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The Congressional Budget Office is a federal agency within the legislative branch of the United States government that provides budget and economic information to Congress.The CBO was created as a nonpartisan agency by the Congressional Budget and Impoundment Control Act of 1974. Wikipedia.

Staiger D.O.,Dartmouth College | Staiger D.O.,National Bureau of Economic Research | Auerbach D.I.,Congressional Budget Office | Buerhaus P.I.,Vanderbilt University
JAMA - Journal of the American Medical Association | Year: 2010

Context: Recent trends in hours worked by physicians may affect workforce needs but have not been thoroughly analyzed. Objectives: To estimate trends in hours worked by US physicians and assess for association with physician fees. Design, Setting, and Participants: Aretrospective analysis of trends in hours worked among US physicians using nationally representative workforce information from the US Census Bureau Current Population Survey between 1976 and 2008 (N=116 733). Trends were estimated among all US physicians and by residency status, sex, age, and work setting. Trends in hours were compared with national trends in physician fees, and estimated separately for physicians located in metropolitan areas with high and low fees in 2001. Main Outcome Measure: Self-reported hours worked in the week before the survey. Results: After remaining stable through the early 1990s, mean hours worked per week decreased by 7.2% between 1996 and 2008 among all physicians (from 54.9 hours per week in 1996-1998 to 51.0 hours per week in 2006-2008; 95% confidence interval [CI], 5.3%-9.0%; P<.001). Excluding resident physicians, whose hours decreased by 9.8% (95% CI, 5.8%-13.7%; P<.001) in the last decade due to duty hour limits imposed in 2003, nonresident physician hours decreased by 5.7% (95% CI, 3.8%-7.7%; P<.001). The decrease in hours was largest for nonresident physicians younger than 45 years (7.4%; 95% CI, 4.7%-10.2%; P<.001) and working outside of the hospital (6.4%; 95% CI, 4.1%-8.7%; P<.001), and the decrease was smallest for those aged 45 years or older (3.7%; 95% CI, 1.0%-6.5%; P=.008) and working in the hospital (4.0%; 95% CI, 0.4%-7.6%; P=.03). After adjusting for inflation, mean physician fees decreased nationwide by 25% between 1995 and 2006, coincident with the decrease in physician hours. In 2001, mean physician hours were less than 49 hours per week in metropolitan areas with the lowest physician fees, whereas physician hours remained more than 52 hours per week elsewhere (P<.001 for difference). Conclusion: A steady decrease in hours worked per week during the last decade was observed for all physicians, which was temporally and geographically associated with lower physician fees. ©2010 American Medical Association. All rights reserved.

Stocking A.,Congressional Budget Office
Journal of Environmental Economics and Management | Year: 2012

Price controls established in a cap-and-trade allowance market are intended to reduce cost uncertainty by constraining allowance prices between a ceiling and floor; however, they could provide opportunities for strategic actions by firms that would lower government revenue and increase emissions. In particular, when the ceiling price is supported by introducing new allowances into the market, firms could choose to buy allowances at the ceiling price, regardless of the prevailing market price, in order to lower the equilibrium price of all allowances. Those purchases could either be transacted by firms intending to manipulate the market price or be induced through the introduction of inaccurate information about the cost of emissions abatement. Theory and simulations using allowance elasticity estimates for U.S. firms suggest that the manipulation could be profitable under the stylized setting and assumptions evaluated in the paper, although in practice many other conditions will determine its use. © 2011 .

Patel V.,United Information Technology | Jamoom E.,National Center for Health Statistics | Hsiao C.-J.,National Center for Health Statistics | Furukawa M.F.,United Information Technology | Buntin M.,Congressional Budget Office
Journal of General Internal Medicine | Year: 2013

BACKGROUND: Federal initiatives are underway that provide physicians with financial incentives for meaningful use (MU) of electronic health records (EHRs) and assistance to purchase and implement EHRs. OBJECTIVE: We sought to examine readiness and interest in MU among primary care physicians and specialists, and identify factors that may affect their readiness to obtain MU incentives. DESIGN/PARTICIPANTS: We analyzed 4 years of data (2008-2011) from the National Ambulatory Medical Care Survey (NAMCS) Electronic Medical Record (EMR) Supplement, an annual cross-sectional nationally representative survey of non-federally employed office-based physicians. MAIN MEASURES: Survey-weighted EHR adoption rates, potential to meet selected MU criteria, and self-reported intention to apply for MU incentives. We also examined the association between physician and practice characteristics and readiness for MU. KEY RESULTS: The overall sample consisted of 10,889 respondents, with weighted response rates of 62 % (2008); 74 % (2009); 66 % (2010); and 61 % (2011). Primary care physicians' adoption of EHRs with the potential to meet MU nearly doubled from 2009 to 2011 (18 % to 38 %, p < 0.01), and was significantly higher than specialists (19 %) in 2011 (p < 0.01). In 2011, half of physicians (52 %) expressed their intention to apply for MU incentives; this did not vary by specialty. Multivariate analyses report that EHR adoption was significantly higher in both 2010 and 2011 compared to 2009, and primary care physicians and physicians working in larger or multi-specialty practices or for HMOs were more likely to adopt EHRs with the potential to meet MU. CONCLUSIONS: Physician EHR adoption rates increased in advance of MU incentive payments. Although interest in MU incentives did not vary by specialty, primary care physicians had significantly higher rates of adopting EHRs with the potential to meet MU. Addressing barriers to EHR adoption, which may vary by specialty, will be important to enhancing coordination of care. © 2013 Society of General Internal Medicine.

Hayford T.B.,Congressional Budget Office
Health Services Research | Year: 2012

Objective To analyze the impact of hospital mergers on treatment intensity and health outcomes. Data Hospital inpatient data from California for 1990 through 2006, encompassing 40 mergers. Study Design I used a geographic-based IV approach to determine the effect of a zip code's exposure to a merger. The merged facility's market share represents exposure, instrumented with combined premerge shares. Additional specifications include Herfindahl Index (HHI), instrumented with predicted change in HHI. Results The primary specification results indicate that merger completion is associated with a 3.7 percent increase in the utilization of bypass surgery and angioplasty and a 1.7 percent increase in inpatient mortality above averages in 2000 for the average zip code. Isolating the competition mechanism mutes the treatment intensity result slightly, but it more than doubles the merger exposure effect on inpatient mortality to a 3.9 percent increase. The competition mechanism is associated with a sizeable increase in number of procedures. Conclusions Unlike previous studies, this analysis finds that hospital mergers are associated with increased treatment intensity and higher inpatient mortality rates among heart disease patients. Access to additional outcome measures such as 30-day mortality and readmission rates might shed additional light on whether the relationship between these outcomes is causal. © Health Research and Educational Trust.

Goldberg M.S.,Congressional Budget Office
Military Medicine | Year: 2010

In the first 6.5 years of Operation Iraqi Freedom (OIF), U.S. military casualties exceeded 3,400 hostile deaths, 800 nonhostile deaths (due to disease, nonbattle injury, and other causes), and over 31,000 troops wounded in action. Casualty rates in Iraq have been considerably lower that during the Vietnam conflict, and a greater proportion of troops wounded in Iraq survive their wounds. Before the surge in troop levels that began in early 2007, the survival rate was 90.4% in Iraq as compared to 86.5% in Vietnam. Wounded-in-action rates increased during the fi rst few months of the surge, but declined below presurge levels after the number of U.S. brigades in Iraq climbed from 15 to its maximum level of 20. Wounds during the surge were somewhat more lethal than previously, but because there were fewer wounding incidents the net effect was a reduction in the hostile death rate.

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