Break-even Ratio Research Articles

Outliers of total shoulder arthroplasty in the bundled payment era.

The Centers for Medicare & Medicaid Services implemented the Bundled Payments for Care Improvement Advanced (BPCIA) Model that covers 90-day care episodes after select orthopedic procedures including anatomic or reverse ball-and-socket total shoulder arthroplasty (TSA/rTSA). This study investigated whether patients undergoing TSA/rTSA for nondegenerative processes incur higher costs than patients undergoing arthroplasty for degenerative processes. A retrospective review was conducted of all patients at a single academic medical center enrolled in the BPCIA model for TSA/rTSA from October 1, 2018, through December 31, 2022. We investigated whether patients undergoing arthroplasty for nondegenerative indications accrued more 90-day postoperative costs compared to patients undergoing arthroplasty for degenerative processes. A Break-even ratio was calculated to determine the number of degenerative TSA/rTSA that would need to be performed to account for the increased expenditures associated with nondegenerative TSA/rTSA. One hundred patients met inclusion criteria during the study period. Costs for TSA/rTSA due to nondegenerative indications exceeded bundle payment amounts at a significantly higher rate compared to degenerative indications (43% vs. 18%, P=.021). TSA/rTSA for nondegenerative indications was also associated with significantly higher total costs ($27,100 vs. $22,200, P=.014), significantly more postoperative emergency department visits (43% vs. 18%, P=.035), and longer hospital length of stay (2.2 vs. 1.6days, P=.121). Break-even ratio analysis demonstrated 1.22-1.54 TSA/rTSA for degenerative indications need to be performed to equal the total spending of one TSA/rTSA for nondegenerative indications. Patients undergoing shoulder arthroplasty for nondegenerative indications within the Centers for Medicare & Medicaid Services BPCIA bundled payments program were at greater risk for incurring higher costs than allocated target payments, as well as significantly higher costs when compared to patients undergoing arthroplasty for degenerative processes. We may need to consider the roles bundled-payment programs have for these patients.

Forage economics calculator web tool: A decision support system for forage management

Economic analysis of forage production and handling aids in making an educated decision related to growing or buying forage, setting forage prices, and purchasing additional equipment. Manual calculation of economics is highly complex, tedious, and time-consuming. Therefore, a multi-device web-based tool, called the “forage economics calculator web tool” (FECWT) was developed using HTML, CSS, and JavaScript. The tool’s interface was designed for a user-friendly experience with easy access to commands set in an easy-to-follow layout. The FECWT uses 29 input variables to generate results “dynamically” for 37 output variables, based either on the supplied default data or with user-provided inputs (imperial or metric units). The tool emphasizes the cost of the bale collection activity performed using tractor or tractor pulling an “automatic bale picker” (ABP), while the cost of other activities (planting, fertilizer & chemical application, harvesting, and baling) are provided as direct inputs. The economic analysis outputs include net return, break-even ratio, payback period, and return on investment. Features of FECWT include the sensitivity of profit to changes in input values, and downloadable reports and charts for record-keeping. Two case studies using farmers’ actual field data inputs demonstrated the FECWT’s effectiveness, with its generated results corroborating well with farmers’ records. The tool allows for “what-if” scenario analysis related to equipment purchase, effect of forage crop, net-return, and low-inputs scenario for different field areas suggests that an ABP purchase for field areas greater than ≥65ha (≥160ac) could be profitable; alfalfa and corn were the most profitable forage and grain-forage crops, where the grain revenue stream of grain-forage crops easily covers the costs and makes a profit; and a low-inputs scenario (no fertilizers, chemicals, and/or seeds) for forages (alfalfa and grass) decreased the net returns on average by 8.1 times at 50% forage yield potential suggesting the use of all inputs and increased field areas (≥65ha) make a better profit in this low-inputs scenario. Potential users of this web tool include farmers, hay producers, custom hay operators, educators, agricultural extension and financial personnel, and others interested in the economics of handling bales.

Optimal control of organic matter applications

Organic matter amendments appear to increase yield, but need to be sustained, as yield decreases when amendments cease. Here we mathematically devise optimal strategies for organic matter applications that take account of how quickly, in years of application, yields build up with amendments and how long these benefits persist. The empirical idea of a nutrient response curve is used and extended to include more than a single nutrient input as well as the effect of yield-enhancing factors such as organic matter that endure for more than one year. Nonlinear regression is used for the selection and the parameter identification for a reciprocal response curve working with a dataset from Rothamsted’s Woburn organic manuring long term experiment. Such a response curve is then treated analytically to develop economically optimum applications over a period of time. A simple static case is developed first and is shown to be equivalent to the well-known break-even ratio (BER) used in nitrogen fertiliser guidance by the Agricultural and Horticultural Development Board in the UK. The mathematical technique of optimal control is then employed to deduce dynamic strategies where the application of an amendment may change from year to year and for different time frames. Because this empirical modelling methodology can appear complex, we infer a rule-of-thumb for an equilibrium level of yield-enhancement rather like the equilibrium level of organic carbon that builds up over several years. This yield-enhancing power of organic matter is somewhat variable and probably does not persist in soil for as long as the organic matter from which it derives. It appears beneficial to apply amendments at a constant rate for much of the time-frame of interest but to begin with a large application to raise the fertility to the yield-enhancement equilibrium. After a transition year with reduced amendments, applications of organic matter are stopped for the final five years with the example amendment studied, farmyard manure. These conclusions depend on the persistence of the yield-enhancing power of organic matter in soil associated with the soil organic carbon kinetics.

Budget Impact Analysis of Self-Monitoring of Blood Glucose vs. Flash-Continuous Glucose Monitoring in Intensive Insulin Users with Diabetes Type 2 Covered by Medicare and Medicaid

Introduction: Self-Monitoring of Blood Glucose (SMBG) uses capillary blood glucose to measure glycemia in diabetic patients. Recently FDA-approved Flash Continuous Glucose Monitoring (F-CGM) reveals glucose levels when scanned by the reading device. The Centers for Medicare and Medicaid Services (CMS) have announced to reimburse F-CGM at the same level as CGM devices. Aim: This analysis’ objective was to quantify the CMS budget impact (BI) of F-CGM reimbursement in patients with type 2 diabetes (T2DM) on intensified insulin therapy (IIT), and compare it to the BI of conventional SMBG via cost-related break-even metrics. These were chosen because - in the absence of RCT-based, primary endpoint-driven clinical superiority evidence of F-CGM over SMBG for this population (REPLACE study) - they are well-suited to inform budget allocation decisions. Methods: An economic model was developed in Excel. CMS reimbursement/patient co-insurance levels for SMBG and F-CGM were used; data on morbidity, treatment and usage patterns were sourced from the literature and official websites. Different scenarios were simulated to elicit break-even points between F-CGM and SMBG. Results: The annual cost of SMBG with 3.7 tests per day (see REPLACE) is $180 per patient, compared to $2,156 incurred per F-CGM patient, representing a cost difference of $1,976/year or $5.41/day. This implies a budget break-even ratio of 1:12 patients (F-CGM:SMBG). Both technologies would break even at a consumption of 44 test strips per day. A year’s SMBG budget would last only 30 days if spent on F-CGM. Conclusion: With diabetes budgets under pressure, thoughtful spending policies are needed. It is recommended to analyze in detail which T2DM subgroups will benefit most from F-CGM, focusing reimbursement to the latter. SMBG, being an established technology, represents - at current reimbursement levels - an attractive spending option to budget holders. Disclosure M. Stueve: Employee; Self; JnJ GmbH Life Scan. Y.F. Zoellner: Research Support; Self; J&J Medical GmbH, LifeScan.

Investigating the Influence of Underground Ore Productions on the Overall Stability of an Existing Open Pit

In the evolution of mining operations that exploit extensive orebodies to depth there inevitably comes a time where the economics of open pit mining reach their break-even ratio. The consideration of underground operations becomes increasingly important to sustain mine production. This paper describes the process of investigation into the influence of full scale underground operations, using three dimensional finite element analysis, to forecast possible pit failure. The numerical analysis was undertaken using data collected at the Prominent Hill mine in South Australia. Analysis was conducted across the range of excavation steps undertaken within the underground mining operation. This full-stage analysis provides predictive information on stability of the open pit in terms of rock/slope failure. The output provides benefits in safety and production and gives operators and regulators much needed data across the mine life to closure.

New Indicators Based on Personnel Cost for Management Efficiency in a Hospital

A simple and fair benchmarking system or financial indicators for use on the clinical department level have been lacking to evaluate the management efficiency and activity of each clinical department or division of a hospital. New financial indicators have therefore been developed based on personnel costs. Indicator 1: The ratio of marginal profit after personnel cost per personnel cost (RMP). Indicator 2: The ratio of investment (=indirect cost) per personnel cost (RIP). The difference between RMP and RIP demonstrates the operation profit in US Dollars for personnel cost (OPP). A turning point in profitability similar to the break-even point (BEP) and break-even ratio (BER) could be also defined by the combination of the RMP and RIP. The merits of these two indicators are not only the ability to indicate the relationship between the medical profit and the investments in the hospital, but also the capability to demonstrate such indicators as BEP, BER and OPP on a single graph. The two indicators were applied to the hospitals in the National Hospital Organization and to the clinical department in one hospital. Using these two indicators, it was possible to evaluate the management efficiency and medical activity not only in the whole hospital but also in each department and DPC/DRG group. This will be of use to a manager of a hospital in checking the management efficiency of his/her hospital despite the variations among hospitals, departments and divisions.

Economic feasibility of a small-scale production plant for entomopathogenic fungi in Nicaragua

Natural insecticides based on the entomopathogenic fungi Beauveria bassiana and Metarhizium anisopliae have been produced on an experimental scale in Nicaragua with a 6-month output for insect control on 1100 ha. Main target insects are the coffee berry borer Hypothenemus hampei, the diamond-backed moth Plutella xylostella, and spittlebugs (Aeneolamia spp. and Prosapia spp.) in sugarcane. The production process involves three life cycles of the fungus, first on solid culture medium, then on rice in Erlenmeyer flasks from which a liquid inoculum is obtained and finally on rice in polypropylene bags. The economic feasibility of scaling up the conidia production for an annual output to cover mycopesticide applications on 20,000 ha is calculated. Total investment for a complete new construction of facilities amounts to US$264,000. The estimated shelf prices of the products range from US$8.00 to US$12.00/ha. A net profit is obtained as soon as the output reaches 75% of full capacity, which is targeted for the third year. In the final year of the planning horizon of 10 years, at which time the debt has been serviced, the break-even ratio is reached at 56% of nominal capacity. The internal rate of return on the total investment is 12.7%. The production is economically sustainable if initial capital is provided below market interest rates via a research or development co-operation treaty.

Selecting Number of Lint Cleanings to Maximize Cotton Bale Values

ABSTRACT EXPERIMENTS that incorporated presently grown cotton varieties and recent grading standards and lint-cleaner developments were conducted over a 3-year period to update lint-cleaning recommendations for spindle-harvested cottons. Harvestings covered periods that provided a good representation of the type of cotton normally expected at Midsouth cotton gins. Gin processing with none, one, and two stages of saw-cylinder lint cleaning was performed on 18 cottons. These treatments were selected because almost two-thirds of all commercial gins have two stages of installed lint cleaning. Five commercial models of controlled-batt, saw-type lint cleaners were used, and the cleaners and their settings were considered representative of current-model saw-cylinder lint cleaners. The data illustrate the entent to which lint cleaning may affect the trash content of cotton, fiber length, and lint market value. A system of break-even ratios was developed to provide a method for determining when weight losses would be offset by increases in grade. The results can assist growers and ginners in selecting the amount of lint cleaning that cotton should receive at gins.

Economics and open pit design — beware of break-even ratios : LILLICO, TM 3F, 5T, 5R WORLD MINING, V27, N3, MAR. 1974, P60–64

Economics and open pit design — beware of break-even ratios : LILLICO, TM 3F, 5T, 5R WORLD MINING, V27, N3, MAR. 1974, P60–64