Changes In Net Revenues Research Articles

Dental Practice Integration into Primary Care: A Microsimulation of Financial Implications for Practices.

Given the widespread lack of access to dental care for many vulnerable Americans, there is a growing realization that integrating dental and primary care may provide comprehensive care. We sought to model the financial impact of integrating dental care provision into a primary care practice. A microsimulation model was used to estimate changes in net revenue per practice by simulating patient visits to a primary dental practice within primary care practices, utilizing national survey and un-identified claims data from a nationwide health insurance plan. The impact of potential changes in utilization rates and payer distributions and hiring additional staff was also evaluated. When dental care services were provided in the primary care setting, annual net revenue changes per practice were −$92,053 (95% CI: −93,054, −91,052) in the first year and $104,626 (95% CI: 103,315, 105,316) in subsequent years. Net revenue per annum after the first year of integration remained positive as long as the overall utilization rates decreased by less than 25%. In settings with a high proportion of publicly insured patients, the net revenue change decreased but was still positive. Integrating primary dental and primary care providers would be financially viable, but this viability depends on demands of dental utilization and payer distributions.

Turn Down for What? The Economic Value of Operational Flexibility in Electricity Markets

This paper explores how enhanced flexibility through lower minimum load levels (also called “turndown” limits) for coal- and natural-gas-fired power plants can impact operations and profitability. Using soft-linked capacity planning and unit commitment models, this research examines the economic value of this flexibility and variation across different regions, generation asset types, and market environments (e.g., level of renewable deployment). Model results suggest that lower minimum loads are most valuable for mid-merit units with intermediate capacity factors, policy conditions that rearrange the merit order (e.g., carbon pricing), regions and scenarios without seasonal layup of assets, and units that are more flexible than generators with otherwise similar characteristics. Lower minimum loads can increase operating hours, increase net revenues, and decrease startups and long-run maintenance costs. The scenarios in this analysis show that plant flexibility affects operations more than annual profitability, which may have a higher system value for integrating renewables than a private value for the flexible unit. For many plants, the modest changes in net revenues with lower minimums mean that the focus will likely be on making operational modifications to increase flexibility rather than on capital investments. Additionally, this analysis quantifies how revenues from ancillary services markets can boost the value of lower minimum loads, especially for efficient natural gas units, but total market size and depth are uncertain.

The Moderating Effect of Disclosure Quality on Changes in the Cost of Debt: Evidence from Municipal Credit Rating Downgrades

We examine whether municipal market participants' sensitivity to changes in local home values varies with the quality of local governments' financial reports. We find the credit ratings and bond yields of governments that are required to comply with GAAP are less sensitive to changes in local home values than similarly-affected governments that are not required to comply with GAAP. These governments do not experience different changes in net revenues ex post. The results are pronounced when the change in home values generates the most uncertainty (i.e., the change is adverse). The results are also stronger after GASB 34 increased the quality of GAAP-compliant issuers' financial reports. We conclude that market participants are less sensitive to signals about the local economy when local governments are required to provide high-quality disclosures.

A nonparametric frontier measure of marketing efficiency: An illustration with corn ethanol plants

This article extends nonparametric measures of efficiency to accommodate the concept of marketing efficiency, which measures changes in net revenues brought about by firms’ use of marketing channels other than spot markets. The measure is appropriate for firms operating under atomistic competition with imperfect information. The proposed measure displays two important features: (a) it uses the alternative of a spot price-based counterfactual to distinguish marketing from allocative efficiency, and (b) it allows for the fact that firms operate in different spot markets and have access to diverse sets of prices. We illustrate this approach with a unique dataset from ethanol plants in the U.S. Corn Belt. [EconLit citations: C61, D2, L2].

Effects of New Funding Models for Patient-Centered Medical Homes on Primary Care Practice Finances and Services: Results of a Microsimulation Model.

We assess the financial implications for primary care practices of participating in patient-centered medical home (PCMH) funding initiatives. We estimated practices' changes in net revenue under 3 PCMH funding initiatives: increased fee-for-service (FFS) payments, traditional FFS with additional per-member-per-month (PMPM) payments, or traditional FFS with PMPM and pay-for-performance (P4P) payments. Net revenue estimates were based on a validated microsimulation model utilizing national practice surveys. Simulated practices reflecting the national range of practice size, location, and patient population were examined under several potential changes in clinical services: investments in patient tracking, communications, and quality improvement; increased support staff; altered visit templates to accommodate longer visits, telephone visits or electronic visits; and extended service delivery hours. Under the status quo of traditional FFS payments, clinics operate near their maximum estimated possible net revenue levels, suggesting they respond strongly to existing financial incentives. Practices gained substantial additional net annual revenue per full-time physician under PMPM or PMPM plus P4P payments ($113,300 per year, 95% CI, $28,500 to $198,200) but not under increased FFS payments (-$53,500, 95% CI, -$69,700 to -$37,200), after accounting for costs of meeting PCMH funding requirements. Expanding services beyond minimum required levels decreased net revenue, because traditional FFS revenues decreased. PCMH funding through PMPM payments could substantially improve practice finances but will not offer sufficient financial incentives to expand services beyond minimum requirements for PCMH funding.

A Partial Budget Analysis for Phosphorus‐Based Nutrient Management Plans for Connecticut Dairy Farms

This study estimated changes in costs of manure handling, costs of the fertilizer replacement value of manure, and expected changes in net revenues associated with the implementation of manure nutrient management plans (NMPs) based on the agronomic critical concentration for P using a partial budget analysis. The net revenue from manure management practices traditionally used by farmers in a baseline year was compared with the expected net revenue from practices recommended in NMPs for four dairy farms over 4 or 5 yr in Connecticut. Yields were not measured across the 2862 field‐years. Compared with the baseline year, the average annual estimated change in net revenue associated with manure applications based on the NMPs was a negative $2,900 for one large farm and a positive $17,600 for the other large farm, while the net revenue change was a positive $200 and $1,400 for the two medium‐sized farms. In years after the baseline the average annual estimated change in net revenue for manure management practices for the NMPs compared with the practices reported by farmers was a negative $2,200 for one large farm and a positive $19,300 for the other large farm; the net revenue change was a positive $2,500 and $1,300 for the medium‐sized farms. The net revenue changes from the NMPs were determined largely by the existing soil test P and K values. The complexity of implementing the NMPs made it difficult to obtain the expected net revenue changes.