to 5 percent of enrollees leaving other plans. A minority of CDHP enrollees used online plan features, but enrollees generally were satisfied with the amount and quality of the information provided by the CDHP. Almost half reported a particularly positive experience, compared to a quarter reporting a particularly negative experience. Thirty percent said they would recommend the plan to others, while an additional 57 percent said they would recommend it depending on the situation. Conclusions. Much more work is needed to determine how consumer experience varies with the number and type of plan options available, the design of the CDHP, and the length of time in the CDHP. Research also is needed on the factors that affect consumer decisions to leave CDHPs.

Health Services Research, 2004

Objective. To compare medical care costs and utilization in a consumer-driven health plan (CDHP) ... more Objective. To compare medical care costs and utilization in a consumer-driven health plan (CDHP) to other health insurance plans. Study Design. We examine claims and employee demographic data from one large employer that adopted a CDHP in 2001. A quasi-experimental pre-post design is used to assign employees to three cohorts: (1) enrolled in a health maintenance organization (HMO) from 2000 to 2002, (2) enrolled in a preferred provider organization (PPO) from 2000 to 2002, or (3) enrolled in a CDHP in 2001 and 2002, after previously enrolling in either an HMO or PPO in 2000. Using this approach we estimate a differencein-difference regression model for expenditure and utilization measures to identify the impact of CDHP. Principal Findings. By 2002, the CDHP cohort experienced lower total expenditures than the PPO cohort but higher expenditures than the HMO cohort. Physician visits and pharmaceutical use and costs were lower in the CDHP cohort compared to the other groups. Hospital costs and admission rates for CDHP enrollees, as well as total physician expenditures, were significantly higher than for enrollees in the HMO and PPO plans. Conclusions. An early evaluation of CDHP expenditures and utilization reveals that the new health plan is a viable alternative to existing health plan designs. Enrollees in the CDHP have lower total expenditures than PPO enrollees, but higher utilization of resource-intensive hospital admissions after an initially favorable selection.

Health Services Research, 2004

Objective. To determine who chooses a Consumer‐Driven Health Plan (CDHP) in a multiplan, multipro... more Objective. To determine who chooses a Consumer‐Driven Health Plan (CDHP) in a multiplan, multiproduct setting, and, specifically, whether the CDHP attracts the sicker employees in a company's risk pool.Study Design. We estimated a health plan choice equation for employees of the University of Minnesota, who had a choice in 2002 of a CDHP and three other health plans—a traditional health maintenance organization (HMO), a preferred provider organization (PPO), and a tiered network product based on care systems. Data from an employee survey were matched to information from the university's payroll system.Principal Findings. Chronic illness of the employee or family members had no effect on choice of the CDHP, but such employees tended to choose the PPO. The employee's age was not related to CDHP choice. Higher‐income employees chose the CDHP, as well as those who preferred health plans with a national provider panel that includes their physician in the panel. Employees tend...

Routledge eBooks, Nov 13, 2017

This paper reports the results of a major study of the impact of international agricultural resea... more This paper reports the results of a major study of the impact of international agricultural research, covering eleven crops in all major regions of the developing world, over the period 1960-2000. Although much of the "common wisdom" concerning the Green Revolution suggests that gains from research were limited to rice and wheat in Asia and Latin America, we find evidence of far broader impacts, extending essentially to all crops and regions. There are important differences, however, in the extent of these impacts. We explore these differences and assess the overall impact of research-driven improvements in technology.

This paper examines the effect of agricultural policy on a country's development and growth. We f... more This paper examines the effect of agricultural policy on a country's development and growth. We find that low agricultural productivity can delay the start of industrialization in a country for a long period of time, causing a country's per capita income to fall far behind the industrial leader. Once industrialization begins, this trend is reversed. However, the extent to which a country catches up to the leader depends primarily on factors that affect productivity in non-agricultural activities. Agricultural policy, therefore, is largely irrelevant in the long run. But in the short run, a country that experiences large improvements in agricultural productivity, due to say a Green Revolution, will experience an increase in its income relative to the leaders.

Review of Economic Dynamics, 2004

Agriculture's share of economic activity is known to vary inversely with a country's level of dev... more Agriculture's share of economic activity is known to vary inversely with a country's level of development. This paper examines whether extensions of the neoclassical growth model can account for some important sectoral patterns observed in a current cross-section of countries and in the time series data for currently rich countries. We find that a straightforward agricultural extension of the neoclassical growth model restricted to match U.S. observations fails to account for important aspects of the crosscountry data. We then introduce a version of the growth model with home production, and we show that this model performs much better. We thank Lee Alston, Bob Evenson and Ed Prescott for their comments. We have also benefited from the comments of participants at the 1998 NEUDC meetings; the 1999 Econometric Society winter meetings; and the 1999 meetings of the Society for Economic Dynamics.

We examine the presence of deliberate diagnostic coding intensity for risk-based beneficiary pros... more We examine the presence of deliberate diagnostic coding intensity for risk-based beneficiary prospective payments in Medicare Advantage (MA) compared to traditional fee-for-service Medicare from 2010 through 2014. We find that risk ratings based on adjusted diagnostic groups (ADGs) and hierarchical condition categories (HCCs) are similar for the fee-for-service population, but the ADG risk adjustor significantly reduces risk scores in the Medicare Advantage population. Like the HCC system, ADGs are based on patients’ diagnoses, but they are not used for MA payment. Our results suggest that upcoding within the risk adjustment system may have over-stated risk differences in the fee-for-service and Medicare Advantage populations, leading to higher payments to Medicare Advantage plans.

Health Care Financing Review, 2006

This article examines the investment of patient care information technology (IT) systems by a nat... more This article examines the investment of patient care information technology (IT) systems by a nationwide sample of U.S. short-term acute care hospitals and the resulting impact these systems have in the productivity of institutions from 1990-1998. Of particular interest is the extent to which for-profit and not-for-profit hospitals obtain different results from the adoption of IT systems. We find that the marginal effect of IT on for-profit hospital productivity is to reduce the number of days supplied, while in not-for-profit hospitals the marginal effect of IT is to increase the quantity of services supplied. This resulting effect is consistent with the differing objectives of not-for-profit and for-profit hospitals and demonstrates the positive marginal value of IT as a sustainable and prudent investment.