Category Archives: Finance

CMS’s proposed changes to outpatient services, if finalized, would hurt hospital margins

Source: Diana Lee, Daniel Steingart, Jessica Gladstone, Jonathan Kanarek, Kendra M. Smith, Peter H. Abdill, Moody’s, Sector Comment, August 8, 2018
(subscription required)

On July 25, The Centers for Medicare and Medicaid Services (CMS) proposed several changes to the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System, which, if finalized, would generally be credit negative for both not-for-profit and for-profit hospitals. Changes include: (1) site neutral clinic visits, (2) expansion of 340B policy changes to off-campus departments of hospitals, and (3) adding certain nonsurgical procedures as covered procedures at ambulatory surgical centers. While on their own, these proposed changes would not be material to overall sector credit quality, the effects would vary by hospital. In general, the proposal to move certain cardiac procedures to ASCs, if finalized and if adopted by clinicians, would likely have the broadest and most significant effect on the hospital sector. Additionally, to the extent that commercial payors follow suit, each of these changes would have more meaningful effects…..

Graying of U.S. Bankruptcy: Fallout from Life in a Risk Society

Source: Deborah Thorne – University of Idaho, Pamela Foohey – Indiana University Maurer School of Law, Robert M. Lawless – University of Illinois College of Law, Katherine M. Porter – University of California – Irvine School of Law, August 5, 2018

From the abstract:
The social safety net for older Americans has been shrinking for the past couple decades. The risks associated with aging, reduced income, and increased healthcare costs, have been off-loaded onto older individuals. At the same time, older Americans are increasingly likely to file consumer bankruptcy, and their representation among those in bankruptcy has never been higher. Using data from the Consumer Bankruptcy Project, we find more than a two-fold increase in the rate at which older Americans (age 65 and over) file for bankruptcy and an almost five-fold increase in the percentage of older persons in the U.S. bankruptcy system. The magnitude of growth in older Americans in bankruptcy is so large that the broader trend of an aging U.S. population can explain only a small portion of the effect. In our data, older Americans report they are struggling with increased financial risks, namely inadequate income and unmanageable costs of healthcare, as they try to deal with reductions to their social safety net. As a result of these increased financial burdens, the median senior bankruptcy filer enters bankruptcy with negative wealth of $17,390 as compared to more than $250,000 for their non-bankrupt peers. For an increasing number of older Americans, their golden years are fraught with economic risks, the result of which is often bankruptcy.

RAND Hospital Data Web-Based Tool

Source: RAND, 2018

From the summary:
Medicare-certified hospitals and other institutional providers are required to submit an annual cost report to a Medicare Administrative Contractor. Cost reports contain provider information such as facility characteristics, utilization data, cost and charges by cost center (in total and for Medicare), Medicare settlement data, and financial statement data. The Centers for Medicare & Medicaid Services (CMS) maintains the cost report data in the Healthcare Provider Cost Reporting Information System (HCRIS). The RAND Hospital Data tool is an effort to enhance CMS HCRIS data to make them more accessible and useful to a broad audience of academics, analysts, and hospital executives and their consultants. The tool provides users with data sets that are conveniently packaged and documented and that include value-added fields derived from HCRIS data, such as measures of occupancy and profitability. The goal of the tool is to make analytic tasks easier for those who work regularly with the data and to broaden the set of users.

How Does Last-Dollar Financial Aid Affect First-Year Student Outcomes? Evidence from the Bridging the Gap Study

Source: Keith Wardrip, Eileen Divringi, and Kyle DeMaria, Federal Reserve Bank of Philadelphia, Community Development and Regional Outreach, May 2018

This report examines the early impacts of a financial aid program that reduces or eliminates tuition and campus fee costs for lower- and middle-income New Jersey residents. The program boosted enrollment among lower-income students, improved students’ perception of college affordability, and reduced student financial stress. However, it is unclear whether first-year improvements in academic performance are attributable to the program.

Calculating percentages and decimals

Source: Canadian Union of Public Employees (CUPE), 2018

Welcome! Are you a CUPE member who’s interested in learning some basic union math? Do you want to serve your local as a union financial officer? We’re glad you’re here. We hope this short, online course helps you develop the skills and the confidence to be more comfortable with math as you develop your union leadership skills. ….

Course Map
Lesson 1 – Percentages and fractions
Lesson 2 – Fractions and decimals
Lesson 3 – Calculating dues
Lesson 4 – Percentages simplified
Lesson 5 – Per capita

Social Security Finances: Findings of the 2018 Trustees Report

Source: Elliot Schreur and Benjamin Veghte, National Academy of Social Insurance, June 2018

From the abstract:
The 2018 Report of the Social Security Trustees projects that revenues will be sufficient to pay all scheduled benefits until 2034 and roughly three quarters of scheduled benefits thereafter. In 2017, Social Security income from payroll contributions, tax revenues, and interest on reserves exceeded outgo by $44 billion. Reserves, now at $2.9 trillion, are projected to begin to be drawn down in 2018 in order to pay full scheduled benefits. The Disability Insurance (DI) Trust Fund is projected to cover scheduled benefits until 2032, and the Old-Age and Survivors Insurance (OASI) Trust Fund until 2034.1 On a combined OASDI basis, Social Security is fully funded until 2034, but faces a projected shortfall thereafter. After the projected depletion of the combined OASDI trust funds, Social Security contributions and tax revenues would continue to be received and would cover about 79 percent of scheduled benefits (and administrative costs, which are less than 1 percent of outgo). The long-range actuarial shortfall over 75 years is projected to be 2.84 percent of taxable payroll – that is, 2.84 percent of all earnings that are subject to Social Security contributions. This projected long-term revenue shortfall is substantially unchanged from the 2.83 percent of taxable payroll reported in the 2017 Trustees Report. Timely revenue increases and/or benefit reductions could bring the program into long-term balance, preventing the projected shortfall.

Related:
Social Security 2018 Trustees Report
Source: Board of Trustees of the Federal Old-Age and Survivors Insurance and Federal Disability Insurance Trust Funds

Postsecondary Institutions and Cost of Attendance in 2017-18; Degrees and Other Awards Conferred: 2016-17; and 12-Month Enrollment: 2016-17: First Look (Preliminary Data)

Source: Scott A. Ginder, Janice E. Kelly-Reid, Farrah B. Mann, National Center for Education Statistics (NCES), Publication #: NCES 2018060, May 2018

From the abstract:
This First Look presents preliminary data findings from the Integrated Postsecondary Education Data System (IPEDS) fall 2017 collection, which included three survey components: Institutional Characteristics for the 2017-18 academic year, Completions covering the period July 1, 2016, through June 30, 2017, and data on 12-Month Enrollment for the 2016-17 academic year.

Campaign Finance Law Database

Source: Campaign Finance Institute, 2018

From the press release:
The Campaign Finance Institute is pleased to release a groundbreaking new tool, “CFI’s Historical Database of State Campaign Finance Laws”. The database covers all of the states’ campaign finance laws every two years since 1996. It is designed for everything from interactive and visualized lookups to downloadable datasets.

Anyone with a serious interest in politics is bound to have made, heard, or wondered about claims to the effect that the laws governing money in politics “make a difference”. These claims may be about who runs for office, how they campaign, who wins, how they govern, or what policies come out in the end. But until now it has been impossible to evaluate most of these claims properly. You cannot really understand a law’s effects unless you can compare jurisdictions with different laws to themselves and each other over time.

CFI’s new tool opens the door to let everyone make those comparisons. It covers every state since 1996 and is structured to handle queries from the simplest to the most complex. Because not everyone will want to use the tool in the same way, the material comes in two formats.

One is a remarkably compact and attractive visualization that will let users look up the answers to what we expect will be their most common questions. For example:
– What are the laws in my state? When did they change?
– Which states disclose what kinds of information about independent spending?
– Which ones changed their contribution limits after Citizens United?
– Which states offer public financing or political contribution tax credits? In rank order, which states had higher and lower disclosure thresholds (or contribution limits, etc.) in any given year?

All of these kinds of questions can be answered through the visualization tool. But the tool is based on only a fraction of what the data can offer. The full database has literally hundreds of pieces of information for each state and year. The visualization only covers about 10% of these. The full set can be downloaded in whole, or part. It then can be manipulated or merged with other data sets at the user’s pleasure. Downloading is the first step for answering “what difference” questions. For example:
– What difference does it make to have higher or lower limits?
– Is the law really responsible for a particular effect – whether positive or negative?

Federal Election Commission: Membership and Policymaking Quorum, In Brief

Source: R. Sam Garrett, Congressional Research Service, CRS Report, R45160, April 12, 2018

The Federal Election Commission (FEC) is the nation’s civil campaign finance regulator. The agency ensures that campaign fundraising and spending is publicly reported; that those regulated by the Federal Election Campaign Act (FECA) and by commission regulations comply and have access to guidance; and that publicly financed presidential campaigns receive funding.

FECA requires that at least four of six commissioners agree to undertake many of the agency’s key policymaking duties. As of this writing, the FEC is operating with four commissioners instead of six. Others reportedly are considering leaving the agency. One nomination to the FEC has been resubmitted during the 115th Congress; no committee or floor action has been taken on it to date.

It is entirely possible that the FEC will retain at least four commissioners and that the agency will remain able to carry out all its duties. If, however, the FEC loses its policymaking quorum—as happened for six months in 2008—the agency will be unable to hold hearings, issue rules, and enforce campaign finance law and regulation. This CRS report briefly explains the kinds of actions that FECA would preclude if the commission lost its policymaking quorum.

This report will be updated in the event of significant changes in the agency’s policymaking quorum or the status of agency nominations….