Medical Device Firm Payments To Physicians Exceed What Drug Companies Pay Physicians And Target Specialties, with Matthew Grennan and Ashley Swanson, Health Affairs (2021)
The Role of Schedule Volatility in Home Health Nursing Turnover, with Hummy Song, Guy David, Joanne Spetz, and Molly Candon, Medical Care Research and Review (2021)
Telemedicine catches on: Changes in the utilization of telemedicine services during the COVID-19 pandemic, with Ari Friedman, Hummy Song, Stephanie Gervasi, Amy Bond, Angela Chen, Guy David, Julie Bailey, and Aaron Smith-McLallen, American Journal of Managed Care (Forthcoming)
Disruptions in Preventive Care: Mammograms During the COVID-19 Pandemic, with Hummy Song, Angela Chen, Daniel Ellis, Guy David, Ari Friedman, Amy Bond, Julie Bailey, Ronald Brooks, and Aaron Smith-McLallen, Health Services Research (2020)
[JOB MARKET PAPER I] "I Quit": The Role of Schedule Volatility in Employee Turnover, with Hummy Song and Guy David (under review)
We examine how employer-driven volatility in workers' schedules impacts their decision to voluntarily leave their job. Using novel time-stamped work log data of salaried home health nurses, we construct a measure of schedule volatility that can be easily implemented by firms. This measure may be endogenous to the worker's decision to quit. We instrument for schedule volatility using time off taken by other workers at the same office, which exogenously increases schedule volatility for all remaining workers. We find that a single 30-day period of high schedule volatility (defined as one standard deviation above the average level of schedule volatility) increases the average worker's probability of quitting that year by approximately 25%. Our results are robust to different measures of schedule volatility and model specifications. Through policy simulations, we illustrate how schedule volatility, and in turn, employee turnover, could be mitigated.
Lobbying Physicians: Payments from Industry and Hospital Spending on Medical Devices, with Matthew Grennan and Ashley Swanson
We draw upon newly merged administrative data sets to study the relationship between payments from medical technology firms to physicians and medical device spending. Because medical device sales representatives tend to have significant domain and product expertise, these payments (and the interactions that accompany them) may facilitate the transfer of valuable information to physicians, but at the potential cost of also inducing bias in treatment decisions. Payments are pervasive: 93 percent of device sales in our sample occur at a hospital where a related surgeon has received a payment. Payments are also highly correlated with spending at the firm-hospital level. Using rich fixed effects and instrumental variable estimators, we find elasticities of spending with respect to payments substantially larger than those in similar studies of pharmaceutical manufacturer payments.
Missing in Action: Military Research in the Medical Literature, with Jeremy W. Cannon and Todd E. Rasmussen (submitted)
So Long, and Thanks for All the Meals: Physician Prescribing After Detailing Stops [paper]
I provide estimates of the causal effects of payments from pharmaceutical companies on the prescribing habits of Medicare Part D physicians. Identifying the causal effects of payments associated with pharmaceutical "detailing" (marketing to physicians) is confounded by dynamic selection in and out of payment assignment by the drug producer. I employ a novel identification strategy which uses exogenous variation in brand-related payments due to pharmaceutical producers undergoing acquisitions by other firms. The analysis focuses on aminosalicylates, the drug class used to treat inflammatory bowel disease, and finds that stopping payments to a physician reduces the probability that she will prescribe any drug from the aminosalicylates class by around 5 percentage points. Decomposing payment effects to persistent and temporary components, I find that at most 50 percent of brand-specific effects and 80 percent of class-specific effects are persistent. Payment effects in other drug classes seem to exhibit similar patterns.
Strategic Pricing and Competitive Procurement in the Physician Services Market, with Guy Arie and Gerard J. Wedig [paper]
We propose and test a model of the strategic interaction between public and private insurers in the physician services market. We depart from the standard healthcare service pricing model and allow physicians to (partially) adjust patient access based on price differences between insurers. Analysis of private and public sector insurer prices and public sector quantities supports the hypothesis that physicians respond to insurer price differences: A 10% increase in private prices decreases public beneficiaries’ share of physician services by 4%, equivalent to a per capita decrease of 1%-14% in services per public beneficiary, ceteris paribus.
I estimate the effects of interscholastic athletic competitions on student performance in public high schools in Texas. I use discontinuities in assignments of schools to interscholastic athletic conferences to identify these effects, and utilize the dynamic RD estimator developed by Cellini et al. (2010) to overcome identification challenges resulting from persistent conference assignments. I find that increased levels of competition have an adverse effect on student performance, with school average ACT scores decreasing by 1.4 percent and rate of students passing the TAKS exam dropping by 3 percentage points. Potential effect mediators are discussed and analyzed.
Works in Progress
Social Distancing and Social Cost: Regional Heterogeneity and Optimal Policy Responses to Secondary COVID-19 Outbreaks, with Stuart Craig [abstract]
Identifying Sorting Into Echo Chambers, with Dionissi Aliprantis and Gregorio Caetano