Purchase Program Research Articles

Die EZB-Geldpolitik in der Zwickmühle

AbstractIt seems clear that the ECB will raise interest rates in July 2022 and end its asset purchase program. This should send a strong and important signal to markets and economic players that the ECB continues to take its mandate for price stability seriously. However, it cannot be said with absolute certainty that these monetary policy decisions herald the start of a gradual tighter stance toward monetary policy normalisation. This is because economic uncertainty is currently extremely high. The ECB therefore finds itself in a difficult dilemma: It must take decisive action against high inflation, but should retain plenty of flexibility to be able to respond to a renewed crisis.

The dynamics of money supply determination under asset purchase programs: A market-based versus a bank-based financial system

This paper proposes a new analytical framework incorporating asset prices and bank credit to investigate the determination of the money supply. Based on multivariate time-series analyses, this paper provides the first evidence that central bank asset purchases, asset prices and bank credit are closely linked to the money supply. Strong evidence of clear differences in the dynamics of money supply determination between the U.S. and Japan has also been found. Firstly, the asset purchases of the Federal Reserve tend to increase the money supply to a greater degree. Secondly, dynamic interactions between asset prices and the money supply are stronger in the U.S. And thirdly, bank credit is more essential to the determination of the money supply in Japan. These findings provide new insights into how financial structure influences the transmission mechanism of unconventional monetary policy.

Causal analysis of central bank holdings of corporate bonds under interference

We investigate whether the transfer of corporate bonds from the private sector to the balance sheet of the central bank permanently alters their relative prices. Answering this question complements the literature on central bank asset purchase programs, documenting significant relative price changes over shorter horizons. We use data on bonds issued over the duration of the European Central Bank's corporate bond purchase program and a novel regression discontinuity design to quantify the causal effect of interest. The estimates indicate that the program did not, on average, permanently alter the yield spreads of eligible bonds relative to those of similar noneligible bonds. This finding suggests that central bank holdings of even relatively illiquid private sector securities can have no distortionary effects on the relative prices of such assets.

Is the Hospital Value-Based Purchasing Program Associated with Reduced Hospital Readmissions?

IntroductionHospital readmissions have been associated with adverse outcomes and elevated financial costs to patients, families, and hospitals across the United States. Historically, nearly 20% of all Medicare discharges had a readmission within 30 days. In an effort to address this issue, the Affordable Care Act (ACA) established the Hospital Readmission Reduction Program (HRRP) in 2012 to positively influence readmissions associated with acute myocardial infarction, chronic obstructive pulmonary disease, heart failure, pneumonia, coronary artery bypass graft surgery, and total hip and/or knee arthroplasty. However, as recently as 2018, there were still 3.8 million 30-day all-cause adult hospital readmissions, with a 14% readmission rate and an average readmission cost of $15,200. The ACA also produced the Hospital Value-Based Purchasing (HVBP) program with the stated intent to (1) reduce mortality and complications, (2) reduce healthcare-associated infections, (3) increase patient safety, (4) improve the patient experience, and (5) increase efficiency and reduce costs. Given the costs and quality implications of an average readmission, it is logical to believe that HVBP eligible hospitals are simultaneously seeking to meet the goals of both programs. However, to date, no studies have examined if that is the case. Thus, in this study, we seek to determine if HVBP eligible hospitals are associated with a reduction in the core set of HRRP readmission rates better than the facilities that are not eligible for the HVBP program.MethodsHospital-level data from calendar year 2019 for 3,276 short-term acute care hospitals in the United States were evaluated using multivariate regression analysis to examine the readmission rate performance between 2,719 HVBP eligible hospitals and 557 ineligible hospitals.ResultsOur six separate multivariable linear regressions revealed a statistically significant and positive association between HVBP participation and readmission rates after controlling for numerous organizational, clinical complexity, and environmental factors. In each case, the magnitude of the positive directional association is moderate, ranging from and increase of +0.19% (pneumonia readmissions) to as high as +0.37% (all cause readmissions) for HVBP eligible hospitals. When considered in the context of the average number of discharges in our data set (x- = 9570), a third of a percent increase from the average 15.56% all cause readmissions to 16.08% in HVBP eligible hospitals equates to 50 additional readmissions annually (9570 × 15.56% = 1,489 vs 9570 × 16.08% = 1,539). At an average cost of $15,200 per readmission, which equates to an average additional cost to the average HVBP eligible hospital in excess of $760,000.DiscussionThe fact that there is a positive association between HVBP participating hospitals and readmissions at all, and that the same effect appears to be persistent across all dependent measures is concerning. One would logically expect hospitals that are focused on quality-based care to thoroughly care for individuals in order for them to not be readmitted to the hospital. The results provided do not necessarily prove that either program is not working. But they also do not confirm that the HVBP and HRRP programs are working together and accomplishing what they were originally designed to do: improve patient care and lower health-care costs.

A Season for PALTC: Improving Quality, Increasing Transparency, and Strengthening Our Workforce

A Season for PALTC: Improving Quality, Increasing Transparency, and Strengthening Our Workforce

Current PROM and PREM use in health system performance measurement: Still a way to go

There is a growing impetus to “measure what matters” to enable health systems to optimise value-based, person-centred healthcare. This paper describes the critical importance of patient-reported outcome and experience measures (PROMs and PREMs) in this pursuit and provides an in-depth overview of how PROM and PREM programs differ between England, the United States, and Australia. A comprehensive timeline of PROM, PREM, legislation/policy, and value-based purchasing (pay-for-performance) program implementation accompanies this discussion. Importantly, this paper highlights disparities between these nations’ PROMs and PREMs programs, evidencing that we still have a way to go towards equal health system performance measurement globally. Experience Framework This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens.

Inclusive purchasing and supply chain resilience capabilities: Lessons for social sustainability

In the face of unexpected changes in their dynamic business environment, purchasing and supply chain (SC) managers have been challenged to boost SC resilience while maintaining their sustainability concerns. In this changing environment, this paper aims to explore: (1) how (social) sustainability affects SC resilience and (2) what the role of purchasing is for SC resilience. Through a dynamic capability view as the theoretical lens, we investigate whether and how an inclusive purchasing programme could enhance SC resilience capabilities to cope with the Covid-19 outbreak. We developed a Case study with various SC members of a multinational cosmetics company that, despite suffering from a sudden demand disruption during the outbreak, maintained its sustainability actions. The results show that four operational SC resilience capabilities were amplified: ‘visibility’, ‘adaptability’, ‘collaboration’ and ‘financial strength’. In addition, a new capability entitled ‘empowerment’ was mobilised during this period. These factors helped the inclusive purchasing maintenance and were essential to supporting social sustainability. In addition, our results show that sustainable PSM, which is overlooked in the literature, is key for SC resilience. This article contributes to theory and practice because it demonstrates the role and relevance of (inclusive) purchasing in a company's ability to cope with SC disruptions, such as those resulting from the outbreak.

The effect of Eurosystem asset purchase programmes on euro area sovereign bond yields during the COVID-19 pandemic.

We investigate the effect of Eurosystem asset purchase programmes (APP) on the monthly yields of 10-year sovereign bonds for 11 euro area sovereigns during January–December 2020. The analysis is based on time-varying coefficient methods applied to monthly panel data covering the period 2004m09–2020m12. During 2020, APP contributed to an average decline in yields estimated in the range of 58–76 bps. In December 2020, the effect per EUR trillion ranged between 34 bps in Germany and 159 bps in Greece. Stronger effects generally display diminishing returns. Our findings suggest that a sharp decline in the size of the APP in the aftermath of the COVID-19 crisis could lead to very sharp increases in bond yields, particularly in peripheral countries. The analysis additionally reveals a differential response to global risks between core and peripheral countries, with the former enjoying safe-haven benefits. Markets’ perceptions of risk are found to be significantly affected by credit ratings, which is in line with recent evidence based on constant parameter methods.

Beyond the interest rate pass-through: monetary policy and banks interest rates since the effective lower bound

ABSTRACT We investigate whether ECB monetary policy influences the retail interest rates in the Euro Area when the policy rate reaches the effective lower bound. We estimate a panel Error Correction Model that accounts for potential heterogeneities in the transmission of monetary policy. The analysis disentangles alternative balance-sheet policies implemented by the ECB. We find that unconventional measures have influenced banking interest rates beyond the pass-through of the current and expected policy rate. These effects are driven by liquidity provisions and by the covered bond purchase programmes. Those policies have been effective in the core and in the peripheral countries; however, the effect of purchases of covered-bond has been stronger in the periphery.

Bias in Patient Experience Scores in Radiation Oncology: A Multicenter Retrospective Analysis.

Patient experience scores are increasingly important in measuring quality of care and determining reimbursement from payers, including the Hospital Value-Based Purchasing Program and the Radiation Oncology Model. However, the role of bias in patient experience scores in oncology is unknown, raising the possibility that such payment structures may inadvertently perpetuate bias in reimbursement. Therefore, the authors characterized patient-, physician-, and practice-level predictors of patient experience scores in patients undergoing radiation therapy. The authors retrospectively reviewed patient experience surveys for radiation oncology patients treated at two large multisite academic cancer centers. The outcome was responses on four survey questions. Covariates included self-reported patient demographics, physician characteristics, practice setting characteristics, and wait-time rating linked to each survey. Multivariable ordinal regression models were fitted to identify predictors of receiving a higher score on each of the survey questions. In total, 2,868 patients completed surveys and were included in the analysis. Patient experience scores were generally high, with >90% of respondents answering 5 of 5 on the four survey items. Physician gender was not associated with any measured patient experience outcomes (P > 0.40 for all). Independent predictors of higher score included a wait-time experience classified as "good" compared with "not good" (q < .001 for all). Oncology practices aiming to improve patient experience scores may wish to focus their attention on improving wait times for patients. Although a difference in patient experience scores on the basis of physician gender was not observed, such bias is likely to be complex, and further research is needed to characterize its effects.

The ECB’s Unconventional Monetary Policy Measures During the Coronavirus Crisis

The objective of the paper is to analyze the key measures of unconventional monetary policy implemented by the European Central Bank (ECB) in response to the coronavirus crisis. The paper focuses on the introduction of the Pandemic emergency purchase programme (PEPP), but also on the adoption of more favorable conditions for refinancing operations and the introduction of additional Targeted longer-term refinancing operations (TLTROs). The ECB’s key interest rates are maintained at their present or lower levels, depending on the inflation outlook in the euro area. The research methodology in the paper includes theoretical and methodological analysis, comparative study, descriptive analysis, empirical study and critical analysis. The paper concludes with summarizing the results from the study.

Preventing re-admission: Are general practitioners the solution?

In the United States the Hospital Readmissions Reduction Program (HRRP) is a Medicare value-based purchasing program that encourages hospitals to improve communication and care coordination to better engage patients and caregivers in discharge plans and, in turn, reduce avoidable readmissions [ [1] Centers for Medicare and Medicaid Services. Value based programs. Hospital Readmissions Reduction Program (HRRP). https://www. cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/Value-Based-Programs/HRRP/Hospital-ReadmissionReduction-Program. Accessed February 21, 2022. Google Scholar ]. The program supports the national goal of improving health care for Americans by linking payment to the quality of hospital care. The Centers for Medicare & Medicaid Service (CMS) includes the following six condition or procedure-specific 30-day risk-standardized unplanned readmission measures in the program: Acute Myocardial Infarction, Chronic Obstructive Pulmonary Disease, Heart Failure, Pneumonia, Coronary Artery Bypass Graft Surgery, Elective Primary Hip and/or Total Knee Arthroplasty. In this issue of the Journal, John et al attempts through a prospective observational cohort study to address the issue of unplanned hospital readmission by using post discharge consultation with either general practitioners (GPs), specialist physicians or none. This study is part of phase 1 of the TARGET-READ study (Transition cAre inteRvention targeted to hiGh risk patiEnts To Reduce rEADmissions; clincialtrials.org NCTO3496896) [ [2] John G. Payrard L. Donzé J. Associations between post-discharge medical consultations and 30-day unplanned hospital readmission: A prospective observational cohort study. Eur J Intern Med. 2022; 99: 57-62https://doi.org/10.1016/j.ejim.2022.01.013 Abstract Full Text Full Text PDF Scopus (1) Google Scholar ]. Associations between post-discharge medical consultations and 30-day unplanned hospital readmission: A prospective observational cohort studyEuropean Journal of Internal MedicineVol. 99PreviewEarly readmission after hospital discharge is frequent, partly preventable, and puts a heavy burden on healthcare systems [1,2]. Many risk factors—like adverse drug events [3], physician workload [4], patients’ comorbidities [5]—and the internationally validated HOSPITAL score for 30-day potentially avoidable readmission [6] can be assessed directly during the hospital stay. However, physiological stresses experienced during hospitalization extend beyond discharge, resulting in a period of increased vulnerability [7]. Full-Text PDF Open Access

The past, present and future of euro area monetary-fiscal interactions

The EU’s Treaties were designed to limit the interaction between fiscal and monetary policies. However, over the last decade, the introduction of the ECB’s Outright Monetary Transactions (OMT) programme and its sovereign bond purchase programmes has created some strong linkages between monetary and fiscal policies in the Eurosystem. The ECB’s monetary policies have improved fiscal debt sustainability and reduced the probability of sovereign default. However, there may need to be limits to the ECB’s purchases of sovereign bonds. This paper discusses the interactions between fiscal and monetary policies in the euro area and describes how the arguments raised by the European Court of Justice in the Weiss and Gauweiler cases suggest there may be hard limits on the size of the Eurosystem’s sovereign bond holdings. These limits may undermine the positive impact of the OMT announcement and force the ECB into some difficult choices in the coming years.

Is Skilled Nursing Facility Financial Status Related to Readmission Rate Improvement?

We examined whether higher skilled nursing facility (SNF) lagged profitability is associated with a lower 30-day all-cause all-payer risk-adjusted hospital readmission rate. Our aim was to provide insight into whether SNFs with limited financial resources are able to respond to incentives to lower their readmission rates to hospitals. We used data from 2012-2016 to estimate a fixed effects (FE) model with a time trend. Our data included financial data from the Centers for Medicare & Medicaid Services Healthcare Cost Report Information System SNF cost reports, facility characteristics including the all-cause all-payer risk-adjusted unplanned 30-day readmission rate from the LTCFocus (Long-Term Care Focus) project at Brown University, and county-level market variables from the Area Health Resource File. We also examined the relationship for a shorter time frame (2012-2015) after stratifying the sample by system membership or ownership. SNFs with an increase in the lagged operating margin showed a statistically significant, small decrease (<.01 percentage point) in the risk-adjusted readmission rate. The results were robust for different time periods and model specifications. Fixed effects model estimates for SNFs in the highest quartile of percentage of Medicaid patients (≥73.9%) had a lagged operating margin coefficient that is almost four times as large as the coefficient of the FE model with all SNFs. SNFs have an important role in achieving the national priority of reducing hospital readmissions. The study findings suggest that managers of SNFs should not see low profitability as an obstacle to reducing readmission rates, which is good news given the low average profitability of SNFs. Further, reductions in profitability due to penalties incurred from the recently implemented Medicare Skilled Nursing Facility Value-Based Purchasing Program may not limit SNFs' ability to lower hospital readmission rates, at least initially. However, policymakers may need to determine whether additional resources to high Medicaid SNFs can lower readmission rates for these SNFs.

Skilled Nursing Facility Performance and Readmission Rates Under Value-Based Purchasing

The new Medicare Skilled Nursing Facility Value-Based Purchasing program (SNF VBP) seeks to improve patient outcomes by awarding financial incentives or penalties based on 30-day hospital readmission rates. Skilled nursing facilities (SNFs) can avoid a penalty through low baseline readmission rates or improvement over time. To assess the baseline performance and improvement over time of SNFs in the SNF VBP program. This cross-sectional study examined readmission rates, financial penalties and incentives, and facility and patient characteristics associated with these outcomes at 14 959 US SNFs that received Medicare payments between January 1, 2015, and December 31, 2019. Outcomes were readmission rates and financial penalties by facility. The SNFs were classified as improvers in the analysis if they had better improvement scores than baseline scores under the program and achievers if they had higher baseline scores than improvement scores. Of 14 959 SNFs studied, 1849 (12.3%) were assigned their improvement score as their performance score in the first year of the program. Of these, 1167 (63.1%) received a financial penalty, whereas 374 (20.2%) received a bonus. Only 52 facilities that performed poorly at baseline (0.3% of all SNFs and 0.7% of below-median performers) were able to improve enough to avoid a financial penalty, despite large improvements in readmission rates. Improver SNFs treated larger racial minority populations (mean [SD], 74.57% [23.42%] White in the improver group vs 79.15% [22.18%] in the achiever group) and were located in counties with larger minority populations (mean [SD], 15.48% [14.05%] Black in the improver group vs 11.57% [12.72%] Black in the achiever group). The most important predictors of improvement were related to SNF finances, such as operating margin (mean [SD], -0.74 [13.87]) and occupancy rates (mean [SD], 79.93 [14.81]). This cross-sectional study suggests that the SNF VBP program did not offer a viable path for nearly all low-performing SNFs to avoid financial penalties through improved readmission rates.

The credibility of monetary policy and the fiscal response to the pandemic in the Eurozone

The novel nature of the economic and social crisis, due to the spread of COVID-19, requires new rules and a drastic change in the economic measures to be adopted. The pandemic has caused a spiral of supply–demand shocks that brings about several market failures that make necessary a public intervention to assure the return to health security in the first place and then to restore economic growth and reduce unemployment. Fiscal policy has to intervene both to cover health expenses and sustain families’ income and firms’ fixed costs, and to create the basis for a future recovery through investment. To guarantee the stability of the resulting higher public debt, expansionary monetary policies have been implemented even in a non-conventional way. In the euro area, among other measures, a pandemic emergency purchase programme (PEPP) has been adopted, through which the European Central Bank (ECB) has been buying temporarily existing public debt on the secondary market. We ask whether the ECB should go even further monetising permanently on the primary markets the public debt of euro area countries or relieving a fraction of the debt that they are currently holding. An alternative possibility would be the issuance of perpetual bonds to be bought by the central bank. Needless to say, such measures are rather controversial, not only considering their political feasibility, but also for the feared effects on the central bank’s anti-inflationary credibility and on moral hazard. We argue that a sufficiently strong political will might help overcoming the objection regarding feasibility. Central bank’s anti-inflationary credibility may not necessarily be a concern: according to the credibility theory, in the case of unexpected shocks, no credibility can be gained by following policies that are not credible themselves. On the other hand, moral hazard cannot be an issue when a given measure is fully justified by the occurrence of extraordinary circumstances. Finally, we show that when the economy is hit by a stochastic shock, a moderate inflation might well be optimal, as it would allow a reduction of the unemployment rate.

From the Great Recession to the COVID-19 Pandemic: The Risk of Expansionary Monetary Policies

Central banks have been pursuing an expansionary monetary policy since before the pandemic, although the health and economic crisis of COVID-19 has boosted asset purchase programmes. After the Great Recession, a new phase began, characterised by low interest rates and liquidity injections. These policies spilled over into financial markets and are leading to higher inflation. These policies stabilised the situation in the short term, but if they continue indefinitely there is a risk of debt overhang, investment mistakes and high inflation in the future. The aim of this article is to analyse monetary policy developments from the Great Recession to the COVID-19 crisis. Correlations between different macroeconomic variables will be shown through IBM SPSS Statistics. For this purpose, bi-variate correlations were used. For the predictions and confidence of the model data, Tableau Desktop Edition was used, which in turn was used for the generation of the graphs. There is a strong correlation between the growth of monetary aggregates and public debt and stock market capitalisation for the selected indicators. The main contribution of this research is the analysis of the long-term effects of a monetary policy.

Future Policy Award 2018: The Good Food Purchasing Program, USA

Adopted first by the City of Los Angeles in 2012, the Good Food Purchasing Program® creates a transparent supply chain and helps institutions to measure and then make shifts in their food purchases. It is the first procurement model to support five food system values—local economies, environmental sustainability, valued workforce, animal welfare and nutrition—in equal measure and thereby encourages myriad organizations to come together to engage for shared goals. Within just six years, the Good Food Purchasing Program has catalyzed a nationwide movement to establish similar policies in localities small and large across the United States, and inspired the creation of the Center for Good Food Purchasing. First adopted by the City of Los Angeles in 2012, it is a procurement standard that offers institutions a system in which current investments toward food are redirected toward more sustainable and fair suppliers. It uses a metric-based, flexible framework that produces a star rating. The Good Food Purchasing Program promotes the purchase of more sustainably produced food, from local economies, especially smaller and mid-sized farms and other food processing operations, which results in production returns at a more regional and local level, and ensures that suppliers' workers are offered safe and healthy working conditions and fair compensation, that livestock receives healthy and humane care, and that consumers—foremost school children, patients, the elderly—enjoy better health and well-being as a result of higher quality nutritious meals. This article will detail its implementation since 2012, provide current information on the impacts the Program has had on the agroecology of regions in the US food system, and recommendations for policy changes that could catalyze more accelerated impact.

A Dynamic Analysis of the Bank of Japan's ETF/REIT Purchase Program

A Dynamic Analysis of the Bank of Japan's ETF/REIT Purchase Program

The Impact of the Public Sector Purchasing Program on Lending Volumes and Credit Perceptions Among SMEs

The Impact of the Public Sector Purchasing Program on Lending Volumes and Credit Perceptions Among SMEs