View Research by Author - Douglas A. Wissoker

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Citation URL: http://www.urban.org/DouglasAWissoker

In its June 2008 Report to Congress, the Medicare Payment Advisory Commission (MedPAC) recommended revision of the prospective payment system (PPS) for skilled nursing facilities (SNFs). The proposed revisions consist of a new component to pay for non-therapy ancillaries (NTA) based on predicted NTA costs, an alternative therapy component that bases therapy payments on predicted therapy needs, and addition of an outlier policy for the PPS. This technical report to MedPAC provides detail on the data, methods, and specific predictive models that underlie the analysis in the Report to Congress.

Medicare has paid skilled nursing facilities (SNFs) using a prospective payment system (PPS) since 1998. This report offers policy options to refine Medicare’s payment of SNF services by developing alternative patient classification models. Three models classify patients according to expected non-therapy ancillary (NTA) costs: two models use data from the SNF to model NTA costs; a third adds data from prior hospital stays. A fourth model predicts rehabilitation therapy costs using patient characteristics. The fifth uses Diagnostic Related Groups to predict total SNF care costs. The report also simulates options for outlier payments for exceptionally high-cost cases.

This study examines whether small minority- and women-owned enterprises (MWEs) use computers less than white-male-owned enterprises and whether higher levels of computer use increase productivity. We use data from a new telephone survey of roughly 1,100 firms and 45 in-depth interviews with business owners. The results suggest that: (1) Small MWEs show no tendency to use computers less than small firms owned by white men; and (2) Using computers for more business functions and/or more intensively for these business functions can raise the productivity and profitability of small MWEs.

The 1996 passage of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) was the largest federal change in welfare policy in decades. The sweeping federal changes included replacing the old cash assistance program with the Temporary Assistance for Needy Families (TANF) program, making assistance temporary through a five-year time limit on federal benefit receipt, changing state funding to a block grant, increasing state program rule flexibility, and enhancing the emphasis on work. Because these changes were so fundamental, there is great need to understand their impact, particularly on the eve of the 5-year reauthorization of the act.

This paper provides new evidence to inform the policy debate about the effect of a newly important industry -- the temporary help industry –- on the labor market outcomes of low-income workers and those at risk of being on public assistance. We use several years of CPS data to document differences in characteristics and employment outcomes between temporary help workers and those in traditional work arrangements. We then use a model-based approach, exploiting SIPP data and using propensity score matching techniques, to compare outcomes for low-income and at-risk workers in the temporary help industry both with those of similar workers in traditional employment and of nonworkers. The analysis shows that workers who are at risk of welfare recipiency are more than twice as likely to be in alternative work arrangements as other workers. An examination of outcomes one year later, including wages, employment duration, and benefits, indicate that, not surprisingly, temporary workers had worse earnings and employment outcomes a year later than did similar individuals initially working in standard employment. Temporary workers fared substantially better one year later than did those who were initially not employed; temporary workers are nearly twice as likely to be working one year later. Although temporary workers do fare worse than those employed in traditional work, their outcomes one year later are much closer to those of standard workers than those of unemployed workers.

Welfare reform in the United States to date has been remarkably successful at reducing welfare caseloads and raising employment rates among current and former welfare recipients. Similar gains have not yet been noted in other aspects of employment, such as job performance, retention, and advancement. Ultimately, these factors will be among the most important determinants of the wages and benefits that welfare recipients earn in the labor market and of their ability to support their families and achieve financial independence. But the research evidence to date on these issues has been limited, and what is available has mostly suggested low rates of retention and advancement.

The role of alternative work arrangements - temporary help, independent contractors, on-call workers, and contract company workers - has caught the attention of both policymakers and academic researchers alike. Current research indicates that 1 in 10 workers are employed in one of these four alternative work arrangements and employment in the temporary help services industry grew five times as fast as overall non-farm employment between 1972 and 1997.

Though accounting for only a small percentage of total Medicare spending, long-term care hospitals (LTCHs) (defined as having an average length of stay [LOS] of 25 days or more) have been growing, in number and in Medicare expenditures, at a rapid rate in recent years. Because they have not been widely studied, we conducted research to describe the characteristics of this increasingly important Medicare provider type. We found that most LTCHs specialize in the provision of respiratory care or rehabilitation. Information from this study can help inform the development of a Medicare prospective payment system for LTCHs. . (Health Care Financing Review 2001 Winter; 23(2):1-18).

Though accounting for only a small percentage of total Medicare spending, long-term care hospitals (LTCHs) (defined as having an average length of stay [LOS] of 25 days or more) have been growing, in number and in Medicare expenditures, at a rapid rate in recent years. Because they have not been widely studied, we conducted research to describe the characteristics of this increasingly important Medicare provider type. We found that most LTCHs specialize in the provision of respiratory care or rehabilitation. Information from this study can help inform the development of a Medicare prospective payment system for LTCHs. (Health Care Financing Review 2001 Winter; 23(2):1-18).

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