76 FR 39006 - Medicare Program; Hospital Inpatient Value-Based Purchasing Program; Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-05

... Pneumonia (PN) 30-Day .8818 Mortality Rate. 7. On page 26516, Table 7 is corrected to read as follows... Day Mortality Rate. MORT-30 PN Pneumonia (PN) 30-Day .9021 Mortality Rate. 8. On page 26527, in the...

Hospital Value-Based Purchasing Performance: Do Organizational and Market Characteristics Matter?

PubMed

Spaulding, Aaron; Edwardson, Nick; Zhao, Mei

The hospital value-based purchasing (HVBP) program of the Centers for Medicare & Medicaid Services challenges hospitals to deliver high-quality care or face a reduction in Medicare payments. How do different organizational structures and market characteristics enable or inhibit successful transition to this new model of value-based care? To address that question, this study employs an institutional theory lens to test whether certain organizational structures and market characteristics mediate hospitals' ability to perform across HVBP domains.Data from the 2014 American Hospital Association Annual Survey Database, Area Health Resource File, the Medicare Hospital Compare Database, and the association between external environment and hospital performance are assessed through multiple regression analysis. Results indicate that hospitals that belong to a system are more likely than independent hospitals to score highly on the domains associated with the HVBP incentive arrangement. However, varying and sometimes counterintuitive market influences bring different dimensions to the HVBP program. A hospital's ability to score well in this new value arrangement may be heavily based on the organization's ability to learn from others, implement change, and apply the appropriate amount of control in various markets.

Mandatory bundled payment getting into formation for value-based care.

PubMed

Fink, John

2015-10-01

Succeeding under Medicare's enterprise Comprehensive Care for Joint Replacement Model will require collaboration among caregivers and financial arrangements to align incentives Priorities for most organization's transition to becoming a value-based hospitals will be care redesign, supply-purchasing strategy, and post-acute care provider partnering. Pursuing value for your joint replacement program will chart a path for other service lines and lead your organization's transition to becoming a value-based enterprise.

Safety-net hospitals more likely than other hospitals to fare poorly under Medicare's value-based purchasing.

PubMed

Gilman, Matlin; Adams, E Kathleen; Hockenberry, Jason M; Milstein, Arnold S; Wilson, Ira B; Becker, Edmund R

2015-03-01

Medicare's value-based purchasing (VBP) program potentially puts safety-net hospitals at a financial disadvantage compared to other hospitals. In 2014, the second year of the program, patient mortality measures were added to the VBP program's algorithm for assigning penalties and rewards. We examined whether the inclusion of mortality measures in the second year of the program had a disproportionate impact on safety-net hospitals nationally. We found that safety-net hospitals were more likely than other hospitals to be penalized under the VBP program as a result of their poorer performance on process and patient experience scores. In 2014, 63 percent of safety-net hospitals versus 51 percent of all other sample hospitals received payment rate reductions under the program. However, safety-net hospitals' performance on mortality measures was comparable to that of other hospitals, with an average VBP survival score of thirty-two versus thirty-one among other hospitals. Although safety-net hospitals are still more likely than other hospitals to fare poorly under the VBP program, increasing the weight given to mortality in the VBP payment algorithm would reduce this disadvantage. Project HOPE—The People-to-People Health Foundation, Inc.

76 FR 2453 - Medicare Program; Hospital Inpatient Value-Based Purchasing Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-13

... requirements under the Hospital IQR program in the FY 2006 IPPS final rule (70 FR 47420). C. Hospital Inpatient... it was amended by section 3001(a)(2)(C) of the Affordable Care Act, required that the Secretary... discharge of 1%, as required by section 1886(o)(7). Section 1886(o)(1)(C) provides that the Hospital VBP...

7 CFR 1485.23 - Miscellaneous provisions.

Code of Federal Regulations, 2012 CFR

2012-01-01

...., participation fees, proceeds of sales, refunds of value added taxes (VAT), the expenditures for which have been... goods with a value of $100 acquired in furtherance of program activities. The inventory shall list and number each item and include the date of purchase or acquisition, cost of purchase, replacement value...

40 CFR 312.29 - The relationship of the purchase price to the value of the property, if the property was not...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 27 2010-07-01 2010-07-01 false The relationship of the purchase price... COMMUNITY RIGHT-TO-KNOW PROGRAMS INNOCENT LANDOWNERS, STANDARDS FOR CONDUCTING ALL APPROPRIATE INQUIRIES Standards and Practices § 312.29 The relationship of the purchase price to the value of the property, if the...

Demographic and psychographic associations of consumer intentions to purchase healthier food products.

PubMed

Burton, Melissa; Wang, Wei Chun; Worsley, Anthony

2015-01-01

This study investigated the associations of nutrition concerns, demographics, universalism (community oriented) values, perceived control over personal health and food buying, and perceived influence over the food system with intentions to purchase low fat, sugar and salt (LFSS) food products. A national online survey of 2204 Australian consumers administered in November 2011. Structural equation modeling was used to examine associations of LFSS purchasing intentions with demographic, values, perceived control, and influence factors. Nutrition concern, perceived influence over the food system, and universalism values were key predictors of LFSS purchasing intentions. Almost two thirds (64.6%) of the variance associated with LFSS purchasing was explained by the structural equation model. Communication programs which focus on universalism values, nutrition concern and perceived influence over the food system are likely to increase LFSS purchasing and perhaps reduce the demand for energy dense, nutrient poor foods.

Demographic and psychographic associations of consumer intentions to purchase healthier food products

PubMed Central

Burton, Melissa; Wang, Wei Chun; Worsley, Anthony

2014-01-01

Objective This study investigated the associations of nutrition concerns, demographics, universalism (community oriented) values, perceived control over personal health and food buying, and perceived influence over the food system with intentions to purchase low fat, sugar and salt (LFSS) food products. Methods A national online survey of 2204 Australian consumers administered in November 2011. Structural equation modeling was used to examine associations of LFSS purchasing intentions with demographic, values, perceived control, and influence factors. Results Nutrition concern, perceived influence over the food system, and universalism values were key predictors of LFSS purchasing intentions. Almost two thirds (64.6%) of the variance associated with LFSS purchasing was explained by the structural equation model. Conclusion Communication programs which focus on universalism values, nutrition concern and perceived influence over the food system are likely to increase LFSS purchasing and perhaps reduce the demand for energy dense, nutrient poor foods. PMID:26844047

Measuring Value in Internal Medicine Residency Training Hospitals Using Publicly Reported Measures.

PubMed

Schickedanz, Adam; Gupta, Reshma; Arora, Vineet M; Braddock, Clarence H

2018-03-01

Graduate medical education (GME) lacks measures of resident preparation for high-quality, cost-conscious practice. The authors used publicly reported teaching hospital value measures to compare internal medicine residency programs on high-value care training and to validate these measures against program director perceptions of value. Program-level value training scores were constructed using Centers for Medicare & Medicaid Services Value-Based Purchasing (VBP) Program hospital quality and cost-efficiency data. Correlations with Association of Program Directors in Internal Medicine Annual Survey high-value care training measures were examined using logistic regression. For every point increase in program-level VBP score, residency directors were more likely to agree that GME programs have a responsibility to contain health care costs (adjusted odds ratio [aOR] 1.18, P = .04), their faculty model high-value care (aOR 1.07, P = .03), and residents are prepared to make high-value medical decisions (aOR 1.07, P = .09). Publicly reported clinical data offer valid measures of GME value training.

Outcomes of a randomized controlled trial of nutrition education to promote farmers' market fruit and vegetable purchases and consumption among women enrolled in the Special Supplemental Nutrition Program for Women, Infants,

USDA-ARS?s Scientific Manuscript database

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides participants seasonal Farmers' Market Nutrition Program (FMNP) vouchers to purchase fruits and vegetables (FV) at farmers' markets and monthly cash value vouchers (CVV) redeemable at farmers' markets. Despite ...

Expected value based fuzzy programming approach to solve integrated supplier selection and inventory control problem with fuzzy demand

NASA Astrophysics Data System (ADS)

Sutrisno; Widowati; Sunarsih; Kartono

2018-01-01

In this paper, a mathematical model in quadratic programming with fuzzy parameter is proposed to determine the optimal strategy for integrated inventory control and supplier selection problem with fuzzy demand. To solve the corresponding optimization problem, we use the expected value based fuzzy programming. Numerical examples are performed to evaluate the model. From the results, the optimal amount of each product that have to be purchased from each supplier for each time period and the optimal amount of each product that have to be stored in the inventory for each time period were determined with minimum total cost and the inventory level was sufficiently closed to the reference level.

42 CFR § 484.330 - Process for determining and applying the value-based payment adjustment under the Home Health...

Code of Federal Regulations, 2010 CFR

2016-10-01

...-based payment adjustment under the Home Health Value-Based Purchasing (HHVBP) Model. § 484.330 Section... (HHVBP) Model Components for Competing Home Health Agencies Within State Boundaries § 484.330 Process for determining and applying the value-based payment adjustment under the Home Health Value-Based Purchasing...

42 CFR § 484.330 - Process for determining and applying the value-based payment adjustment under the Home Health...

Code of Federal Regulations, 2010 CFR

2017-10-01

...-based payment adjustment under the Home Health Value-Based Purchasing (HHVBP) Model. § 484.330 Section... (HHVBP) Model Components for Competing Home Health Agencies Within State Boundaries § 484.330 Process for determining and applying the value-based payment adjustment under the Home Health Value-Based Purchasing...

Impact of Provider Incentives on Quality and Value of Health Care.

PubMed

Doran, Tim; Maurer, Kristin A; Ryan, Andrew M

2017-03-20

The use of financial incentives to improve quality in health care has become widespread. Yet evidence on the effectiveness of incentives suggests that they have generally had limited impact on the value of care and have not led to better patient outcomes. Lessons from social psychology and behavioral economics indicate that incentive programs in health care have not been effectively designed to achieve their intended impact. In the United States, Medicare's Hospital Readmission Reduction Program and Hospital Value-Based Purchasing Program, created under the Affordable Care Act (ACA), provide evidence on how variations in the design of incentive programs correspond with differences in effect. As financial incentives continue to be used as a tool to increase the value and quality of health care, improving the design of programs will be crucial to ensure their success.

Impact of Standardized New Medication Education Program on Postdischarge Patients' Knowledge and Satisfaction.

PubMed

Jones, Tammie R; Coke, Lola

2016-10-01

This study, implemented on 2 medical-surgical units, evaluated the impact of a standardized, evidence-based new medication education program. Outcomes evaluated included patient postdischarge knowledge of new medication purpose and side effects, patient satisfaction with new medication, and Medicare reimbursement earn-back potential. As a result, knowledge scores for new medication purpose and side effects were high post intervention. Patient satisfaction with new medication education increased. Value-based purchasing reimbursement earn-back potential improved.

An advanced look at surgical performance under Medicare's hospital-inpatient value-based purchasing program: who is winning and who is losing?

PubMed

Dupree, James M; Neimeyer, Jennifer; McHugh, Megan

2014-01-01

The Centers for Medicare and Medicaid Services (CMS) is beginning to shift from paying providers based on volume to more explicitly rewarding quality of care. The hospital value-based purchasing (VBP) program is the first in a series of mandatory programs to financially reward and penalize US hospitals based on quality measure performance. Our objective was to identify the characteristics of hospitals that perform well (and those that perform poorly) on the surgical measures in CMS' hospital VBP program. Using 2008 to 2010 performance data from CMS' Hospital Compare website and the 2009 American Hospital Association annual survey, we examined surgical measure performance for all acute care general hospitals in the US. Outcomes were determined by a composite surgical performance score indicating the percentage of eligible surgical performance points that a hospital received. There were 3,030 hospitals included in our study. Composite surgical performance scores were 15.6% lower at public hospitals than at for-profit hospitals (p < 0.01). Additionally, there were significant differences in the routes by which hospitals achieved points, with smaller hospitals, for-profit hospitals, Magnet hospitals, and NSQIP hospitals all more likely to obtain points via the achievement route. The results of our study indicate that public hospitals perform worse on the surgical measures in the hospital VBP program. This study raises important questions about the impact that this new, mandatory program will have on public hospitals, which serve an important safety-net role and appear to be disadvantaged in the hospital VBP program. This issue should continue to be investigated as these mandatory quality programs are updated in future years. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Understanding Patient Satisfaction Ratings for Radiology Services

PubMed Central

Lang, Elvira V.; Yuh, William T.C.; Kelly, Ronda; Macadam, Luke; Potts, Richard; Mayr, Nina A.

2015-01-01

Under the Hospital Value-Based Purchasing Program of the Centers for Medicare & Medicaid Services patient satisfaction accounts for 30% of the measures of and payments for quality of care. Understanding what drives satisfaction data, how it is obtained, converted into scores, and formulated into rankings, is increasingly critical for imaging departments. PMID:24261356

What Is the Value of Value-Based Purchasing?

PubMed

Tanenbaum, Sandra J

2016-10-01

Value-based purchasing (VBP) is a widely favored strategy for improving the US health care system. The meaning of value that predominates in VBP schemes is (1) conformance to selected process and/or outcome metrics, and sometimes (2) such conformance at the lowest possible cost. In other words, VBP schemes choose some number of "quality indicators" and financially incent providers to meet them (and not others). Process measures are usually based on clinical science that cannot determine the effects of a process on individual patients or patients with comorbidities, and do not necessarily measure effects that patients value; additionally, there is no provision for different patients valuing different things. Proximate outcome measures may or may not predict distal ones, and the more distal the outcome, the less reliably it can be attributed to health care. Outcome measures may be quite rudimentary, such as mortality rates, or highly contestable: survival or function after prostate surgery? When cost is an element of value-based purchasing, it is the cost to the value-based payer and not to other payers or patients' families. The greatest value of value-based purchasing may not be to patients or even payers, but to policy makers seeking a morally justifiable alternative to politically contested regulatory policies. Copyright © 2016 by Duke University Press.

Affordability, accountability, and accessibility in health care reform: implications for cardiovascular and pulmonary rehabilitation.

PubMed

King, Marjorie L

2013-01-01

Because health care costs in the United States have been growing disproportionately compared to inflation for many years, without a clear connection to improved quality or increased access to care, employers and payers have begun to test new models of health care delivery and payment. These models are linked to the concepts of affordability, accountability, and accessibility and incorporate the premise that there must be shared responsibility for improving meaningful patient outcomes, with attention to the coordination of team-based and patient-centered care, and value for services purchased. This article explores emerging health care delivery and payment models, including expanded access to care related to the Affordable Care Act of 2010, patient-centered medical homes and neighborhoods, accountable and coordinated care organizations, and value-based purchasing and insurance design, with an emphasis on implications for cardiovascular and pulmonary rehabilitation programs and the American Association of Cardiovascular and Pulmonary Rehabilitation.

Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Procurement Organization Reporting and Communication; Transplant Outcome Measures and Documentation Requirements; Electronic Health Record (EHR) Incentive Programs; Payment to Nonexcepted Off-Campus Provider-Based Department of a Hospital; Hospital Value-Based Purchasing (VBP) Program; Establishment of Payment Rates Under the Medicare Physician Fee Schedule for Nonexcepted Items and Services Furnished by an Off-Campus Provider-Based Department of a Hospital. Final rule with comment period and interim final rule with comment period.

PubMed

2016-11-14

This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2017 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. Further, in this final rule with comment period, we are making changes to tolerance thresholds for clinical outcomes for solid organ transplant programs; to Organ Procurement Organizations (OPOs) definitions, outcome measures, and organ transport documentation; and to the Medicare and Medicaid Electronic Health Record Incentive Programs. We also are removing the HCAHPS Pain Management dimension from the Hospital Value-Based Purchasing (VBP) Program. In addition, we are implementing section 603 of the Bipartisan Budget Act of 2015 relating to payment for certain items and services furnished by certain off-campus provider-based departments of a provider. In this document, we also are issuing an interim final rule with comment period to establish the Medicare Physician Fee Schedule payment rates for the nonexcepted items and services billed by a nonexcepted off-campus provider-based department of a hospital in accordance with the provisions of section 603.

Pay for performance: will dentistry follow?

PubMed

Voinea-Griffin, Andreea; Fellows, Jeffrey L; Rindal, Donald B; Barasch, Andrei; Gilbert, Gregg H; Safford, Monika M

2010-04-28

"Pay for performance" is an incentive system that has been gaining acceptance in medicine and is currently being considered for implementation in dentistry. However, it remains unclear whether pay for performance can effect significant and lasting changes in provider behavior and quality of care. Provider acceptance will likely increase if pay for performance programs reward true quality. Therefore, we adopted a quality-oriented approach in reviewing those factors which could influence whether it will be embraced by the dental profession. The factors contributing to the adoption of value-based purchasing were categorized according to the Donabedian quality of care framework. We identified the dental insurance market, the dental profession position, the organization of dental practice, and the dental patient involvement as structural factors influencing the way dental care is practiced and paid for. After considering variations in dental care and the early stage of development for evidence-based dentistry, the scarcity of outcome indicators, lack of clinical markers, inconsistent use of diagnostic codes and scarcity of electronic dental records, we concluded that, for pay for performance programs to be successfully implemented in dentistry, the dental profession and health services researchers should: 1) expand the knowledge base; 2) increase considerably evidence-based clinical guidelines; and 3) create evidence-based performance measures tied to existing clinical practice guidelines. In this paper, we explored factors that would influence the adoption of value-based purchasing programs in dentistry. Although none of these factors were essential deterrents for the implementation of pay for performance programs in medicine, the aggregate seems to indicate that significant changes are needed before this type of program could be considered a realistic option in dentistry.

Marketing depression care management to employers: design of a randomized controlled trial.

PubMed

Rost, Kathryn M; Marshall, Donna

2010-03-16

Randomized trials demonstrate that depression care management can improve clinical and work outcomes sufficiently for selected employers to realize a return on investment. Employers can now purchase depression products that provide depression care management, defined as employee screening, education, monitoring, and clinician feedback for all depressed employees. We developed an intervention to encourage employers to purchase a depression product that offers the type, intensity, and duration of care management shown to improve clinical and work outcomes. In a randomized controlled trial conducted with 360 employers of 30 regional business coalitions, the research team proposes to compare the impact of a value-based marketing intervention to usual-care marketing on employer purchase of depression products. The study will also identify mediators and organizational-level moderators of intervention impact. Employers randomized to the value-based condition receive a presentation encouraging them to purchase depression products scientifically shown to benefit the employee and the employer. Employers randomized to the usual-care condition receive a presentation encouraging them to monitor and improve quality indicators for outpatient depression treatment. Because previous research demonstrates that the usual-care intervention will have little to no impact on employer purchasing, depression product purchasing rates in the usual-care condition capture vendor efforts to market depression products to employers in both conditions while the value-based intervention is being conducted. Employers in both conditions are also provided free technical assistance to undertake the actions each presentation encourages. The research team will use intent-to-treat models of all available data to evaluate intervention impact on the purchase of depression products using a cumulative incidence analysis of 12- and 24-month data. By addressing the 'value to whom?' question, the study advances knowledge about one of the most pivotal problems in the translation of evidence-based care to 'real world' settings: whether purchasers can be influenced to buy healthcare products on the basis of value and not exclusively on the basis of cost. If value-based marketing increases depression product purchase rates over usual care, this study will provide encouragement to market new healthcare products on the basis of the product's value to the purchaser as well as the recipient of care. NCT01013220.

Marketing depression care management to employers: design of a randomized controlled trial

PubMed Central

2010-01-01

Background Randomized trials demonstrate that depression care management can improve clinical and work outcomes sufficiently for selected employers to realize a return on investment. Employers can now purchase depression products that provide depression care management, defined as employee screening, education, monitoring, and clinician feedback for all depressed employees. We developed an intervention to encourage employers to purchase a depression product that offers the type, intensity, and duration of care management shown to improve clinical and work outcomes. Methods In a randomized controlled trial conducted with 360 employers of 30 regional business coalitions, the research team proposes to compare the impact of a value-based marketing intervention to usual-care marketing on employer purchase of depression products. The study will also identify mediators and organizational-level moderators of intervention impact. Employers randomized to the value-based condition receive a presentation encouraging them to purchase depression products scientifically shown to benefit the employee and the employer. Employers randomized to the usual-care condition receive a presentation encouraging them to monitor and improve quality indicators for outpatient depression treatment. Because previous research demonstrates that the usual-care intervention will have little to no impact on employer purchasing, depression product purchasing rates in the usual-care condition capture vendor efforts to market depression products to employers in both conditions while the value-based intervention is being conducted. Employers in both conditions are also provided free technical assistance to undertake the actions each presentation encourages. The research team will use intent-to-treat models of all available data to evaluate intervention impact on the purchase of depression products using a cumulative incidence analysis of 12- and 24-month data. Discussion By addressing the 'value to whom?' question, the study advances knowledge about one of the most pivotal problems in the translation of evidence-based care to 'real world' settings: whether purchasers can be influenced to buy healthcare products on the basis of value and not exclusively on the basis of cost. If value-based marketing increases depression product purchase rates over usual care, this study will provide encouragement to market new healthcare products on the basis of the product's value to the purchaser as well as the recipient of care. Trial Registration Clinical Trials Registration Number: NCT01013220 PMID:20233448

Understanding Corporate Sponsorships: Moving from a $100 Ad Purchase to a $1,000 Sponsorship Agreement

ERIC Educational Resources Information Center

Hatfield, Laura M.; Hatfield, Lance C.

2014-01-01

A corporate sponsorship program, built on an appropriate knowledge base, can help bridge the funding gap that exists in interscholastic athletics between the cost of fielding teams and decreasing budget allocations. This article describes sponsorship in its most effective form as a business concept, the value that athletic departments provide to…

DoD and DOS Need Better Procedures to Monitor and Expend DoD Funds for the Afghan National Police Training Program

DTIC Science & Technology

2011-07-07

charged the Government for unreasonable roundtrip airline tickets, a one day rental car and parking fees of $104 even though other transportation...purchases was based on high dollar values, and the items included equipment, parts, cell phones, catered meals, fuel, and rental vehicles listed on 10

Is There a Relationship Between Value-Based Purchasing and Hospital Profitability? An Exploratory Study of Missouri Hospitals.

PubMed

Turner, Jason S; Broom, Kevin D; Counte, Michael A

2015-01-01

Recent US legislation is attempting to transition inpatient Medicare payments to a value-based purchasing (VBP) program. The VBP program is a pay-for-performance (P4P) system that incentivizes hospitals to improve patient satisfaction, health outcomes, and adherence to clinical protocols while simultaneously holding down costs. Our study evaluates (1) the impact of financial performance on the VBP adjustments and (2) whether there is a correlation between the VBP adjustment and the financial performance of Missouri hospitals that opted into the program. While upward and downward adjustments to the inpatient base rate may be related to hospital financial performance, prior financial performance may also be related to the adjustments. Financial health may allow facilities to invest and position the hospital for favorable future P4P adjustments. The results of our analysis indicate the VBP adjustment to the inpatient base rate is very small (±0.18%), clustered around zero, and is not correlated with financial performance. We also find that financial performance and improvement in the years prior to the adjustment are not related to the VBP adjustment or its respective components. This suggests that CMS is avoiding penalizing less profitable facilities, but the adjustment is also so small and tightly clustered around zero that it is failing to provide an adequate incentive to hospitals. The costs of improving patient satisfaction, clinical process adherence, health care outcomes, and efficiency above that of peers coupled with the growing number of metrics being used to calculate the VBP adjustments call into question the financial incentives of the hospital VBP program.

Understanding Hospital Value-Based Purchasing.

PubMed

Brooks, Jo Ann

2016-05-01

This column is designed to provide a nursing perspective on new hospital quality measurements. Future articles will cover the various quality indicators hospitals face and the role of the nurse in meeting mandated benchmarks. Reader responses to this column are welcome and will help to make it more useful to nurses in meeting the challenges posed by health care reform and changing Medicare reimbursement programs.

Moving healthcare quality forward with nursing-sensitive value-based purchasing.

PubMed

Kavanagh, Kevin T; Cimiotti, Jeannie P; Abusalem, Said; Coty, Mary-Beth

2012-12-01

To underscore the need for health system reform and emphasize nursing measures as a key component in our healthcare reimbursement system. Nursing-sensitive value-based purchasing (NSVBP) has been proposed as an initiative that would help to promote optimal staffing and practice environment through financial rewards and transparency of structure, process, and patient outcome measures. This article reviews the medical, governmental, institutional, and lay literature regarding the necessity for, method of implementation of, and potential impact of NSVBP. Research has shown that adverse events and mortality are highly dependent on nurse staffing levels and skill mix. The National Database of Nursing Quality Indicators (NDNQI), along with other well-developed indicators, can be used as nursing-sensitive measurements for value-based purchasing initiatives. Nursing-sensitive measures are an important component of value-based purchasing. Value-based purchasing is in its infancy. Devising an effective system that recognizes and incorporates nursing measures will facilitate the success of this initiative. NSVBP needs to be designed and incentivized to decrease adverse events, hospital stays, and readmission rates, thereby decreasing societal healthcare costs. NSVBP has the potential for improving the quality of nursing care by financially motivating hospitals to have an optimal nurse practice environment capable of producing optimal patient outcomes by aligning cost effectiveness for hospitals to that of the patient and society. © 2012 Sigma Theta Tau International.

Moving Healthcare Quality Forward With Nursing-Sensitive Value-Based Purchasing

PubMed Central

Kavanagh, Kevin T; Cimiotti, Jeannie P; Abusalem, Said; Coty, Mary-Beth

2012-01-01

Purpose: To underscore the need for health system reform and emphasize nursing measures as a key component in our healthcare reimbursement system. Design and Methods: Nursing-sensitive value-based purchasing (NSVBP) has been proposed as an initiative that would help to promote optimal staffing and practice environment through financial rewards and transparency of structure, process, and patient outcome measures. This article reviews the medical, governmental, institutional, and lay literature regarding the necessity for, method of implementation of, and potential impact of NSVBP. Findings: Research has shown that adverse events and mortality are highly dependent on nurse staffing levels and skill mix. The National Database of Nursing Quality Indicators (NDNQI), along with other well-developed indicators, can be used as nursing-sensitive measurements for value-based purchasing initiatives. Nursing-sensitive measures are an important component of value-based purchasing. Conclusions: Value-based purchasing is in its infancy. Devising an effective system that recognizes and incorporates nursing measures will facilitate the success of this initiative. NSVBP needs to be designed and incentivized to decrease adverse events, hospital stays, and readmission rates, thereby decreasing societal healthcare costs. Clinical Relevance: NSVBP has the potential for improving the quality of nursing care by financially motivating hospitals to have an optimal nurse practice environment capable of producing optimal patient outcomes by aligning cost effectiveness for hospitals to that of the patient and society. PMID:23066956

Quality improvement and cost reduction realized by a purchaser through diabetes disease management.

PubMed

Snyder, James W; Malaskovitz, Joyce; Griego, Janet; Persson, Jeffrey; Flatt, Kristy

2003-01-01

This report documents the clinical improvements and costs experienced by a purchaser after introduction of a diabetes disease management program. A purchaser contracted with American Healthways, a disease management organization, to initiate a diabetes disease management program called Diabetes Decisions. Started in 1998, the program grew to include 662 participants. The results reported are based on the continuously participating population (12 months of participation in the program for the reporting year). Participants were entered into American Healthways' clinical information system and risk-stratified, and an individualized treatment plan was devised. Outbound telephone calls by specially trained nurses were a key intervention. Data were collected on key process measures, financial parameters, and participant satisfaction. By year 3, there were 422 continuously participating participants. From baseline to the third year of the program, significant increases in frequency of A1C testing (21.3% to 82.2%), dilated retinal exams (17.2% to 70.7%), and performance of foot exams (2.0% to 75.6%) were noted. For 166 participants with five A1C determinations, A1C values dropped from 8.89% to 7.88%. Participants experienced a 36% drop in inpatient costs. Without adjustment for medical inflation, total medical costs decreased by 26.8% from the baseline period, dropping to $268.63 per diabetes participant per month (PDPPM) by year 3, a gross savings of $98.49 PDPPM. After subtracting the fees paid to Diabetes Decisions, a net savings of $986,538 was realized. This yielded a return on investment of 3.37. By investing in a diabetes disease management program, a purchaser was able to realize significant improvements in clinical care, substantial cost savings, and a favorable return on investment.

77 FR 43723 - Energy Efficiency and Conservation Loan Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-26

... communities by investing in energy efficiency, and (5) encouraging the use of renewable energy fuels for both... contracts. Impacts The new Subpart H. for the Energy Efficiency and Conservation Loan Program can have several economic impacts. The benefits include: (1) The value of purchased energy saved; (2) the value of...

Health information technology: help or hindrance?

PubMed

Ketchersid, Terry

2014-07-01

The practice of medicine in general and nephrology in particular grows increasingly complex with each passing year. In parallel with this trend, the purchasers of health care are slowly shifting the reimbursement paradigm from one based on rewarding transactions, or work performed, to one that rewards value delivered. Within this context, the health-care value equation is broadly defined as quality divided by costs. Health information technology has been widely recognized as 1 of the foundations for delivering better care at lower costs. As the largest purchaser of health care in the world, the Centers for Medicare and Medicaid Services has deployed a series of interrelated programs designed to spur the adoption and utilization of health information technology. This review examines our known collective experience in the practice of nephrology to date with several of these programs and attempts to answer the following question: Is health information technology helping or hindering the delivery of value to the nation's health-care system? Through this review, it was concluded overall that the effect of health information technology appears positive; however, it cannot be objectively determined because of the infancy of its utilization in the practice of medicine. Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

76 FR 51933 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-19

... that the Forest Service (FS) establish a process by which purchasers may appeal decisions concerning... program is designed to ensure that small business timber purchasers have the opportunity to purchase a... businesses every five years based on the actual volume of saw timber purchased by small businesses...

Assessing the State of Procurement Knowledge Production: Implications for the Federal Government

DTIC Science & Technology

2011-10-31

NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND...archiving of the canonical knowledge base, quality control of published information, and assignment of priority and credit for their work to authors...recognizes the value of theory-based research and graduate education in strategic purchasing—evidenced by its investment in an acclaimed strategic purchasing

Purchases Made with a Fruit and Vegetable Voucher in a Rural Mexican-Heritage Community.

PubMed

Hanbury, Meagan M; Gomez-Camacho, Rosa; Kaiser, Lucia; Sadeghi, Banafsheh; de la Torre, Adela

2017-10-01

Recent recommendations for US food assistance programs are intended to ensure foods provided through these programs help households consume a varied, healthful diet. From a policy viewpoint, it is important to examine the impact of economic incentives to purchase healthy foods across subpopulations, particularly low-income Latinos, who comprise 40% of the WIC program nationwide. Our aim was to determine how rural, Mexican-heritage households (N = 227) residing in California's Central Valley distributed fruit and vegetable (F/V) voucher spending among F/V subgroups and specific items over a 1-year period. Households contained at least one child who was between 3 and 8 years old at baseline and had a parent of Mexican-heritage. F/V voucher purchase data were collected via grocery store scanners. Expenditure and frequency shares of subgroups and individual items were analyzed to determine purchasing habits. Fruits were the most commonly purchased subgroup, representing 55% of spending and 45% of frequency. Households allocated low percentages of their voucher to dark green and red/orange vegetables-7 and 9% respectively. Approximately 20% of purchases were good potassium sources and 30% of purchases were good fiber sources. Many of the most frequently purchased items were of cultural significance (tomatillo, chayote, chili/jalapeño pepper, and Mexican squash). This study suggests that economic incentives can contribute important nutrients to participants' diets and targeted vouchers provided by food assistance programs should continue to include culturally important foods and be aware of the cultural values of their participants.

Teaching Grocery Store Purchasing Skills to Students with Intellectual Disabilities Using a Computer-Based Instruction Program

ERIC Educational Resources Information Center

Hansen, David L.; Morgan, Robert L.

2008-01-01

This research evaluated effects of a multi-media computer-based instruction (CBI) program designed to teach grocery store purchasing skills to three high-school students with intellectual disabilities. A multiple baseline design across participants used measures of computer performance mastery and grocery store probes to evaluate the CBI. All…

Medicare and Medicaid programs: hospital outpatient prospective payment; ambulatory surgical center payment; hospital value-based purchasing program; physician self-referral; and patient notification requirements in provider agreements. Final rule with comment period.

PubMed

2011-11-30

This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) for CY 2012 to implement applicable statutory requirements and changes arising from our continuing experience with this system. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the OPPS. In addition, this final rule with comment period updates the revised Medicare ambulatory surgical center (ASC) payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system. In this final rule with comment period, we set forth the relative payment weights and payment amounts for services furnished in ASCs, specific HCPCS codes to which these changes apply, and other ratesetting information for the CY 2012 ASC payment system. We are revising the requirements for the Hospital Outpatient Quality Reporting (OQR) Program, adding new requirements for ASC Quality Reporting System, and making additional changes to provisions of the Hospital Inpatient Value-Based Purchasing (VBP) Program. We also are allowing eligible hospitals and CAHs participating in the Medicare Electronic Health Record (EHR) Incentive Program to meet the clinical quality measure reporting requirement of the EHR Incentive Program for payment year 2012 by participating in the 2012 Medicare EHR Incentive Program Electronic Reporting Pilot. Finally, we are making changes to the rules governing the whole hospital and rural provider exceptions to the physician self-referral prohibition for expansion of facility capacity and changes to provider agreement regulations on patient notification requirements.

Is There a Relationship Between Value-Based Purchasing and Hospital Profitability? An Exploratory Study of Missouri Hospitals

PubMed Central

Broom, Kevin D.; Counte, Michael A.

2015-01-01

Recent US legislation is attempting to transition inpatient Medicare payments to a value-based purchasing (VBP) program. The VBP program is a pay-for-performance (P4P) system that incentivizes hospitals to improve patient satisfaction, health outcomes, and adherence to clinical protocols while simultaneously holding down costs. Our study evaluates (1) the impact of financial performance on the VBP adjustments and (2) whether there is a correlation between the VBP adjustment and the financial performance of Missouri hospitals that opted into the program. While upward and downward adjustments to the inpatient base rate may be related to hospital financial performance, prior financial performance may also be related to the adjustments. Financial health may allow facilities to invest and position the hospital for favorable future P4P adjustments. The results of our analysis indicate the VBP adjustment to the inpatient base rate is very small (±0.18%), clustered around zero, and is not correlated with financial performance. We also find that financial performance and improvement in the years prior to the adjustment are not related to the VBP adjustment or its respective components. This suggests that CMS is avoiding penalizing less profitable facilities, but the adjustment is also so small and tightly clustered around zero that it is failing to provide an adequate incentive to hospitals. The costs of improving patient satisfaction, clinical process adherence, health care outcomes, and efficiency above that of peers coupled with the growing number of metrics being used to calculate the VBP adjustments call into question the financial incentives of the hospital VBP program. PMID:28462265

7 CFR 1467.13 - Modifications.

Code of Federal Regulations, 2011 CFR

2011-01-01

... must meet WRP regulations and program objectives, comply with the definition of wetland restoration as... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS WETLANDS RESERVE PROGRAM § 1467.13 Modifications. (a... the program so long as the modification will not adversely affect the wetland functions and values for...

Energy-efficient Public Procurement: Best Practice in Program Delivery

DOE Office of Scientific and Technical Information (OSTI.GOV)

Payne, Christopher; Weber, Andrew; Semple, Abby

2013-02-15

This document illustrates the key issues and considerations involved in implementing energy-efficient public procurement. Our primary sources of information have been our partners in the Super Efficient Equipment and Appliance Deployment (SEAD) Initiative Procurement Working Group. Where applicable, we have highlighted specific ways in which working group participants have successfully overcome barriers to delivering effective programs. The following key points emerge from this analysis of programs for energy-efficient public procurement. Lessons for both developed and developing programs are highlighted throughout the guide. 1. Policy: Policy provides the initiative to begin a transition from first cost to life-cycle cost based purchasingmore » methods and culture. Effective policy is well-communicated, establishes accountability from top to bottom of organizations and simplifies the processes necessary to comply. Flexibility and responsiveness are essential in policy development and implementation. Mandatory and voluntary policies may complement one another. 2. Procurement Criteria: Procurement staff must be confident that energy-efficient procurement criteria offer the best long-term value for their organization’s money and represent real environmental gains. Involving multiple stakeholders at the early stages of the criteria creation process can result in greater levels of cooperation from private industry. Criteria should make comparison of products easy for purchasers and require minimal additional calculations. Criteria will need to be regularly updated to reflect market developments. 3. Training: Resources for the creation of training programs are usually very limited, but well-targeted training is necessary in order for a program to be effective. Training must emphasize a process that is efficient for purchasers and simplifies compliance. Purchaser resources and policy must be well designed for training to be effective. Training program development is an excellent opportunity for collaboration amongst public authorities. 4. Procurement Processes: Many tools and guides intended to help buyers comply with energy-efficient procurement policy are designed without detailed knowledge of the procurement process. A deeper understanding of purchasing pathways allows resources to be better directed. Current research by national and international bodies aims to analyze purchasing pathways and can assist in developing future resources.« less

Medicare and Medicaid Programs; CY 2018 Home Health Prospective Payment System Rate Update and CY 2019 Case-Mix Adjustment Methodology Refinements; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Final rule.

PubMed

2017-11-07

This final rule updates the home health prospective payment system (HH PPS) payment rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor, effective for home health episodes of care ending on or after January 1, 2018. This rule also: Updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking; implements the third year of a 3-year phase-in of a reduction to the national, standardized 60-day episode payment to account for estimated case-mix growth unrelated to increases in patient acuity (that is, nominal case-mix growth) between calendar year (CY) 2012 and CY 2014; and discusses our efforts to monitor the potential impacts of the rebasing adjustments that were implemented in CY 2014 through CY 2017. In addition, this rule finalizes changes to the Home Health Value-Based Purchasing (HHVBP) Model and to the Home Health Quality Reporting Program (HH QRP). We are not finalizing the implementation of the Home Health Groupings Model (HHGM) in this final rule.

Statement of the Problem: Health Reform, Value-Based Purchasing, Alternative Payment Strategies, and Children and Youth With Special Health Care Needs.

PubMed

Bachman, Sara S; Comeau, Meg; Long, Thomas F

2017-05-01

There is increasing interest in maximizing health care purchasing value by emphasizing strategies that promote cost-effectiveness while achieving optimal health outcomes. These value-based purchasing (VBP) strategies have largely focused on adult health, and little is known about the impact of VBP program development and implementation on children, especially children and youth with special health care needs (CYSHCN). With the increasing emphasis on VBP, policymakers must critically analyze the potential impact of VBP for CYSCHN, because this group of children, by definition, uses more health care services than other children and inevitably incurs higher per person costs. We provide a history and definition of VBP and insurance design, noting its origin in employer-sponsored health insurance, and discuss various financing and payment strategies that may be pursued under a VBP framework. The relevance of these approaches for CYSHCN is discussed, and recommendations for next steps are provided. There is considerable work to be done if VBP strategies are to be applied to CYSHCN. Issues include the low prevalence of specific special health care need conditions, how to factor in a life course perspective, in which investments in children's health pay off over a long period of time, the marginal savings that may or may not accrue, the increased risk of family financial hardship, and the potential to exacerbate existing inequities across race, class, ethnicity, functional status, and other social determinants of health. Copyright © 2017 by the American Academy of Pediatrics.

Value-based purchasing and hospital acquired conditions: are we seeing improvement?

PubMed

Spaulding, Aaron; Zhao, Mei; Haley, D Rob

2014-12-01

To determine if the Value-Based Purchasing Performance Scoring system correlates with hospital acquired condition quality indicators. This study utilizes the following secondary data sources: the American Hospital Association (AHA) annual survey and the Centers for Medicare and Medicaid (CMS) Value-Based Purchasing and Hospital Acquired Conditions databases. Zero-inflated negative binomial regression was used to examine the effect of CMS total performance score on counts of hospital acquired conditions. Hospital structure variables including size, ownership, teaching status, payer mix, case mix, and location were utilized as control variables. The secondary data sources were merged into a single database using Stata 10. Total performance scores, which are used to determine if hospitals should receive incentive money, do not correlate well with quality outcome in the form of hospital acquired conditions. Value-based purchasing does not appear to correlate with improved quality and patient safety as indicated by Hospital Acquired Condition (HAC) scores. This leads us to believe that either the total performance score does not measure what it should, or the quality outcome measurements do not reflect the quality of the total performance scores measure. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Grocery store beverage choices by participants in federal food assistance and nutrition programs.

PubMed

Andreyeva, Tatiana; Luedicke, Joerg; Henderson, Kathryn E; Tripp, Amanda S

2012-10-01

Sugar-sweetened beverages are a target for reduction in the 2010 Dietary Guidelines for Americans. Concerns have been raised about sugar-sweetened beverages purchased with Supplemental Nutrition Assistance Program (SNAP) benefits. This paper describes purchases of non-alcoholic refreshment beverages among participants in the U.S. Department of Agriculture's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and SNAP. Grocery store scanner data from a regional supermarket chain were used to assess refreshment beverage purchases of 39,172 households in January-June 2011. The sample consisted of families with a history of WIC participation in 2009-2011; about half also participated in SNAP. Beverage spending and volume purchased were compared for WIC sampled households either using SNAP benefits (SNAP) or not (WIC-only). Analyses were completed in 2012. Refreshment beverages were a significant contributor to expenditure on groceries by SNAP and WIC households. Sugar-sweetened beverages accounted for 58% of refreshment beverage purchases made by SNAP households and 48% of purchases by WIC-only households. Soft drinks were purchased most by all households. Fruit-based beverages were mainly 100% juice for WIC-only households and sugary fruit drinks for SNAP households. SNAP benefits paid for 72% of the sugar-sweetened beverage purchases made by SNAP households. Nationwide, SNAP was estimated to pay at least $1.7 to $2.1 billion annually for sugar-sweetened beverages purchased in grocery stores. Considerable amounts of sugar-sweetened beverages are purchased by households participating in WIC and SNAP. The SNAP program pays for most of the sugar-sweetened beverage purchases among SNAP households. The upcoming SNAP reauthorization could be a good time to reconsider the program priorities to align public funds with public health. Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

78 FR 78424 - Order Granting a Limited Exemption From Rule 102(a) of Regulation M to Certain Business...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-26

..., purchasing, or attempting to induce another person to bid for or purchase a ``covered security'' until the... purchases of Shares or any reference security by the Company or any affiliated purchaser of the Company are... trusts to permit similar repurchase programs.\\4\\ Based on our experience with these prior requests, we...

7 CFR 1485.23 - Miscellaneous provisions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... refunds generated from an activity, i.e., participation fees, proceeds of sales, refunds of value added... shall maintain an inventory of all capital goods with a value of $100 acquired in furtherance of program..., cost of purchase, replacement value, serial number, make, model, and electrical requirements. (3) The...

Impact of a Rewards-Based Incentive Program on Promoting Fruit and Vegetable Purchases

PubMed Central

Phipps, Etienne J.; Braitman, Leonard E.; Stites, Shana D.; Singletary, S. Brook; Wallace, Samantha L.; Hunt, Lacy; Axelrod, Saul; Glanz, Karen; Uplinger, Nadine

2015-01-01

Objectives. We assessed the impact of a rewards-based incentive program on fruit and vegetable purchases by low-income families. Methods. We conducted a 4-phase prospective cohort study with randomized intervention and wait-listed control groups in Philadelphia, Pennsylvania, in December 2010 through October 2011. The intervention provided a rebate of 50% of the dollar amount spent on fresh or frozen fruit and vegetables, reduced to 25% during a tapering phase, then eliminated. Primary outcome measures were number of servings of fruit and of vegetables purchased per week. Results. Households assigned to the intervention purchased an average of 8 (95% confidence interval [CI] = 1.5, 16.9) more servings of vegetables and 2.5 (95% CI = 0.3, 9.5) more servings of fruit per week than did control households. In longitudinal price-adjusted analyses, when the incentive was reduced and then discontinued, the amounts purchased were similar to baseline. Conclusions. Investigation of the financial costs and potential benefits of incentive programs to supermarkets, government agencies, and other stakeholders is needed to identify sustainable interventions. PMID:24625144

24 CFR 906.40 - Supporting documentation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... program, based on analysis of data on such elements as purchase prices, costs of repair or rehabilitation... extent to which there are eligible residents who are expected to be interested in purchase (See § 906.45...) past experience in carrying out homeownership programs for low-income families, and (if applicable) its...

Charting the Emergence of Corporate Procurement of Utility-Scale PV

DOE Office of Scientific and Technical Information (OSTI.GOV)

Heeter, Jenny S.; Cook, Jeffrey J.; Bird, Lori A.

Corporations and other institutions have contracted for more than 2300 MW of off-site solar, using power purchase agreements, green tariffs, or bilateral deals with utilities. This paper examines the benefits, challenges, and outlooks for large-scale off-site solar purchasing in the United States. Pathways differ based on where they are available, the hedge value they can provide, and their ease of implementation. The paper features case studies of an aggregate PPA (Massachusetts Institute of Technology, Boston Medical Center, and Post Office Square), a corporation exiting their incumbent utility (MGM Resorts), a utility offering large scale renewables to corporate customers (Alabama Powersmore » Renewable Procurement Program), and a company with approval to sell energy into wholesale markets (Google Energy Inc.).« less

13 CFR 120.1705 - Pool formation requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... requirements. SBA may adjust the Pool characteristics periodically based on program experience and market... a Pool involving a Pool Loan it does not own, it must purchase the Loan Interest it proposes to pool... purchase the Loan Interest and take it into inventory or settle the purchase of the Loan Interest through...

7 CFR 623.9 - Easement priority.

Code of Federal Regulations, 2011 CFR

2011-01-01

... restored, (e) Wetland function or values, (f) Likelihood of successful restoration of wetland values, (g... AGRICULTURE WATER RESOURCES EMERGENCY WETLANDS RESERVE PROGRAM § 623.9 Easement priority. The State... government expenditure on restoration and easement purchase. The factors for determining the priority for...

76 FR 13974 - Information Collection; Small Business Timber Sale Set-Aside Program; Appeal Procedures on...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-15

... reinstate an appeals process for decisions concerning recomputation of Small Business Set-Aside shares... to purchase a fair proportion of National Forest System timber offered for sale. Under the program... businesses every 5 years based on the actual volume of sawtimber that has been purchased by small businesses...

Adding Value through Program Integration: A Kayaking Model (Rental, Retail, Repair, Clinics and Outings).

ERIC Educational Resources Information Center

Poff, Raymond

Outdoor programs can offset initial investment costs in services and products by developing integrated program areas. The experience of Outdoors Unlimited, a recently created kayaking program at Brigham Young University (Utah), is provided as a model. The purchase of 11 kayaks for rental was followed by the introduction of retail sales, repair…

Why do consumers respond to eco-labels? The case of Korea.

PubMed

Hwang, Jung-Ah; Park, Youkyoung; Kim, Yeonbae

2016-01-01

Although eco-labels were introduced with the intention of encouraging eco-friendly purchasing behavior by consumers, they have had little effect on consumers' purchasing decisions, and therefore a significant gap exists between eco-label awareness and actual purchasing behavior. The aim of this study was to analyze consumer preference, in terms of public and private values, for two types of Korean eco-label that have been administered by the Korean government since 1992. Analyses were based on a structural equation model, employing the theory of reasoned action. Data were collected by survey. The results indicate that although general consumers are highly aware of the publicly valuable information that eco-labels provide, privately valuable information exerts far greater power over their purchasing intentions. Therefore, a supplementary policy that converts public value to private value could promote the purchase of eco-labeled products.

An Empirical Examination of Counterdrug Interdiction Program Effectiveness.

DTIC Science & Technology

1997-01-01

inversely correlated with the street price index. Chapter IV examines the time dependence of the street price index and argues that interdiction activities...essentially asymptotic behavior in which the cumulative distribution function, for large values of the independent variable, converges to an inverse power-law...log(S) /log(M). Such an inverse power-law relation between unit purchase price and purchase volume is indeed observed within the STRIDE data

Determining the value of disease management programs.

PubMed

Selby, Joe V; Scanlon, Dennis; Lafata, Jennifer Elston; Villagra, Victor; Beich, Jeff; Salber, Patricia R

2003-09-01

Increasing prevalence, rising costs, and persisting deficiencies in quality of care for chronic diseases pose economic and policy challenges to providers and purchasers. Disease management (DM) programs may address these challenges, but neither purchasers nor providers can assess their value. The potpourri of current quality indicators provides limited insight into the actual clinical benefit achieved. A conference sponsored by the Agency for Healthcare Research and Quality (AHRQ) and held in October 2002 explored new approaches to measuring and reporting the value of DM for diabetes mellitus. Quantifying the value of DM requires measuring clinical benefit and net impact on health care costs for the entire population with diabetes. If quality is measured with indicators that are clearly linked to outcomes, clinical benefit can be estimated. Natural history models combine the expected benefits of improvements in multiple indicators to yield a single, composite measure, the quality-adjusted life-year. Such metrics could fairly express, in terms of survival and complications prevention, relatively disparate DM programs' benefits. Measuring and comparing health care costs requires data validation and appropriate case-mix adjustment. Comparing value across programs may provide more accurate assessments of performance, enhance quality improvement efforts within systems, and contribute generalizable knowledge on the utility of DM approaches. Conference attendees recommended pilot projects to further explore use of natural history models for measuring and reporting the value of DM.

Incentivizing fruit and vegetable purchases among participants in the Special Supplemental Nutrition Program for Women, Infants, and Children.

PubMed

Andreyeva, Tatiana; Luedicke, Joerg

2015-01-01

In 2009, the US Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) began to provide participants with cash-value vouchers to purchase fruits and vegetables ($US 10 for women and $US 6 for children per month). The present paper assesses the potential effects of the new WIC incentives on fruit and vegetable purchases among WIC households in two New England states. A pre-post assessment of changes in fruit and vegetable purchases after the WIC revisions in generalized estimating equation models. Scanner data on grocery purchases from a regional supermarket chain in New England, USA. WIC-participating households (n 2137) that regularly shopped at the chain during January-September 2009 and January-September 2010. After the WIC revisions, purchases of fresh and frozen vegetables increased in volume by 17·5 % and 27·8 %, respectively. The biggest improvements were observed for fresh fruit, an increase of 28·6 %, adding almost a kilogram of fresh fruits per household per month. WIC households spent three times more of their WIC vouchers on purchasing fresh fruits than fresh vegetables. The magnitudes of substitution effects were relatively small: between 4 % (fresh fruit) and 13 % (canned vegetables) of the amounts purchased in 2009 with non-WIC funds were replaced by purchases made using WIC vouchers in 2010. The provision of fruit and vegetable benefits in the revised WIC food packages increased overall purchases of fruits and vegetables among WIC-participating households in New England. Efforts to encourage consumption of fruits and vegetables by people receiving federal food assistance are paying off.

Who purchases nonprescription syringes? Characterizing customers of the Expanded Syringe Access Program (ESAP).

PubMed

Battles, Haven B; Rowe, Kirsten A; Ortega-Peluso, Christina; Klein, Susan J; Tesoriero, James M

2009-11-01

This study represents the first attempt in the USA to survey pharmacy nonprescription syringe customers at their point of purchase. We surveyed 62 individuals purchasing nonprescription syringes in seven pharmacies located in NYC and Albany, NY, USA. Three quarters of respondents purchased for illicit use, and 36% purchased for medical use, with differences found by race and gender. Half got their syringes from pharmacies "most of the time." Half had ever been refused a syringe purchase in a NYS pharmacy, with men, Blacks, and Hispanics reporting higher levels of refusals than women or whites. Two thirds reported syringe reuse but very few reported sharing. While approximately one quarter safely obtained and disposed of syringes "most of the time," two thirds used both safe and unsafe methods. Pharmacy-based syringe access programs are essential in areas not served by syringe exchanges.

Notes from the field: the economic value chain in disease management organizations.

PubMed

Fetterolf, Donald

2006-12-01

The disease management (DM) "value chain" is composed of a linear series of steps that include operational milestones in the development of knowledge, each stage evolving from the preceding one. As an adaptation of Michael Porter's "value chain" model, the process flow in DM moves along the following path: (1) data/information technology, (2) information generation, (3) analysis, (4) assessment/recommendations, (5) actionable customer plan, and (6) program assessment/reassessment. Each of these stages is managed as a major line of product operations within a DM company or health plan. Metrics around each of the key production variables create benchmark milestones, ongoing management insight into program effectiveness, and potential drivers for activity-based cost accounting pricing models. The value chain process must remain robust from early entry of data and information into the system, through the final presentation and recommendations for our clients if the program is to be effective. For individuals involved in the evaluation or review of DM programs, this framework is an excellent method to visualize the key components and sequence in the process. The value chain model is an excellent way to establish the value of a formal DM program and to create a consultancy relationship with a client involved in purchasing these complex services.

The current state of nursing performance measurement, public reporting, and value-based purchasing.

PubMed

Kurtzman, Ellen T; Dawson, Ellen M; Johnson, Jean E

2008-08-01

Over the last decade, there has been a substantial investment in holding health care providers accountable for the quality of care provided in hospitals and other settings of care. This investment has been realized through the proliferation of national policies that address performance measurement, public reporting, and value-based purchasing. Although nurses represent the largest segment of the health care workforce and despite their acknowledged role in patient safety and health care outcomes, they have been largely absent from policy setting in these areas. This article provides an analysis of current nursing performance measurement and public reporting initiatives and presents a summary of emerging trends in value-based purchasing, with an emphasis on activities in the United States. The article synthesizes issues of relevance to advancing the current climate for nursing quality and concludes with key issues for future policy setting.

Patient Hospital Experience Improved Modestly, But No Evidence Medicare Incentives Promoted Meaningful Gains.

PubMed

Papanicolas, Irene; Figueroa, José F; Orav, E John; Jha, Ashish K

2017-01-01

The Centers for Medicare and Medicaid Services (CMS) has played a leading role in efforts to improve patients' experiences with hospital care. Yet little is known about how much patient experience has changed over the past decade, and even less is known about the impact of CMS's most recent strategy: tying payments to performance under the Value-Based Purchasing (VBP) program. We examined trends in multiple measures of patient satisfaction in the period 2008-14. We found that patient experience has improved modestly at US hospitals-both those participating in the VBP program and others-with the majority of improvement concentrated in the period before the program was implemented. While certain subsets of hospitals improved more than others, we found no evidence that the program has had a beneficial effect. As policy makers continue to promote value-based payment as a way to improve patient experience, it will be critical to ensure that payment is structured in ways that actually drive improvement. Project HOPE—The People-to-People Health Foundation, Inc.

Hospitals Known for Nursing Excellence Perform Better on Value Based Purchasing Measures

PubMed Central

Lasater, Karen B.; Germack, Hayley D.; Small, Dylan S.; McHugh, Matthew D.

2018-01-01

It is well-established that hospitals recognized for good nursing care – Magnet hospitals – are associated with better patient outcomes. Less is known about how Magnet hospitals compare to non-Magnets on quality measures linked to Medicare reimbursement. The purpose of this study was to determine how Magnet hospitals perform compared to matched non-Magnet hospitals on Hospital Value Based Purchasing (VBP) measures. A cross-sectional analysis of three linked data sources was performed. The sample included 3,021 non-federal acute care hospitals participating in the VBP program (323 Magnets; 2,698 non-Magnets). Propensity score matching was used to match Magnet and non-Magnet hospitals with similar hospital characteristics. After matching, linear and logistic regression models were used to examine the relationship between Magnet status and VBP performance. After matching and adjusting for hospital characteristics, Magnet recognition predicted higher scores on Total Performance (Regression Coefficient [RC] = 1.66, p < 0.05), Clinical Processes (RC = 3.85; p < 0.01), and Patient Experience (RC = 6.33; p < 0.001). The relationships between Magnet recognition and the Outcome and Efficiency domains were not statistically significant. Magnet hospitals known for nursing excellence perform better on Hospital VBP measures. As healthcare systems adapt to evolving incentives that reward value, attention to nurses at the front lines may be central to ensuring high-value care for patients. PMID:28558604

Spend today, clean tomorrow: Predicting methamphetamine abstinence in a randomized controlled trial

PubMed Central

Murtaugh, Kimberly Ling; Krishnamurti, Tamar; Davis, Alexander L.; Reback, Cathy J.; Shoptaw, Steven

2013-01-01

Objective This secondary analysis of data from a randomized controlled trial tested two behavioral economics mechanisms (substitutability and delay discounting) to explain outcomes using contingency management (CM) for methamphetamine dependence. Frequency and purchase type (hedonic/utilitarian and consumable/durable) of CM payments were also examined. Methods 82 methamphetamine-dependent gay/bisexual men randomly assigned to conditions delivering CM received monetary vouchers in exchange for stimulant-negative urine samples in a 16-week trial requiring thrice weekly visits (Shoptaw et al., 2005). At any visit participants could redeem vouchers for goods. A time-lagged counting process Cox Proportional Hazards model for recurrent event survival analysis examined aspects of the frequency and type of these CM purchases. Results After controlling for severity of baseline methamphetamine use and accumulated CM wealth, as measured by cumulative successful earning days, participants who redeemed CM earnings at any visit (“spenders”) were significantly more likely to produce stimulant-negative urine samples in the subsequent visit, compared to those who did not redeem (“savers”) 1.011* [1.005, 1.017], Z=3.43, p<0.001. Conclusions Findings support the economic concept of substitutability of CM purchases and explain trial outcomes as a function of frequency of CM purchases rather than frequency or accumulated total CM earnings. Promotion of frequent purchases in incentive-based programs should facilitate substitution for the perceived value of methamphetamine and improve abstinence outcomes. PMID:24001246

Rolling capital: managing investments in a value-based care world.

PubMed

Jasuta, Lynette

2016-06-01

The importance of capital planning is increasing as the healthcare industry moves toward value-based care. Replacing unwieldy and inflexible traditional capital planning processes with a rolling capital planning approach can result in: Greater standardization, facilitating better strategic planning across the whole system. Reduced labor intensity in the planning and budgeting process. Reduced costs through being able to plan better for replacement purchases and take advantage of group purchasing and bundling opportunities. Increased transparency in the decision-making process.

Executive summary: value-based purchasing and technology assessment in orthopaedics.

PubMed

Ranawat, Anil S; Nunley, Ryan; Bozic, Kevin

2009-10-01

As US healthcare expenditures continue to rise, reform has shifted from spending controls to value-based purchasing. This paradigm shift is a drastic change on how health care is delivered and reimbursed. For the shift to work, policymakers and physicians must restructure the present system by using initiatives such as process reengineering, insurance and payment reforms, physician reeducation, data and quality measurements, and technology assessments. Value, as defined in economic terms, will be a critical concept in modern healthcare reform. We summarize the conclusions of this ABJS Carl T. Brighton Workshop on healthcare reform.

Prevalence of Malaria Parasitemia and Purchase of Artemisinin-Based Combination Therapies (ACTs) among Drug Shop Clients in Two Regions in Tanzania with ACT Subsidies

PubMed Central

Briggs, Melissa A.; Kalolella, Admirabilis; Bruxvoort, Katia; Wiegand, Ryan; Lopez, Gerard; Festo, Charles; Lyaruu, Pierre; Kenani, Mitya; Abdulla, Salim; Goodman, Catherine; Kachur, S. Patrick

2014-01-01

Background Throughout Africa, many people seek care for malaria in private-sector drug shops where diagnostic testing is often unavailable. Recently, subsidized artemisinin-based combination therapies (ACTs), a first-line medication for uncomplicated malaria, were made available in these drug shops in Tanzania. This study assessed the prevalence of malaria among and purchase of ACTs by drug shop clients in the setting of a national ACT subsidy program and sub-national drug shop accreditation program. Method and Findings A cross-sectional survey of drug shop clients was performed in two regions in Tanzania, one with a government drug shop accreditation program and one without, from March-May, 2012. Drug shops were randomly sampled from non-urban districts. Shop attendants were interviewed about their education, training, and accreditation status. Clients were interviewed about their symptoms and medication purchases, then underwent a limited physical examination and laboratory testing for malaria. Malaria prevalence and predictors of ACT purchase were assessed using univariate analysis and multiple logistic regression. Amongst 777 clients from 73 drug shops, the prevalence of laboratory-confirmed malaria was 12% (95% CI: 6–18%). Less than a third of clients with malaria had purchased ACTs, and less than a quarter of clients who purchased ACTs tested positive for malaria. Clients were more likely to have purchased ACTs if the participant was <5 years old (aOR: 6.6; 95% CI: 3.9–11.0) or the shop attendant had >5 years, experience (aOR: 2.8; 95% CI: 1.2–6.3). Having malaria was only a predictor of ACT purchase in the region with a drug shop accreditation program (aOR: 3.4; 95% CI: 1.5–7.4). Conclusion Malaria is common amongst persons presenting to drug shops with a complaint of fever. The low proportion of persons with malaria purchasing ACTs, and the high proportion of ACTs going to persons without malaria demonstrates a need to better target who receives ACTs in these drug shops. PMID:24732258

Prevalence of malaria parasitemia and purchase of artemisinin-based combination therapies (ACTs) among drug shop clients in two regions in Tanzania with ACT subsidies.

PubMed

Briggs, Melissa A; Kalolella, Admirabilis; Bruxvoort, Katia; Wiegand, Ryan; Lopez, Gerard; Festo, Charles; Lyaruu, Pierre; Kenani, Mitya; Abdulla, Salim; Goodman, Catherine; Kachur, S Patrick

2014-01-01

Throughout Africa, many people seek care for malaria in private-sector drug shops where diagnostic testing is often unavailable. Recently, subsidized artemisinin-based combination therapies (ACTs), a first-line medication for uncomplicated malaria, were made available in these drug shops in Tanzania. This study assessed the prevalence of malaria among and purchase of ACTs by drug shop clients in the setting of a national ACT subsidy program and sub-national drug shop accreditation program. A cross-sectional survey of drug shop clients was performed in two regions in Tanzania, one with a government drug shop accreditation program and one without, from March-May, 2012. Drug shops were randomly sampled from non-urban districts. Shop attendants were interviewed about their education, training, and accreditation status. Clients were interviewed about their symptoms and medication purchases, then underwent a limited physical examination and laboratory testing for malaria. Malaria prevalence and predictors of ACT purchase were assessed using univariate analysis and multiple logistic regression. Amongst 777 clients from 73 drug shops, the prevalence of laboratory-confirmed malaria was 12% (95% CI: 6-18%). Less than a third of clients with malaria had purchased ACTs, and less than a quarter of clients who purchased ACTs tested positive for malaria. Clients were more likely to have purchased ACTs if the participant was <5 years old (aOR: 6.6; 95% CI: 3.9-11.0) or the shop attendant had >5 years, experience (aOR: 2.8; 95% CI: 1.2-6.3). Having malaria was only a predictor of ACT purchase in the region with a drug shop accreditation program (aOR: 3.4; 95% CI: 1.5-7.4). Malaria is common amongst persons presenting to drug shops with a complaint of fever. The low proportion of persons with malaria purchasing ACTs, and the high proportion of ACTs going to persons without malaria demonstrates a need to better target who receives ACTs in these drug shops.

78 FR 13549 - Special Supplemental Nutrition Program for Women, Infants and Children (WIC): Implementation of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-28

... FI must usually be purchased in totality. In addition, FIs do not yield data on the type, amount, and... amend Sec. 246.2 to add the definition of EBT. Cash-Value Voucher/Cash-Value Benefit. Federal WIC regulations (Sec. 246.2) provide definitions for cash-value vouchers (CVV) and food instruments, and within...

Factors affecting the valuation of physician practices.

PubMed

Cleverley, W O

1997-12-01

Valuation of physician practices provides physicians with a benchmark of their business success and helps purchasers negotiate a purchase price. The Center for Healthcare Industry Performance Studies (CHIPS) recently conducted a survey of physician practice acquisitions. The survey collected data on salaries and benefits paid to physicians after practice acquisition, historical profitability of the acquired practice, and specific values assigned to both tangible and intangible assets in the practice. Some of the survey's critical conclusions include: hospitals tend to acquire unprofitable practices, value is based on historical revenues rather than historical profits, the importance of valuation methodology and payer mix is underestimated, tangible assets represent a large part of the purchase price, and hospitals tend to pay higher physician compensation than do other purchasers.

The Relationship Between Hospital Value-Based Purchasing Program Scores and Hospital Bond Ratings.

PubMed

Rangnekar, Anooja; Johnson, Tricia; Garman, Andrew; O'Neil, Patricia

2015-01-01

Tax-exempt hospitals and health systems often borrow long-term debt to fund capital investments. Lenders use bond ratings as a standard metric to assess whether to lend funds to a hospital. Credit rating agencies have historically relied on financial performance measures and a hospital's ability to service debt obligations to determine bond ratings. With the growth in pay-for-performance-based reimbursement models, rating agencies are expanding their hospital bond rating criteria to include hospital utilization and value-based purchasing (VBP) measures. In this study, we evaluated the relationship between the Hospital VBP domains--Clinical Process of Care, Patient Experience of Care, Outcome, and Medicare Spending per Beneficiary (MSPB)--and hospital bond ratings. Given the historical focus on financial performance, we hypothesized that hospital bond ratings are not associated with any of the Hospital VBP domains. This was a retrospective, cross-sectional study of all hospitals that were rated by Moody's for fiscal year 2012 and participated in the Centers for Medicare & Medicaid Services' VBP program as of January 2014 (N = 285). Of the 285 hospitals in the study, 15% had been assigned a bond rating of Aa, and 46% had been assigned an A rating. Using a binary logistic regression model, we found an association between MSPB only and bond ratings, after controlling for other VBP and financial performance scores; however, MSPB did not improve the overall predictive accuracy of the model. Inclusion of VBP scores in the methodology used to determine hospital bond ratings is likely to affect hospital bond ratings in the near term.

Linking Quality and Spending to Measure Value for People with Serious Illness.

PubMed

Ryan, Andrew M; Rodgers, Phillip E

2018-03-01

Healthcare payment is rapidly evolving to reward value by measuring and paying for quality and spending performance. Rewarding value for the care of seriously ill patients presents unique challenges. To evaluate the state of current efforts to measure and reward value for the care of seriously ill patients. We performed a PubMed search of articles related to (1) measures of spending for people with serious illness and (2) linking spending and quality measures and rewarding performance for the care of people with serious illness. We limited our search to U.S.-based studies published in English between January 1, 1960, and March 31, 2017. We supplemented this search by identifying public programs and other known initiatives that linked quality and spending for the seriously ill and extracted key program elements. Our search related to linking spending and quality measures and rewarding performance for the care of people with serious illness yielded 277 articles. We identified three current public programs that currently link measures of quality and spending-or are likely to within the next few years-the Oncology Care Model; the Comprehensive End-Stage Renal Disease Model; and Home Health Value-Based Purchasing. Models that link quality and spending consist of four core components: (1) measuring quality, (2) measuring spending, (3) the payment adjustment model, and (4) the linking/incentive model. We found that current efforts to reward value for seriously ill patients are targeted for specific patient populations, do not broadly encourage the use of palliative care, and have not closely aligned quality and spending measures related to palliative care. We develop recommendations for policymakers and stakeholders about how measures of spending and quality can be balanced in value-based payment programs.

Linking Quality and Spending to Measure Value for People with Serious Illness

PubMed Central

Rodgers, Phillip E.

2018-01-01

Abstract Background: Healthcare payment is rapidly evolving to reward value by measuring and paying for quality and spending performance. Rewarding value for the care of seriously ill patients presents unique challenges. Objective: To evaluate the state of current efforts to measure and reward value for the care of seriously ill patients. Design: We performed a PubMed search of articles related to (1) measures of spending for people with serious illness and (2) linking spending and quality measures and rewarding performance for the care of people with serious illness. We limited our search to U.S.-based studies published in English between January 1, 1960, and March 31, 2017. We supplemented this search by identifying public programs and other known initiatives that linked quality and spending for the seriously ill and extracted key program elements. Results: Our search related to linking spending and quality measures and rewarding performance for the care of people with serious illness yielded 277 articles. We identified three current public programs that currently link measures of quality and spending—or are likely to within the next few years—the Oncology Care Model; the Comprehensive End-Stage Renal Disease Model; and Home Health Value-Based Purchasing. Models that link quality and spending consist of four core components: (1) measuring quality, (2) measuring spending, (3) the payment adjustment model, and (4) the linking/incentive model. We found that current efforts to reward value for seriously ill patients are targeted for specific patient populations, do not broadly encourage the use of palliative care, and have not closely aligned quality and spending measures related to palliative care. Conclusions: We develop recommendations for policymakers and stakeholders about how measures of spending and quality can be balanced in value-based payment programs. PMID:29091529

Medicare and Medicaid Programs; CY 2016 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Final rule.

PubMed

2015-11-05

This final rule will update Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective for episodes ending on or after January 1, 2016. As required by the Affordable Care Act, this rule implements the 3rd year of the 4-year phase-in of the rebasing adjustments to the HH PPS payment rates. This rule updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking and provides a clarification regarding the use of the "initial encounter'' seventh character applicable to certain ICD-10-CM code categories. This final rule will also finalize reductions to the national, standardized 60-day episode payment rate in CY 2016, CY 2017, and CY 2018 of 0.97 percent in each year to account for estimated case-mix growth unrelated to increases in patient acuity (nominal case-mix growth) between CY 2012 and CY 2014. In addition, this rule implements a HH value-based purchasing (HHVBP) model, beginning January 1, 2016, in which all Medicare-certified HHAs in selected states will be required to participate. Finally, this rule finalizes minor changes to the home health quality reporting program and minor technical regulations text changes.

California safety-net hospitals likely to be penalized by ACA value, readmission, and meaningful-use programs.

PubMed

Gilman, Matlin; Adams, E Kathleen; Hockenberry, Jason M; Wilson, Ira B; Milstein, Arnold S; Becker, Edmund R

2014-08-01

The Affordable Care Act includes provisions to increase the value obtained from health care spending. A growing concern among health policy experts is that new Medicare policies designed to improve the quality and efficiency of hospital care, such as value-based purchasing (VBP), the Hospital Readmissions Reduction Program (HRRP), and electronic health record (EHR) meaningful-use criteria, will disproportionately affect safety-net hospitals, which are already facing reduced disproportionate-share hospital (DSH) payments under both Medicare and Medicaid. We examined hospitals in California to determine whether safety-net institutions were more likely than others to incur penalties under these programs. To assess quality, we also examined whether mortality outcomes were different at these hospitals. Our study found that compared to non-safety-net hospitals, safety-net institutions had lower thirty-day risk-adjusted mortality rates in the period 2009-11 for acute myocardial infarction, heart failure, and pneumonia and marginally lower adjusted Medicare costs. Nonetheless, safety-net hospitals were more likely than others to be penalized under the VBP program and the HRRP and more likely not to meet EHR meaningful-use criteria. The combined effects of Medicare value-based payment policies on the financial viability of safety-net hospitals need to be considered along with DSH payment cuts as national policy makers further incorporate performance measures into the overall payment system. Project HOPE—The People-to-People Health Foundation, Inc.

Planning and development of the Better Bites program: a pricing manipulation strategy to improve healthy eating in a hospital cafeteria.

PubMed

Liebert, Mina L; Patsch, Amy J; Smith, Jennifer Howard; Behrens, Timothy K; Charles, Tami; Bailey, Taryn R

2013-07-01

The Better Bites program, a hospital cafeteria nutrition intervention strategy, was developed by combining evidence-based practices with hospital-specific formative research, including key informant interviews, the Nutrition Environment Measures Study in Restaurants, hospital employee surveys, and nutrition services staff surveys. The primary program components are pricing manipulation and marketing to promote delicious, affordable, and healthy foods to hospital employees and other cafeteria patrons. The pricing manipulation component includes decreasing the price of the healthy items and increasing the price of the unhealthy items using a 35% price differential. Point-of-purchase marketing highlights taste, cost, and health benefits of the healthy items. The program aims to increase purchases of healthy foods and decrease purchases of unhealthy foods, while maintaining revenue neutrality. This article addresses the formative research, planning, and development that informed the Better Bites program.

A randomized controlled trial of nutrition education to promote farmers' market fruit and vegetable purchases and consumption among women enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children

USDA-ARS?s Scientific Manuscript database

This report describes the protocol guiding the design and evaluation of a theory-driven, web-based lesson to promote farmers' market fruit and vegetable (FV) purchases and consumption among women enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). Designed t...

[The price-based certainty of purchase influences consumer behavior for discount].

PubMed

Arihara, Katsuhiko; Ariga, Atsunori; Furuya, Takeshi

2016-04-01

Tversky & Kahneman (1981) reported that most participants decided to drive when they could save money on a low-price good as compared to when they could save on a high-price good, even though the discount prices were same. Although this irrational decision making has been interpreted as a rate-dependent estimation of value (prospect theory), this study newly proposes that it can be explained by the certainty of purchase based on the price of goods. Experiment 1 replicated the previously reported difference in decision making, and additionally demonstrated that participants' certainty of purchase was lower for a high- than a low-price good. When it was emphasized that participants' intention to purchase high- and low-price goods were equally sure, decision making did not significantly differ (Experiment 2). Furthermore, decision making differed based only on the certainty of purchase even,when prices of goods were-same (Experiment 3). Consumers' decision making may be rather rational, depending straightforwardly on the certainty of purchase that is susceptible to price.

A General Bayesian Network Approach to Analyzing Online Game Item Values and Its Influence on Consumer Satisfaction and Purchase Intention

NASA Astrophysics Data System (ADS)

Lee, Kun Chang; Park, Bong-Won

Many online game users purchase game items with which to play free-to-play games. Because of a lack of research into which there is no specified framework for categorizing the values of game items, this study proposes four types of online game item values based on an analysis of literature regarding online game characteristics. It then proposes to investigate how online game users perceive satisfaction and purchase intention from the proposed four types of online game item values. Though regression analysis has been used frequently to answer this kind of research question, we propose a new approach, a General Bayesian Network (GBN), which can be performed in an understandable way without sacrificing predictive accuracy. Conventional techniques, such as regression analysis, do not provide significant explanation for this kind of problem because they are fixed to a linear structure and are limited in explaining why customers are likely to purchase game items and if they are satisfied with their purchases. In contrast, the proposed GBN provides a flexible underlying structure based on questionnaire survey data and offers robust decision support on this kind of research question by identifying its causal relationships. To illustrate the validity of GBN in solving the research question in this study, 327 valid questionnaires were analyzed using GBN with what-if and goal-seeking approaches. The experimental results were promising and meaningful in comparison with regression analysis results.

Foreign Exchange and Library Collections in Nigeria.

ERIC Educational Resources Information Center

Obiagwu, M. C.

1987-01-01

This discussion of the difficulties involved in acquiring materials for academic libraries in Nigeria uses statistics at one university to demonstrate the drop in foreign exchange based orders. Alternatives to overseas purchasing, including local purchasing, gifts and exchanges, and resource sharing programs, are also discussed. (CLB)

A dynamic programming-based particle swarm optimization algorithm for an inventory management problem under uncertainty

NASA Astrophysics Data System (ADS)

Xu, Jiuping; Zeng, Ziqiang; Han, Bernard; Lei, Xiao

2013-07-01

This article presents a dynamic programming-based particle swarm optimization (DP-based PSO) algorithm for solving an inventory management problem for large-scale construction projects under a fuzzy random environment. By taking into account the purchasing behaviour and strategy under rules of international bidding, a multi-objective fuzzy random dynamic programming model is constructed. To deal with the uncertainties, a hybrid crisp approach is used to transform fuzzy random parameters into fuzzy variables that are subsequently defuzzified by using an expected value operator with optimistic-pessimistic index. The iterative nature of the authors' model motivates them to develop a DP-based PSO algorithm. More specifically, their approach treats the state variables as hidden parameters. This in turn eliminates many redundant feasibility checks during initialization and particle updates at each iteration. Results and sensitivity analysis are presented to highlight the performance of the authors' optimization method, which is very effective as compared to the standard PSO algorithm.

IN PURSUIT OF AN INTERNATIONAL APPROACH TO QUALITY ASSURANCE FOR ENVIRONMENTAL TECHNOLOGY VERIFICATION

EPA Science Inventory

In the mid-1990's, the USEPA began the Environmental Technology Verification (ETV) Program in order to provide purchasers of environmental technology with independently acquired, quality-assured, test data, upon which to base their purchasing decisions. From the beginning, a str...

FRAMEWORK FOR ENVIRONMENTAL DECISION-MAKING, FRED: A TOOL FOR ENVIRONMENTALLY-PREFERABLE PURCHASING

EPA Science Inventory

In support of the Environmentally Preferable Purchasing Program of the US EPA, the Systems Analysis Branch has developed a decision-making tool based on life cycle assessment. This tool, the Framework for Responsible Environmental Decision-making or FRED streamlines LCA by choosi...

[Panorama of purchasing food products from family farmers for the Brazilian School Nutrition Program].

PubMed

Saraiva, Elisa Braga; da Silva, Ana Paula Ferreira; de Sousa, Anete Araújo; Cerqueira, Gabrielle Fernandes; Chagas, Carolina Martins dos Santos; Toral, Natacha

2013-04-01

This article seeks to describe the viewpoint of purchasing food products from family farmers, analyzing their performance within the new guidelines of the Brazilian School Nutrition Program (PNAE). It is a critical assessment based on a review of the literature and the official data provided by the National Fund for the Development of Education/Ministry of Education relating to 2010. The program budget in 2010 was approximately R$2.5 billion and attended 45.6 million children, adolescents and adults. From the total amount, R$150,397,052.68 was allocated for the purchase of agricultural products from family farmers. In Brazil, 47.4% of the local councils acquired food products from family farmers for the Brazilian School Nutrition Program and the purchase percentage was, on average, 22.7%. Given the nature of recent legislation, other aspects should be explored in order to strengthen the compliance with the regulations in different Brazilian contexts and thus contribute both to local economic development and the provision of school meals which fulfill the principles of a healthy and adequate diet.

Essays in applied microeconomics

NASA Astrophysics Data System (ADS)

Davis, Lucas William

2005-11-01

The first essay measures the impact of an outbreak of pediatric leukemia on local housing values. A model of residential location choice is used to describe conditions under which the gradient of the hedonic price function with respect to health risk is equal to household marginal willingness to pay to avoid pediatric leukemia risk. This equalizing differential is estimated using property-level sales records from a county in Nevada where residents have recently experienced a severe increase in pediatric leukemia. Housing values are compared before and after the increase with a nearby county acting as a control group. The results indicate that housing values decreased 15.6% during the period of maximum risk. Results are similar for alternative measures of risk and across houses of different sizes. With risk estimates derived using a Bayesian learning model the results imply a statistical value of pediatric leukemia of $5.6 million. The results from the paper provide some of the first market-based estimates of the value of health for children. The second essay evaluates the cost-effectiveness of public incentives that encourage households to purchase high-efficiency durable goods. The demand for durable goods and the demand for energy and other inputs are modeled jointly as the solution to a household production problem. The empirical analysis focuses on the case of clothes washers. The production technology and utilization decision are estimated using household-level data from field trials in which participants received front-loading clothes washers free of charge. The estimation strategy exploits this quasi-random replacement of washers to derive robust estimates of the utilization decision. The results indicate a price elasticity, -.06, that is statistically different from zero across specifications. The parameters from the utilization decision are used to estimate the purchase decision using data from the Consumer Expenditure Survey, 1994-2002. Households consider optimal utilization levels, purchase prices, water rates, energy rates and other factors when deciding which clothes washer to purchase. The complete model is used to simulate the effects of rebate programs and other policies on adoption patterns of clothes washers and household demand for water and energy.

Connecting plug-in vehicles with green electricity through consumer demand

NASA Astrophysics Data System (ADS)

Axsen, Jonn; Kurani, Kenneth S.

2013-03-01

The environmental benefits of plug-in electric vehicles (PEVs) increase if the vehicles are powered by electricity from ‘green’ sources such as solar, wind or small-scale hydroelectricity. Here, we explore the potential to build a market that pairs consumer purchases of PEVs with purchases of green electricity. We implement a web-based survey with three US samples defined by vehicle purchases: conventional new vehicle buyers (n = 1064), hybrid vehicle buyers (n = 364) and PEV buyers (n = 74). Respondents state their interest in a PEV as their next vehicle, in purchasing green electricity in one of three ways, i.e., monthly subscription, two-year lease or solar panel purchase, and in combining the two products. Although we find that a link between PEVs and green electricity is not presently strong in the consciousness of most consumers, the combination is attractive to some consumers when presented. Across all three respondent segments, pairing a PEV with a green electricity program increased interest in PEVs—with a 23% demand increase among buyers of conventional vehicles. Overall, about one-third of respondents presently value the combination of a PEV with green electricity; the proportion is much higher among previous HEV and PEV buyers. Respondents’ reported motives for interest in both products and their combination include financial savings (particularly among conventional buyers), concerns about air pollution and the environment, and interest in new technology (particularly among PEV buyers). The results provide guidance regarding policy and marketing strategies to advance PEVs and green electricity demand.

University of Maryland MRSEC - For Members: Purchasing

Science.gov Websites

Educational Education Pre-College Programs Homeschool Programs Undergraduate & Graduate Programs Teacher next to each file. Purchasing Policies & Procedures Purchases of products and services require pre

SNAP Benefits: Can an Adequate Benefit Be Defined?123

PubMed Central

Yaktine, Ann L.; Caswell, Julie A.

2014-01-01

The Supplemental Nutrition Assistance Program (SNAP) increases the food purchasing power of participating households. A committee convened by the Institute of Medicine (IOM) examined the question of whether it is feasible to define SNAP allotment adequacy. Total resources; individual, household, and environmental factors; and SNAP program characteristics that affect allotment adequacy were identified from a framework developed by the IOM committee. The committee concluded that it is feasible to define SNAP allotment adequacy; however, such a definition must take into account the degree to which participants’ total resources and individual, household, and environmental factors influence the purchasing power of SNAP benefits and the impact of SNAP program characteristics on the calculation of the dollar value of the SNAP allotment. The committee recommended that the USDA Food and Nutrition Service investigate ways to incorporate these factors and program characteristics into research aimed at defining allotment adequacy. PMID:24425718

Consumer peach preferences and purchasing behavior: a mixed methods study.

PubMed

Kelley, Kathleen M; Primrose, Rachel; Crassweller, Robert; Hayes, John E; Marini, Richard

2016-05-01

Peaches (Prunus persica (L.) Stokes) are grown in several regions throughout the USA, are eaten fresh, and used as ingredients in value-added processed products. An Internet survey was conducted to investigate Mid-Atlantic consumers' fresh and processed peach purchasing behaviors, and whether packaging certain numbers of peaches together, providing information about nutritional content, and other factors would increase purchases. Additionally, laboratory-based sensory testing was used to better understand peel color, texture, sweetness, sourness, and flavor preferences for cultivars commonly grown in the Mid-Atlantic region. Irrespective of fresh peach consumption frequency, certain value-added products were of interest. For some products, interest in purchasing was higher than reported purchasing behavior. Preference for certain fresh peach characteristics, such as peel color, differed between less frequent fresh peach consumers and those who consumed fresh peaches more often. Of the four peach cultivars included in the sensory test, most were liked; however, there were some cultivar differences pertaining to color, texture, sweetness, tartness, and flavor liking. Potential marketing strategies can be developed based on frequency of fresh peach consumption and household demographics. Data can be used to select peaches that best appeal to consumers. © 2015 Society of Chemical Industry. © 2015 Society of Chemical Industry.

Regional group purchasing of vaccines: review of the Pan American Health Organization EPI revolving fund and the Gulf Cooperation Council group purchasing program.

PubMed

DeRoeck, Denise; Bawazir, Saleh A; Carrasco, Peter; Kaddar, Miloud; Brooks, Alan; Fitzsimmons, John; Andrus, Jon

2006-01-01

This paper reviews the key design features, accomplishments of and lessons learned from two regional group procurement mechanisms dealing with vaccines that have been in operation for more than 25 years. The Pan American Health Organization (PAHO) EPI Revolving Fund purchases vaccines and immunization supplies on behalf of more than 35 countries in the Latin American and Caribbean region. Based on a 'central contracting' model, the program handles most aspects of procurement-from tendering to contracting with and paying producers--using a common fund to pay producers before being reimbursed by countries once goods are received in-country. The Gulf Cooperation Council (GCC) Group Purchasing Program among seven Persian Gulf States issues joint tenders for vaccines, as well as drugs and other medical goods. Through this 'group contracting' program, countries are responsible for contracting with and paying producers on their own, once the group has selected winning bids. Both programs have experienced substantial growth in the past two decades and are considered to have contributed to or accelerated achievements of immunization programs in both regions, including the introduction of new vaccines. The paper identifies several features of both programs--both those designed to attract country participation and those designed to ensure the programs' financial viability--which help explain their success and longevity.

7 CFR 1955.114 - Sales steps for program property (housing).

Code of Federal Regulations, 2010 CFR

2010-01-01

... property. (1) The following provisions apply to all offers to purchase SFH inventory property: (i) Program property will be available for purchase only by program applicants for the first 45 days from the date of... 45-day exclusive period for program applicants, program property may be purchased by offerors...

Evaluation of purchase intention of customers in two wheeler automobile segment: AHP and TOPSIS

NASA Astrophysics Data System (ADS)

Sri Yogi, Kottala

2018-03-01

Winning heart of customers is preeminent main design of any business organization in global business environment. This paper explored customer’s priorities while purchasing a two wheeler automobile segment using Analytical Hierarchy Process (AHP) and Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) as a multi criteria decision making tools to accomplish the research objectives. Study has been done to analyze different criteria to be considered during purchasing of two wheeler automobiles among respondents using structured questionnaire based on SAATY scale. Based on our previous work on empirical & fuzzy logic approach to product quality and purchase intention of customers in two wheeler- operational, performance, economic, brand value and maintenance aspects are considered as decision criteria of customers while purchasing a two wheeler. The study suggests high pick up during overtaking, petrol saving, reasonable spare parts price, unique in design and identity and easy to change gear as main criterion in purchasing process. We also found some leading two wheeler automobiles models available in Indian market using some objective function criterion in choosing some important characteristics like price, cylinder capacity, brake horse power and weight during purchasing process of two wheeler automobile in Indian market based on respondents perception.

Public provision of four-wheeled walkers: contingent valuation study of economic benefit.

PubMed

Haines, Terry; Brown, Cassandra; Morrison, Jan

2008-09-01

To quantify the economic value of publicly provided four-wheeled walkers as judged by recipients in Queensland, Australia. Contingent valuation study using willingness-to-pay approach. A sample of 49 Australian older adults who received a publicly funded four-wheeled walker in the past 3 months completed the survey via telephone. A discrete choice bidding response format with a randomly selected starting bid was employed to glean valuations. This approach yielded only one non-response, and one zero dollar response. The mean (standard deviation) valuation provided was $ A 290 ($ A 167), which was $ A 84 in excess of the price paid by the public provider agency to purchase the equipment. Starting bid was significantly associated with values provided. The current public provision program of four-wheeled walkers is likely to generate net societal benefit. These findings coupled with arguments based on equity build a moderate case for the continuation of this program.

Case management's value is finally recognized. What happens now? .

PubMed

2015-10-01

In recent years, case management has been recognized as a key in improving healthcare quality and reducing costs, but while hospitals are giving case managers more responsibilities, many administrators are not approving an increase in staff to handle the extra work. Case managers can help their hospital succeed with the Centers for Medicare & Medicaid Services' Value-based Purchasing program, the readmission reduction program, and bundled payments. Case management directors should make sure the hospital's senior leadership understands the roles and responsibilities of case managers and how their interventions can affect outcomes and the bottom line. The number of caseloads depends on the case management model, the responsibilities of case managers, and whether they have assistants or case management extenders who can take over some tasks and allow the licensed staff to work at the top of their licenses. Don't let technology replace communication and patient-centered interactions.

7 CFR 1467.3 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Conservation Service or the person delegated authority to act for the Chief. Commenced conversion wetland means... protection of wetland functions and values, including necessary activities, as set forth in the Wetlands... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS WETLANDS RESERVE PROGRAM § 1467.3 Definitions. The...

7 CFR 1467.3 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Conservation Service or the person delegated authority to act for the Chief. Commenced conversion wetland means... protection of wetland functions and values, including necessary activities, as set forth in the Wetlands... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS WETLANDS RESERVE PROGRAM § 1467.3 Definitions. The...

7 CFR 1467.3 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Conservation Service or the person delegated authority to act for the Chief. Commenced conversion wetland means... protection of wetland functions and values, including necessary activities, as set forth in the Wetlands... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS WETLANDS RESERVE PROGRAM § 1467.3 Definitions. The...

7 CFR 1467.7 - Enrollment process.

Code of Federal Regulations, 2010 CFR

2010-01-01

... which provides for the restoration and protection of the functions and values of wetlands; (iii... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS WETLANDS RESERVE PROGRAM § 1467.7 Enrollment process. (a... easement acquisition activities after the property has been enrolled. (2) Restoration cost-share agreement...

7 CFR 1467.7 - Enrollment process.

Code of Federal Regulations, 2011 CFR

2011-01-01

... which provides for the restoration and protection of the functions and values of wetlands; (iii... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS WETLANDS RESERVE PROGRAM § 1467.7 Enrollment process. (a... easement acquisition activities after the property has been enrolled. (2) Restoration cost-share agreement...

24 CFR 291.545 - Financing purchase of the home.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 2 2013-04-01 2013-04-01 false Financing purchase of the home. 291... Neighbor Next Door Sales Program § 291.545 Financing purchase of the home. (a) Purchase using conventional... conventional financing to purchase a home under the GNND Sales Program, the amount of the mortgage may not...

24 CFR 291.545 - Financing purchase of the home.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Financing purchase of the home. 291... Neighbor Next Door Sales Program § 291.545 Financing purchase of the home. (a) Purchase using conventional... conventional financing to purchase a home under the GNND Sales Program, the amount of the mortgage may not...

24 CFR 291.545 - Financing purchase of the home.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 2 2011-04-01 2011-04-01 false Financing purchase of the home. 291... Neighbor Next Door Sales Program § 291.545 Financing purchase of the home. (a) Purchase using conventional... conventional financing to purchase a home under the GNND Sales Program, the amount of the mortgage may not...

24 CFR 291.545 - Financing purchase of the home.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 24 Housing and Urban Development 2 2014-04-01 2014-04-01 false Financing purchase of the home. 291... Neighbor Next Door Sales Program § 291.545 Financing purchase of the home. (a) Purchase using conventional... conventional financing to purchase a home under the GNND Sales Program, the amount of the mortgage may not...

24 CFR 291.545 - Financing purchase of the home.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 2 2012-04-01 2012-04-01 false Financing purchase of the home. 291... Neighbor Next Door Sales Program § 291.545 Financing purchase of the home. (a) Purchase using conventional... conventional financing to purchase a home under the GNND Sales Program, the amount of the mortgage may not...

7 CFR 1435.602 - Eligible sugar to be purchased by CCC.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 10 2014-01-01 2014-01-01 false Eligible sugar to be purchased by CCC. 1435.602... CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS SUGAR PROGRAM Feedstock Flexibility Program § 1435.602 Eligible sugar to be purchased by CCC. (a) CCC will only purchase raw sugar...

Expected value analysis for integrated supplier selection and inventory control of multi-product inventory system with fuzzy cost

NASA Astrophysics Data System (ADS)

Sutrisno, Widowati, Tjahjana, R. Heru

2017-12-01

The future cost in many industrial problem is obviously uncertain. Then a mathematical analysis for a problem with uncertain cost is needed. In this article, we deals with the fuzzy expected value analysis to solve an integrated supplier selection and supplier selection problem with uncertain cost where the costs uncertainty is approached by a fuzzy variable. We formulate the mathematical model of the problems fuzzy expected value based quadratic optimization with total cost objective function and solve it by using expected value based fuzzy programming. From the numerical examples result performed by the authors, the supplier selection problem was solved i.e. the optimal supplier was selected for each time period where the optimal product volume of all product that should be purchased from each supplier for each time period was determined and the product stock level was controlled as decided by the authors i.e. it was followed the given reference level.

Medicare and Medicaid Programs; CY 2017 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Final rule.

PubMed

2016-11-03

This final rule updates the Home Health Prospective Payment System (HH PPS) payment rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor; effective for home health episodes of care ending on or after January 1, 2017. This rule also: Implements the last year of the 4-year phase-in of the rebasing adjustments to the HH PPS payment rates; updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking; implements the 2nd-year of a 3-year phase-in of a reduction to the national, standardized 60-day episode payment to account for estimated case-mix growth unrelated to increases in patient acuity (that is, nominal case-mix growth) between CY 2012 and CY 2014; finalizes changes to the methodology used to calculate payments made under the HH PPS for high-cost "outlier" episodes of care; implements changes in payment for furnishing Negative Pressure Wound Therapy (NPWT) using a disposable device for patients under a home health plan of care; discusses our efforts to monitor the potential impacts of the rebasing adjustments; includes an update on subsequent research and analysis as a result of the findings from the home health study; and finalizes changes to the Home Health Value-Based Purchasing (HHVBP) Model, which was implemented on January 1, 2016; and updates to the Home Health Quality Reporting Program (HH QRP).

48 CFR 313.301 - Government-wide commercial purchase card.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., Appendix B, “Improving the Management of Government Charge Card Programs;” GSA's SmartPay Program guidance; and HHS Purchase Card program standards. (2) The OPDIVs, through their designated Agency/Organization... training requirements to ensure effective implementation of the HHS purchase card program. (3) OPDIVs shall...

24 CFR 291.515 - Purchaser qualifications.

Code of Federal Regulations, 2010 CFR

2010-04-01

... in § 291.530) at the time he/she submits a bid to purchase a home through the program and at the time of closing on the purchase of the home; (b) The person must certify to his/her good faith intention... Next Door Sales Program § 291.515 Purchaser qualifications. To qualify to purchase a home through the...

24 CFR 906.15 - Requirements applicable to a family purchasing a property under a homeownership program.

Code of Federal Regulations, 2010 CFR

2010-04-01

... purchasing a property under a homeownership program. 906.15 Section 906.15 Housing and Urban Development... Purchaser Requirements § 906.15 Requirements applicable to a family purchasing a property under a... resident occupying the unit under § 906.13, a family purchasing a property under a PHA homeownership...

Corner Store Purchases in a Low-Income Urban Community in NYC.

PubMed

Kiszko, Kamila; Cantor, Jonathan; Abrams, Courtney; Ruddock, Charmaine; Moltzen, Kelly; Devia, Carlos; McFarline, Bernice; Singh, Hardeep; Elbel, Brian

2015-12-01

We assessed purchases made, motivations for shopping, and frequency of shopping at four New York City corner stores (bodegas). Surveys and purchase inventories (n = 779) were collected from consumers at four bodegas in Bronx, NY. We use Chi square tests to compare types of consumers, items purchased and characteristics of purchases based on how frequently the consumer shops at the specific store and the time of day the purchase was made. Most consumers shopped at the bodega because it was close to their home (52 %). The majority (68 %) reported shopping at the bodega at least once per day. The five most commonly purchased items were sugary beverages, (29.27 %), sugary snacks (22.34 %), coffee, (13.99 %), sandwiches, (13.09 %) and non-baked potato chips (12.2 %). Nearly 60 % of bodega customers reported their purchase to be healthy. Most of the participants shopped at the bodega frequently, valued its convenient location, and purchased unhealthy items. Work is needed to discover ways to encourage healthier choices at these stores.

Making Wise Buys: Five Values to Consider when Evaluating a Library Purchase

ERIC Educational Resources Information Center

Durr, Chris

2011-01-01

Library staff members should ultimately base their purchasing choices on the mission statements of their employing institutions. Fortunately, library mission statements have much in common. Undoubtedly, for example, all libraries have a goal that includes "serve the information needs of the community," because on some level, all libraries are…

A Community-Based Marketing Campaign at Farmers Markets to Encourage Fruit and Vegetable Purchases in Rural Counties With High Rates of Obesity, Kentucky, 2015-2016.

PubMed

DeWitt, Emily; McGladrey, Margaret; Liu, Emily; Peritore, Nicole; Webber, Kelly; Butterworth, Brooke; Vail, Ann; Gustafson, Alison

2017-08-31

Availability of farmers markets may increase fruit and vegetable consumption among rural residents of the United States. We conducted a community-based marketing campaign, Plate it Up Kentucky Proud (PIUKP), in 6 rural communities over 2 years to determine the association between exposure to the campaign and fruit and vegetable purchases, adjusted for Supplemental Nutrition Assistance Program recipient status. Logistic regression was used to examine the odds of the PIUKP campaign influencing purchases. Awareness of the PIUKP marketing campaign was significantly associated with a willingness to prepare fruits and vegetables at home. Using marketing strategies at farmers markets may be an effective way to improve fruit and vegetable purchases in rural communities.

7 CFR 1467.12 - The WRPO development.

Code of Federal Regulations, 2011 CFR

2011-01-01

... OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS WETLANDS RESERVE PROGRAM § 1467.12 The WRPO... WRPO will be developed to ensure that cost-effective restoration and maximization of wildlife benefits and wetland functions and values will result. Specifically, the WRPO will consider and address, to the...

7 CFR 1467.12 - The WRPO development.

Code of Federal Regulations, 2010 CFR

2010-01-01

... OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS WETLANDS RESERVE PROGRAM § 1467.12 The WRPO... WRPO will be developed to ensure that cost-effective restoration and maximization of wildlife benefits and wetland functions and values will result. Specifically, the WRPO will consider and address, to the...

7 CFR 1467.15 - Violations and remedies.

Code of Federal Regulations, 2011 CFR

2011-01-01

... OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS WETLANDS RESERVE PROGRAM § 1467.15 Violations... contract, or any restoration cost-share agreement involving the participant, the participant shall be given... important wetland functions and values or other rights of the United States under the easement. The...

7 CFR 1467.15 - Violations and remedies.

Code of Federal Regulations, 2010 CFR

2010-01-01

... OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS WETLANDS RESERVE PROGRAM § 1467.15 Violations... contract, or any restoration cost-share agreement involving the participant, the participant shall be given... important wetland functions and values or other rights of the United States under the easement. The...

Medicare Payment Penalties and Safety Net Hospital Profitability: Minimal Impact on These Vulnerable Hospitals.

PubMed

Bazzoli, Gloria J; Thompson, Michael P; Waters, Teresa M

2018-02-08

To examine relationships between penalties assessed by Medicare's Hospital Readmission Reduction Program and Value-Based Purchasing Program and hospital financial condition. Centers for Medicare and Medicaid Services, American Hospital Association, and Area Health Resource File data for 4,824 hospital-year observations. Bivariate and multivariate analysis of pooled cross-sectional data. Safety net hospitals have significantly higher HRRP/VBP penalties, but, unlike nonsafety net hospitals, increases in their penalty rate did not significantly affect their total margins. Safety net hospitals appear to rely on nonpatient care revenues to offset higher penalties for the years studied. While reassuring, these funding streams are volatile and may not be able to compensate for cumulative losses over time. © Health Research and Educational Trust.

12 CFR 652.35 - Eligible non-program investments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... investments. All eligible investments, except money market instruments, must be readily marketable. An... value in an active and universally recognized secondary market. You must evaluate and document the size and liquidity of the secondary market for the investment at time of purchase. (d) Obligor limits. (1...

12 CFR 652.35 - Eligible non-program investments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... investments. All eligible investments, except money market instruments, must be readily marketable. An... value in an active and universally recognized secondary market. You must evaluate and document the size and liquidity of the secondary market for the investment at time of purchase. (d) Obligor limits. (1...

12 CFR 652.35 - Eligible non-program investments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... investments. All eligible investments, except money market instruments, must be readily marketable. An... value in an active and universally recognized secondary market. You must evaluate and document the size and liquidity of the secondary market for the investment at time of purchase. (d) Obligor limits. (1...

Pay for performance in thoracic surgery.

PubMed

Varela, Gonzalo

2007-08-01

In the context of improving the quality of the medical practice, PFP programs have been developed to reward best medical practice. Early studies showed little gain in quality after implementing PFP family practice programs and some unintended consequences, like excluding high-risk patients from medical services when good outcomes were linked to payment. To date, no PFP programs have been implemented in surgical practice, but it is expected that value-based purchasing philosophy will be extended to surgical specialties in the near future. Quality initiatives in surgery can be based on outcome or process measures. Outcomes-focused quality approaches rely on accurate information obtained from multiinstitutional clinical databases for calculation of risk-adjusted models. Primary outcomes such surgical mortality are uncommon in modern thoracic surgery and outcome measures should rely on more prevalent intermediate outcomes such as specific postoperative morbidities or emergency readmission. Process-based quality approaches need to be based on scientific evidence linking process to outcomes. It is our responsibility to develop practice guidelines or international practice consensus to facilitate the parameters to be evaluated in the near future.

24 CFR 291.565 - Continuing obligations after purchase.

Code of Federal Regulations, 2010 CFR

2010-04-01

... purchase. 291.565 Section 291.565 Housing and Urban Development Regulations Relating to Housing and Urban... Neighbor Next Door Sales Program § 291.565 Continuing obligations after purchase. To remain in compliance.../her sole residence, the home purchased through the GNND Sales Program; and (b) Certify initially and...

42 CFR § 484.325 - Payments for home health services under Home Health Value-Based Purchasing (HHVBP) Model.

Code of Federal Regulations, 2010 CFR

2017-10-01

... Purchasing (HHVBP) Model. CMS will determine a payment adjustment up to the maximum applicable percentage... Total Performance Score using a linear exchange function. Payment adjustments made under the HHVBP Model... 42 Public Health 5 2017-10-01 2017-10-01 false Payments for home health services under Home Health...

42 CFR § 484.325 - Payments for home health services under Home Health Value-Based Purchasing (HHVBP) Model.

Code of Federal Regulations, 2010 CFR

2016-10-01

... Purchasing (HHVBP) Model. CMS will determine a payment adjustment up to the maximum applicable percentage... Total Performance Score using a linear exchange function. Payment adjustments made under the HHVBP Model... 42 Public Health 5 2016-10-01 2016-10-01 false Payments for home health services under Home Health...

An approach to value-based simulator selection: The creation and evaluation of the simulator value index tool.

PubMed

Rooney, Deborah M; Hananel, David M; Covington, Benjamin J; Dionise, Patrick L; Nykamp, Michael T; Pederson, Melvin; Sahloul, Jamal M; Vasquez, Rachael; Seagull, F Jacob; Pinsky, Harold M; Sweier, Domenica G; Cooke, James M

2018-04-01

Currently there is no reliable, standardized mechanism to support health care professionals during the evaluation of and procurement processes for simulators. A tool founded on best practices could facilitate simulator purchase processes. In a 3-phase process, we identified top factors considered during the simulator purchase process through expert consensus (n = 127), created the Simulator Value Index (SVI) tool, evaluated targeted validity evidence, and evaluated the practical value of this SVI. A web-based survey was sent to simulation professionals. Participants (n = 79) used the SVI and provided feedback. We evaluated the practical value of 4 tool variations by calculating their sensitivity to predict a preferred simulator. Seventeen top factors were identified and ranked. The top 2 were technical stability/reliability of the simulator and customer service, with no practical differences in rank across institution or stakeholder role. Full SVI variations predicted successfully the preferred simulator with good (87%) sensitivity, whereas the sensitivity of variations in cost and customer service and cost and technical stability decreased (≤54%). The majority (73%) of participants agreed that the SVI was helpful at guiding simulator purchase decisions, and 88% agreed the SVI tool would help facilitate discussion with peers and leadership. Our findings indicate the SVI supports the process of simulator purchase using a standardized framework. Sensitivity of the tool improved when factors extend beyond traditionally targeted factors. We propose the tool will facilitate discussion amongst simulation professionals dealing with simulation, provide essential information for finance and procurement professionals, and improve the long-term value of simulation solutions. Limitations and application of the tool are discussed. Copyright © 2017 Elsevier Inc. All rights reserved.

Effects of a food advertising literacy intervention on Taiwanese children's food purchasing behaviors.

PubMed

Liao, Li-Ling; Lai, I-Ju; Chang, Li-Chun; Lee, Chia-Kuei

2016-08-01

Unhealthy food advertising is an important contributor to childhood obesity. The purpose of this pilot study was to evaluate the impact of a food advertising literacy program that incorporated components of health-promoting media literacy education on fifth-grade children. Participants were 140 fifth-graders (10 and 11 years old) from one school who were randomly divided into three groups. Experimental Group A received a food advertising literacy program, experimental Group B received a comparable knowledge-based nutrition education program and the control group did not receive any nutrition education. Repeated measures analysis of variance and multivariate analysis of covariance were used to test mean changes between pretest, posttest and follow-up on participants' nutritional knowledge, food advertising literacy and food purchasing behavior. Results showed that, as compared with Group B and the control groups, Group A showed higher nutritional knowledge, food advertising literacy and food purchasing behavior at post-intervention, but had no significant improvements in nutritional knowledge and food purchasing behavior at the 1-month follow-up. Although some improvements were observed, future studies should consider a long-term, settings-based approach that is closely connected with children's daily lives, as this might be helpful to solidify children's skills in recognizing, evaluating and understanding unhealthy food advertising. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Something of Value: How Franchise Sellers Make Training Pay

ERIC Educational Resources Information Center

Berger, Gladys

1975-01-01

Training can be the most important benefit included in the purchase of a franchise. Several of these training programs used by franchise sellers (Castro Convertibles, Roto-Rooter, H and R Block, Dunhill Personnel Systems Inc., Carvel, Holiday Inns, Sheraton Inns Inc., McDonald's) are discussed. (Author/BP)

School Insurance.

ERIC Educational Resources Information Center

1964

The importance of insurance in the school budget is the theme of this comprehensive bulletin on the practices and policies for Texas school districts. Also considered is the development of desirable school board policies in purchasing insurance and operating the program. Areas of discussion are: risks to be covered, amount of coverage, values,…

44 CFR 79.7 - Offers and appeals under the SRL program.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., and shall continue throughout the process. After FEMA awards the project grant, the subgrantee shall...), the responsibilities of and benefits to the property owner, a summary of the consultation process... the market value of the property, the basis for the purchase offer, and the final offer amount. The...

Your loyalty program is betraying you.

PubMed

Nunes, Joseph C; Drèze, Xavier

2006-04-01

Even as loyalty programs are launched left and right, many are being scuttled. How can that be? These days, everyone knows that an old customer retained is worth more than a new customer won. What is so hard about making a simple loyalty program work? Quite a lot, the authors say. The biggest challenges include clarifying business goals, engineering the reward structure, and creating incentives powerful enough to change buying behavior but not so generous that they erode margins. Additionally, companies have to sort out the puzzles of consumer psychology, which can result, for example, in two rewards of equal economic value inspiring very different levels of purchasing. In their research, the authors have discovered patterns in what the successful loyalty programs get right and in how the others fail. Together, their findings constitute a tool kit for designing something rare indeed: a program that won't do you wrong. To begin with, it's important to know exactly what a loyalty program can do. It can keep customers from defecting, induce them to consolidate certain purchases with one seller (in other words, win a greater share of wallet), prompt customers to make additional purchases, yield insight into their behavior and preferences, and turn a profit. A program can meet these objectives in several ways--for instance, by offering rewards (points, say, or frequent-flier miles) divisible enough to provide many redemption opportunities but not so divisible that they fail to lock in customers. Companies striving to generate customer loyalty should avoid five common mistakes: Don't create a new commodity, which can result in price wars and other tit-for-tat competitive moves; don't cater to the disloyal by making rewards easy for just anyone to reap; don't reward purchasing volume over profitability; don't give away the store; and, finally, don't promise what can't be delivered.

Benefits of High-Intensity Intensive Care Unit Physician Staffing under the Affordable Care Act

PubMed Central

Logani, Sachin; Green, Adam; Gasperino, James

2011-01-01

The Affordable Care Act signed into law by President Obama, with its value-based purchasing program, is designed to link payment to quality processes and outcomes. Treatment of critically ill patients represents nearly 1% of the gross domestic product and 25% of a typical hospital budget. Data suggest that high-intensity staffing patterns in the intensive care unit (ICU) are associated with cost savings and improved outcomes. We evaluate the literature investigating the cost-effectiveness and clinical outcomes of high-intensity ICU physician staffing as recommended by The Leapfrog Group (a consortium of companies that purchase health care for their employees) and identify ways to overcome barriers to nationwide implementation of these standards. Hospitals that have implemented the Leapfrog initiative have demonstrated reductions in mortality and length of stay and increased cost savings. High-intensity staffing models appear to be an immediate cost-effective way for hospitals to meet the challenges of health care reform. PMID:22110908

Double Up Food Bucks program effects on SNAP recipients' fruit and vegetable purchases.

PubMed

Steele-Adjognon, Marie; Weatherspoon, Dave

2017-12-12

To encourage the consumption of more fresh fruits and vegetables, the 2014 United Sates Farm Bill allocated funds to the Double Up Food Bucks Program. This program provided Supplemental Nutrition Assistance Program beneficiaries who spent $10 on fresh fruits and vegetables, in one transaction, with a $10 gift card exclusively for Michigan grown fresh fruits and vegetables. This study analyzes how fruit and vegetable expenditures, expenditure shares, variety and purchase decisions were affected by the initiation and conclusion, as well as any persistent effects of the program. Changes in fruit and vegetable purchase behaviors due to Double Up Food Bucks in a supermarket serving a low-income, predominantly Hispanic community in Detroit, Michigan were evaluated using a difference in difference fixed effects estimation strategy. We find that the Double Up Food Bucks program increased vegetable expenditures, fruit and vegetable expenditure shares, and variety of fruits and vegetables purchased but the effects were modest and not sustainable without the financial incentive. Fruit expenditures and the fruit and vegetable purchase decision were unaffected by the program. This study provides valuable insight on how a nutrition program influences a low-income, urban, Hispanic community's fruit and vegetable purchase behavior. Policy recommendations include either removing or lowering the purchase hurdle for incentive eligibility and dropping the Michigan grown requirement to better align with the customers' preferences for fresh fruits and vegetables.

Reductions in High-End Imaging Utilization With Radiology Review and Consultation.

PubMed

Ingraham, Bailey; Miller, Kristen; Iaia, Alberto; Sneider, Michael B; Naqvi, Shabbir; Evans, Kimberly; Gheyi, Vinay; Anzilotti, Kert

2016-09-01

Following the uptake of value-based purchasing in concert with health care reform in the United States, providers, insurers, and patients are looking for ways to reduce excessive, dangerous, and/or inappropriate high-end imaging utilization (HEIU). Inappropriate HEIU is associated with patient safety risks due to unnecessary exposure to radiation, misappropriation of scarce equipment resources and staff, complications to clinical care, and needless, excessive costs for the patient, hospital, and payer. This paper presents a cost-effective radiology-initiated improvement program piloted in the Christiana Hospital Coordinated Care Network. The pilot demonstrated the effectiveness of regulating high-end imaging orders through radiologists' review of requests of the order as part of the consult process. Over the 2014-2015 fiscal year, 2,177 high-end imaging orders were reviewed by 26 radiologists for approval, rejection, or recommendation of an alternate examination. Of the orders, 86.7% (1887) were approved, 4.0% (87) were rejected, and 9.3% (203) received recommendation for an alternate examination. Based on improved patient safety, cost savings, and appropriate resource use, these findings suggest that radiologists' review can effectively reduce excessive HEIU. This method, with an appropriate algorithm to assist with handling a larger volume of orders, would be ideal to implement systemwide to manage HEIU cost efficiency, simultaneously providing radiologists with more control in their area of expertise and positively impacting quality, safety, and value-based purchasing goals. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

The effect of proportional v. value pricing on fountain drink purchases: results from a field experiment.

PubMed

Gollust, Sarah E; Tang, Xuyang; Runge, Carlisle Ford; French, Simone A; Rothman, Alexander J

2018-05-15

Reducing sugar-sweetened beverage consumption is a public health priority, yet finding an effective and acceptable policy intervention is challenging. One strategy is to use proportional pricing (a consistent price per fluid ounce) instead of the typical value-priced approach where large beverages offer better value. The purpose of the present study was to evaluate whether proportional pricing affects the purchasing of fountain beverages at a university cinema concession stand. Four price strategies for beverages were evaluated over ten weekends of film screenings. We manipulated two factors: the price structure (value pricing v. proportional pricing) and the provision of information about the price per fluid ounce (labels v. no labels). The key outcomes were the number and size of beverages purchased. We analysed data using regression analyses, with standard errors clustered by film and controlling for the day and time of purchase. A university cinema concession stand in Minnesota, USA, in spring 2015. University students. Over the study period (360 beverages purchased) there were no significant effects of the proportional pricing treatment. Pairing a label with the standard value pricing increased the likelihood of purchasing large drinks but the label did not affect purchasing when paired with proportional pricing. Proportional prices did not significantly affect the size of beverages purchased by students at a university cinema, but adding a price-per-ounce label increased large drink purchases when drinks were value-priced. More work is needed to address whether pricing and labelling strategies might promote healthier beverage purchases.

The Path to Savings: Understanding the Federal Purchase of Energy-Consuming Products

DOE Office of Scientific and Technical Information (OSTI.GOV)

Taylor, Margaret; Fujita, K. Sydny

Energy efficiency has been a federal procurement policy objective since at least 1992, with the origin of the Energy Efficient Product Procurement (EEPP) program within the larger Federal Energy Management Program (FEMP). Today, the EEPP program’s mandate is based on requirements that 95% of new contract actions, task orders, and delivery orders for products and services be energy and water efficient, as laid out in Executive Order 13514 in 2009. Facilitating full compliance with EO 13514 presents a significant strategic planning challenge to the FEMP EEPP program, given the size of the federal government, the range of missions of itsmore » many agencies, the mix of management approaches for its buildings, and the diverse set of roughly 80 energy efficient products which has been established through preceding legislation and executive orders. The goal of this report is to aid the program in prioritizing its resources by providing an overview of how the purchase of energy-consuming products occurs in today’s evolving federal procurement system, as well as identify likely intervention points and compliance review mechanisms. Through a synthesis of the literature on U.S. federal sector procurement and two dozen primary interviews, the report particularly focuses on the importance of price in determining the actor(s) responsible for any given purchase of an energy-consuming product. This identification is important, as the relevant actors are trained and reviewed in different ways that the FEMP EEPP program can prioritize for targeting, based on the decision criteria such as the potential energy savings associated with the actor’s purchases or the administrative ease of the intervention.« less

17 CFR 240.3b-13 - Definition of eligible OTC derivative instrument.

Code of Federal Regulations, 2012 CFR

2012-04-01

... purchase or sale of a security on a firm basis; or (2) Provides, in whole or in part, on a firm or... derivative instrument means any contract, agreement, or transaction that: (1) Provides, in whole or in part, on a firm or contingent basis, for the purchase or sale of, or is based on the value of, or any...

17 CFR 240.3b-13 - Definition of eligible OTC derivative instrument.

Code of Federal Regulations, 2013 CFR

2013-04-01

... purchase or sale of a security on a firm basis; or (2) Provides, in whole or in part, on a firm or... derivative instrument means any contract, agreement, or transaction that: (1) Provides, in whole or in part, on a firm or contingent basis, for the purchase or sale of, or is based on the value of, or any...

17 CFR 240.3b-13 - Definition of eligible OTC derivative instrument.

Code of Federal Regulations, 2014 CFR

2014-04-01

... purchase or sale of a security on a firm basis; or (2) Provides, in whole or in part, on a firm or... derivative instrument means any contract, agreement, or transaction that: (1) Provides, in whole or in part, on a firm or contingent basis, for the purchase or sale of, or is based on the value of, or any...

Proposal of a New SI Base Unit for Value. An Hedonic Estimation of the Physical Purchasing Power (PhPP) of Money.

NASA Astrophysics Data System (ADS)

Defilla, Steivan

2006-03-01

Hitherto, the purchasing power of money, i.e. its transaction value, has been measured in terms of inflation index numbers and consumer baskets. Consumer baskets are variable phenomena and their use as measurement units for value confuses the measuring with the measurand. We propose an invariant numeraire, or value unit, based on the market value of a Planck energy (1956 MJ). Planck units form a natural system of units independent of any civilization. The hedonic estimation of the PhPP of a currency differentiates energy by product as well as by thermodynamic quality (exergy). Following SI rules, we propose to name the value unit walras (Wal) in honour of the economist Leon Walras (1834 - 1910). One Wal can also be interpreted as the minimum cost of physiological life of a reference person during one year. The study uses official disaggregated Swiss Producer and Consumer Price Index data and estimates the PhPP of the Swiss franc in 2003.

Improving Adherence to Mediterranean-Style Diet With a Community Culinary Coaching Program: Methodology Development and Process Evaluation.

PubMed

Polak, Rani; Pober, David; Morris, Avigail; Arieli, Rakefet; Moore, Margaret; Berry, Elliot; Ziv, Mati

The Community Culinary Coaching Program is a community-based participatory program aimed at improving communal settlement residents' nutrition. The residents, central kitchens, preschools, and communal dining rooms were identified as areas for intervention. Evaluation included goals accomplishment assessed by food purchases by the central kitchens, and residents' feedback through focus groups. Purchasing included more vegetables (mean (standard error) percent change), (+7% (4); P = .32), fish (+115% (11); P < .001), whole grains, and legumes (+77% (9); P < .001); and less soup powders (-40% (9); P < .05), processed beef (-55% (8); P < .001), and margarine (-100% (4); P < .001). Residents recommended continuing the program beyond the project duration. This model might be useful in organizations with communal dining facilities.

Demographics and beef preferences affect consumer motivation for purchasing fresh beef steaks and roasts.

PubMed

Reicks, A L; Brooks, J C; Garmyn, A J; Thompson, L D; Lyford, C L; Miller, M F

2011-04-01

Surveys completed by 1370 consumers determined the motivational factors affecting consumer purchasing decisions for fresh beef steaks and roasts in three regions in the United States. Females placed greater importance on tenderness, ease of preparation, and nutritional value of steaks and roasts when compared to males. Age influenced tenderness, product consistency, and nutritional value of steaks, but influenced flavor, product consistency, and nutritional value of roasts. Consumers felt juiciness, nutritional value, and natural products were less important in determining their purchasing choices of steaks and roasts as their level of education increased. The preferred degree of doneness of steaks influenced the value placed on six of the nine purchasing motivators. Beef preferences and demographics influenced consumer purchasing decisions for fresh beef steaks and roasts. Results from this study can be used to help identify factors to positively influence purchasing decisions within targeted market segments. © 2010 The American Meat Science Association. Published by Elsevier Ltd. All rights reserved.

Pawtucket Heart Health Program Point-of-Purchase Nutrition Education Program in Supermarkets.

ERIC Educational Resources Information Center

Hunt, Mary K.; And Others

1990-01-01

Evaluates a point-of-purchase nutrition education program in Pawtucket (Rhode Island). Uses consumer interviews to evaluate the effect of awareness of shelf labels on purchase behavior. Reports increases in shoppers' ability to identify correct shelf labels and in the number of shoppers who were encouraged to buy the identified foods. (FMW)

Purchases of ready-to-eat cereals vary across US household sociodemographic categories according to nutritional value and advertising targets.

PubMed

Castetbon, Katia; Harris, Jennifer L; Schwartz, Marlene B

2012-08-01

To describe ready-to-eat (RTE) cereal purchases in 2008 in the USA according to cereal nutritional quality and marketing strategy and household sociodemographic characteristics. Cross-sectional study of purchases in one year. Each type of cereal was assigned to one of four nutrition quality categories (based on Nutrient Profile Index, NPI) and one of four advertising categories based on television exposure and analysis of packaging (child-targeted, family-targeted, adult-targeted and no television advertising). Medians and distributions of purchase indicators were calculated for the cereal categories and the distributions were compared across sociodemographic groups. RTE cereals (n 249) with complete label and nutritional content. RTE cereal purchases according to household sociodemographic characteristics obtained from Nielsen Homescan, a nationally representative panel of households. Purchases of RTE cereals were highest in households with one or more child and lowest in African-American and Asian households, as well as those earning <$US 30 000 per annum. The lowest-quality products were purchased by four times as many households as the highest-quality cereals, but loyalty to these products was lower. Purchases of cereals by households with children and in African-American and Hispanic households increased as cereal nutritional quality declined. Compared with non-advertised products, advertised child-targeted cereals were purchased thirteen times more frequently; family-targeted brand purchases were ten times higher; and adult-targeted cereals were purchased four times more frequently. Our findings suggest that improving the nutritional quality of RTE cereals with advertising targeted to children could also lead to increased consumption of healthier products by young people.

17 CFR 270.23c-1 - Repurchase of securities by closed-end companies.

Code of Federal Regulations, 2010 CFR

2010-04-01

... issuer. (5) Payment of the purchase price is accompanied or preceded by a written confirmation of the purchase. (6) The purchase is made at a price not above the market value, if any, or the asset value of..., within the preceding six months, informed stockholders of its intention to purchase stock of such class...

Providing Affordable Housing: Small Communities Benefit from Upgrading Dilapidated Homes.

ERIC Educational Resources Information Center

Hestekin, Kay

1991-01-01

Describes the Affordable Housing Opportunities Program (AHOP) created by the Eau Claire County Housing Authority in Wisconsin. The AHOP buys, renovates, and sells homes for prices below fair market value. This provides safe, sanitary housing for families who could not otherwise afford it. Describes the purchase, renovation, and sale of four…

THE ROLE OF CONSUMER VALUES AND SOCIO-DEMOGRAPHICS IN GREEN PRODUCT SATISFACTION: THE CASE OF HYBRID CARS.

PubMed

Hur, Won-Moo; Woo, Jeong; Kim, Yeonshin

2015-10-01

This study investigated the relationship between consumer value and customer satisfaction, seeking a better understanding of the motivations underlying "green product" purchases. Based on the influence of demographic factors, it further explores the moderation effects of buyers' socio-demographics on the link between value and satisfaction. Data were collected through a mail survey of American hybrid car buyers. Consumer value, satisfaction, and socio-demographic information were measured, and the proposed relationships among them were tested using hierarchical multiple regression analysis. This study's findings reveal that values (i.e., functional and social) significantly impact hybrid satisfaction and that the effects vary by sex and age. This research provides insight into the motivations of green product purchases by incorporating important consumer characteristics.

Hospital Value-Based Purchasing: The Association Between Patient Experience and Clinical Outcome.

PubMed

Haley, D Rob; Hamadi, Hanadi; Zhao, Mei; Xu, Jing; Wang, Yi

The Affordable Care Act of 2010 introduced a Hospital Value-Based Purchasing Total Performance Score for payment purposes and to evaluate hospital quality of care. In fiscal year 2016, Total Performance Score was composed of (1) Clinical Processes of Care, (2) Patient Experience of Care, (3) Outcome, and (4) Efficiency domains. The objective of this study was to examine the association between the Patient Experience of Care and Outcome domains. The Donabedian model of structure, process, and outcome was used as a conceptual framework for this study. Data from the 2015-2016 Area Health Resource File, the 2016 American Hospital Association database, and the 2016 Hospital Value-Based Purchasing were used. Univariate, bivariate, and multivariate analyses were conducted to examine the impact of patient experience on outcome of care and hospitals. From a sample of 1866 hospitals across the United States, patient experience was significantly and positively associated with patient outcome. In addition, for-profit hospitals, hospitals with more beds, nonteaching hospitals, and hospitals located in less competitive markets were found to have a significant association with better outcomes. The study's findings are important as policy makers consider additional or alternative indicators that may better represent and encourage higher quality of care within acute care hospitals.

Experiences of Families with Relatives with Intellectual and Developmental Disabilities in a Consumer-Directed Support Program

ERIC Educational Resources Information Center

Caldwell, Joe

2007-01-01

The current study explores the experiences of families with relatives with intellectual and developmental disabilities participating in a consumer-directed support program in the USA. The Illinois Home Based Support Services Program provides a limited budget to purchase and manage services. However, within recent years the program has faced cuts…

U.S.-Russian Cooperation in Science and Technology: A Case Study of the TOPAZ Space-Based Nuclear Reactor International Program

NASA Astrophysics Data System (ADS)

Dabrowski, Richard S.

2014-08-01

The TOPAZ International Program (TIP) was the final name given to a series of projects to purchase and test the TOPAZ-II, a space-based nuclear reactor of a type that had been further developed in the Soviet Union than in the United States. In the changing political situation associated with the break-up of the Soviet Union it became possible for the United States to not just purchase the system, but also to employ Russian scientists, engineers and testing facilities to verify its reliability. The lessons learned from the TIP illuminate some of the institutional and cultural challenges to U.S. - Russian cooperation in technology research which remain true today.

24 CFR 882.410 - Rent adjustments.

Code of Federal Regulations, 2010 CFR

2010-04-01

... PROGRAM) SECTION 8 MODERATE REHABILITATION PROGRAMS Special Procedures for Moderate Rehabilitation-Basic... Annual Adjustment Factor by the base rents. However, if the amounts borrowed to finance the rehabilitation costs or to finance purchase of the property are subject to a variable rate or are otherwise...

A Profiling Float System for the North Arabian Sea

DTIC Science & Technology

2017-11-29

purpose of this Defense University Research Instrumentation Program grant was to purchase a set of profiling floats to form an upper ocean observing ...purchase a set of profiling floats to form an upper ocean observing system for the Northern Arabian Sea Circulation - autonomous research (NASCar...resolution numerical simulations. To achieve these goals the DRI will utilize new observational methods that do not rely on a traditional ship-based

Financial incentives and purchase restrictions in a food benefit program affect the types of foods and beverages purchased: results from a randomized trial.

PubMed

French, Simone A; Rydell, Sarah A; Mitchell, Nathan R; Michael Oakes, J; Elbel, Brian; Harnack, Lisa

2017-09-16

This research evaluated the effects of financial incentives and purchase restrictions on food purchasing in a food benefit program for low income people. Participants (n=279) were randomized to groups: 1) Incentive- 30% financial incentive for fruits and vegetables purchased with food benefits; 2) Restriction- no purchase of sugar-sweetened beverages, sweet baked goods, or candies with food benefits; 3) Incentive plus Restriction; or 4) Control- no incentive or restrictions. Participants received a study-specific debit card where funds were added monthly for 12-weeks. Food purchase receipts were collected over 16 weeks. Total dollars spent on grocery purchases and by targeted food categories were computed from receipts. Group differences were examined using general linear models. Weekly purchases of fruit significantly increased in the Incentive plus Restriction ($4.8) compared to the Restriction ($1.7) and Control ($2.1) groups (p <.01). Sugar-sweetened beverage purchases significantly decreased in the Incentive plus Restriction (-$0.8 per week) and Restriction ($-1.4 per week) groups compared to the Control group (+$1.5; p< .0001). Sweet baked goods purchases significantly decreased in the Restriction (-$0.70 per week) compared to the Control group (+$0.82 per week; p < .01). Paired financial incentives and restrictions on foods and beverages purchased with food program funds may support more healthful food purchases compared to no incentives or restrictions. Clinicaltrials.gov Identifier: NCT02643576 .

[Revelation of purchase system of developed nation to large medical equipment group purchase in our country].

PubMed

Tao, Lin; Guan, Bing; Liu, Shan

2011-01-01

There were some features of purchase system in developed nation, such as clear purchase objectives flexible methods, standard programming, emphasis on competition and open process. The measures suggested include playing the role of competition purchasing; establishing the e-business modern purchasing information system; establishing legislation system; and completing business purchasing.

Economic evaluation of price discounts and skill-building strategies on purchase and consumption of healthy food and beverages: The SHELf randomized controlled trial.

PubMed

Le, Ha N D; Gold, Lisa; Abbott, Gavin; Crawford, David; McNaughton, Sarah A; Mhurchu, Cliona Ni; Pollard, Christina; Ball, Kylie

2016-06-01

Pricing strategies are a promising approach for promoting healthier dietary choices. However, robust evidence of the cost-effectiveness of pricing manipulations on dietary behaviour is limited. We aimed to assess the cost-effectiveness of a 20% price reduction on fruits and vegetables and a combined skills-based behaviour change and price reduction intervention. Cost-effectiveness analysis from a societal perspective was undertaken for the randomized controlled trial Supermarket Healthy Eating for Life (SHELf). Female shoppers in Melbourne, Australia were randomized to: (1) skill-building (n = 160); (2) price reductions (n = 161); (3) combined skill-building and price reduction (n = 161); or (4) control group (n = 161). The intervention was implemented for three months followed by a six month follow-up. Costs were measured in 2012 Australian dollars. Fruit and vegetable purchasing and consumption were measured in grams/week. At three months, compared to control participants, price reduction participants increased vegetable purchases by 233 g/week (95% CI 4 to 462, p = 0.046) and fruit purchases by 364 g/week (95% CI 95 to 633, p = 0.008). Participants in the combined group purchased 280 g/week more fruits (95% CI 27 to 533, p = 0.03) than participants in the control group. Increases were not maintained six-month post intervention. No effect was noticed in the skill-building group. Compared to the control group, the price reduction intervention cost an additional A$2.3 per increased serving of vegetables purchased per week or an additional A$3 per increased serving of fruit purchased per week. The combined intervention cost an additional A$12 per increased serving of fruit purchased per week compared to the control group. A 20% discount on fruits and vegetables was effective in promoting overall fruit and vegetable purchases during the period the discount was active and may be cost-effective. The price discount program gave better value for money than the combined price reduction and skill-building intervention. The SHELf trial is registered with Current Controlled Trials Registration ISRCTN39432901. Copyright © 2016 Elsevier Ltd. All rights reserved.

Effects of a 2014 Statewide Policy Change on Cash-Value Voucher Redemptions for Fruits/Vegetables Among Participants in the Supplemental Nutrition Program for Women, Infants, and Children (WIC).

PubMed

Okeke, Janice O; Ekanayake, Ruwani M; Santorelli, Melissa L

2017-10-01

Purpose In 2014, the New Jersey Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) began requiring WIC-authorized stores to stock at least two fresh fruits and two fresh vegetables. We aimed to evaluate the effect of this policy change on fruit and vegetable purchases among WIC-participating households and to assess variation by household access to a healthy food store such as a supermarket or large grocery store. Description Households with continuous WIC enrollment from June 2013 to May 2015 were included (n = 16,415). Participants receive monthly cash-value vouchers (CVVs) to purchase fruits and vegetables. For each household, the CVV redemption proportion was calculated for the period before and after the policy by dividing the total dollar amount redeemed by the total dollar amount issued. Complete redemption was defined as a proportion ≥90% and the change in complete redemption odds was assessed after adjusting for Supplemental Nutrition Assistance Program participation. Assessment We observed a small increase following the policy change [odds ratio (OR) 1.10, 95% confidence interval (CI) 1.04-1.17]; however, the effect varied by healthy food access (p = 0.03). The odds increased for households with access to at least one healthy food store (OR 1.13, 95% CI 1.06-1.20) while no effect was observed for households without such access (OR 0.91, 95% CI 0.76-1.10). Conclusion Policy change was associated with a small increase in purchasing, but only among households with healthy food access. The state is addressing this gap through technical assistance interventions targeting WIC-authorized small stores in communities with limited access.

Report: EPA's Fiscal Year 2015 Purchase Card and Convenience Check Program Assessed as Low Risk

EPA Pesticide Factsheets

Report #16-P-0124, March 29, 2016. We determined the EPA's purchase card and convenience check program for FY 2015 to be at a low risk for illegal, improper or erroneous purchases and payments due to strengthened internal controls.

The Defense Logistics Agency Properly Awarded Power Purchase Agreements and the Army Obtained Fair Market Value for Leases Supporting Power Purchase Agreements

DTIC Science & Technology

2016-09-28

Fair Market Value for Leases Supporting Power Purchase Agreements I N T E G R I T Y  E F F I C I E N C Y  A C C O U N T A B I L I T Y  E X... Market Value for Leases Supporting Power Purchase Agreements Visit us at www.dodig.mil September 28, 2016 Objective We determined whether the...Department of the Army properly awarded and obtained fair market value for leases supporting energy production projects. We conducted this audit in

Hipoglicemiantes Orais Para Diabetes Mellitus Tipo 2: Comparação de Preços no Brasil e em Outros Sistemas Universais de Saúde.

PubMed

de Oliveira, Gustavo L A; Izidoro, Jans B; Ferré, Felipe; E Sousa, Samuel R A; Acurcio, Francisco A

2018-06-20

To estimate the average price of oral hypoglycemic agents provided by the Brazilian health system (SUS) and to compare them to other public health systems. Cross-sectional study about drug prices purchased by Belo Horizonte (municipal level), Minas Gerais (state level) and federal institutions in January and February of 2014. Average prices were calculated by defined daily dosage (DDD) and were compared to the management levels and the program "Aqui Tem Farmácia Popular" (ATFP). For international comparison, reimbursement values from Spain, Portugal, the United Kingdom and Canada (Province of Quebec) were used. Belo Horizonte had higher average prices than Minas Gerais. In general, essential oral hypoglycemic agents purchased by the SUS had lower prices than ATFP. For example, glibenclamide 5 mg was 1.023% more expensive. Metformin purchased by ATFP was more expensive than by SUS. Eight drugs purchased by SUS had average values above the respective Brazilian price ceiling. As an international comparison, SUS had lower average prices for glibenclamide and metformin. In ATFP, metformin was more expensive than in other countries, while glibenclamide was cheaper than Portugal only. The municipal management level had higher average prices than state level. Oral hypoglycemic agents purchased by SUS are predominantly cheaper than ATFP. Average prices paid by SUS are lower, while the prices paid by ATFP are higher than the reimbursed amounts from other countries. Copyright © 2018. Published by Elsevier Inc.

Avionics Simulation, Development and Software Engineering

NASA Technical Reports Server (NTRS)

Francis, Ronald C.; Settle, Gray; Tobbe, Patrick A.; Kissel, Ralph; Glaese, John; Blanche, Jim; Wallace, L. D.

2001-01-01

This monthly report summarizes the work performed under contract NAS8-00114 for Marshall Space Flight Center in the following tasks: 1) Purchase Order No. H-32831D, Task Order 001A, GPB Program Software Oversight; 2) Purchase Order No. H-32832D, Task Order 002, ISS EXPRESS Racks Software Support; 3) Purchase Order No. H-32833D, Task Order 003, SSRMS Math Model Integration; 4) Purchase Order No. H-32834D, Task Order 004, GPB Program Hardware Oversight; 5) Purchase Order No. H-32835D, Task Order 005, Electrodynamic Tether Operations and Control Analysis; 6) Purchase Order No. H-32837D, Task Order 007, SRB Command Receiver/Decoder; and 7) Purchase Order No. H-32838D, Task Order 008, AVGS/DART SW and Simulation Support

7 CFR 1450.106 - Payments.

Code of Federal Regulations, 2012 CFR

2012-01-01

... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS BIOMASS CROP ASSISTANCE PROGRAM (BCAP) Matching Payments... the qualified biomass conversion facility for the market-based sale of eligible material in an amount...

7 CFR 1450.106 - Payments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS BIOMASS CROP ASSISTANCE PROGRAM (BCAP) Matching Payments... the qualified biomass conversion facility for the market-based sale of eligible material in an amount...

7 CFR 1450.106 - Payments.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS BIOMASS CROP ASSISTANCE PROGRAM (BCAP) Matching Payments... the qualified biomass conversion facility for the market-based sale of eligible material in an amount...

7 CFR 1450.106 - Payments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS BIOMASS CROP ASSISTANCE PROGRAM (BCAP) Matching Payments... the qualified biomass conversion facility for the market-based sale of eligible material in an amount...

Promoting fruit and vegetable consumption in different lifestyle groups: recommendations for program development based on behavioral research and consumer media data.

PubMed

Della, Lindsay J; DeJoy, David M; Lance, Charles E

2008-01-01

Fruit and vegetable consumption affects the etiology of cardiovascular disease as well as many different types of cancers. Still, Americans' consumption of fruit and vegetables is low. This article builds on initial research that assessed the validity of using a consumer-based psychographic audience segmentation in tandem with the theory of planned behavior to explain differences among individuals' consumption of fruit and vegetables. In this article, we integrate the findings from our initial analyses with media and purchase data from each audience segment. We then propose distinct, tailored program suggestions for reinventing social marketing programs focused on increasing fruit and vegetable consumption in each segment. Finally, we discuss the implications of utilizing a consumer-based psychographic audience segmentation versus a more traditional readiness-to-change social marketing segmentation. Differences between these two segmentation strategies, such as the ability to access media usage and purchase data, are highlighted and discussed.

Promoting fruit and vegetable consumption in different lifestyle groups: Recommendations for program development based on behavioral research and consumer media data

PubMed Central

DeJoy, David M.; Lance, Charles E.

2014-01-01

Fruit and vegetable consumption impacts the etiology of cardiovascular disease as well as many different types of cancers. Still, Americans' consumption of fruit and vegetables is low. This article builds on initial research that assessed the validity of using a consumer-based psychographic audience segmentation in tandem with the theory of planned behavior to explain differences among individuals' consumption of fruit and vegetables. In this article, we integrate the findings from our initial analyses with media and purchase data from each audience segment. We then propose distinct, tailored program suggestions for reinventing social marketing programs focused on increasing fruit and vegetable consumption in each segment. Finally, we discuss the implications of utilizing a consumer-based psychographic audience segmentation versus more traditional readiness-to-change social marketing segmentation. Differences between these two segmentation strategies, such as the ability to access media usage and purchase data, are highlighted and discussed. PMID:18935880

48 CFR 2913.301 - Governmentwide commercial purchase card.

Code of Federal Regulations, 2013 CFR

2013-10-01

... other methods of purchasing. However, the same legal restrictions apply to credit card purchases that.../Agency Purchase/Credit Card Program procedures. A number of the more common restrictions which... purchase card. 2913.301 Section 2913.301 Federal Acquisition Regulations System DEPARTMENT OF LABOR...

48 CFR 2913.301 - Governmentwide commercial purchase card.

Code of Federal Regulations, 2014 CFR

2014-10-01

... other methods of purchasing. However, the same legal restrictions apply to credit card purchases that.../Agency Purchase/Credit Card Program procedures. A number of the more common restrictions which... purchase card. 2913.301 Section 2913.301 Federal Acquisition Regulations System DEPARTMENT OF LABOR...

48 CFR 2913.301 - Governmentwide commercial purchase card.

Code of Federal Regulations, 2011 CFR

2011-10-01

... other methods of purchasing. However, the same legal restrictions apply to credit card purchases that.../Agency Purchase/Credit Card Program procedures. A number of the more common restrictions which... purchase card. 2913.301 Section 2913.301 Federal Acquisition Regulations System DEPARTMENT OF LABOR...

76 FR 38117 - Notice of Intent To Prepare an Environmental Assessment Regarding DLA Energy's Mobility Fuel...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-29

... Prepare an Environmental Assessment Regarding DLA Energy's Mobility Fuel Purchasing Programs AGENCY... Assessment Regarding DLA Energy's Mobility Fuel Purchasing Programs. SUMMARY: The Defense Logistics Agency is... deployment of fuels and other energy sources. DLA Energy's action, to purchase mobility fuels for the...

Measure in the ESRD QIP for PY 2020. Final rule.

PubMed

2017-08-04

This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2018. It also revises and rebases the market basket index by updating the base year from 2010 to 2014, and by adding a new cost category for Installation, Maintenance, and Repair Services. The rule also finalizes revisions to the SNF Quality Reporting Program (QRP), including measure and standardized resident assessment data policies and policies related to public display. In addition, it finalizes policies for the Skilled Nursing Facility Value-Based Purchasing Program that will affect Medicare payment to SNFs beginning in FY 2019. The final rule also clarifies the regulatory requirements for team composition for surveys conducted for investigating a complaint and aligns regulatory provisions for investigation of complaints with the statutory requirements. The final rule also finalizes the performance period for the National Healthcare Safety Network (NHSN) Healthcare Personnel (HCP) Influenza Vaccination Reporting Measure included in the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) for Payment Year 2020.

Using a Lean Six Sigma Approach to Yield Sustained Pressure Ulcer Prevention for Complex Critical Care Patients.

PubMed

Donovan, Elizabeth A; Manta, Christine J; Goldsack, Jennifer C; Collins, Michelle L

2016-01-01

Under value-based purchasing, Medicare withholds reimbursements for hospital-acquired pressure ulcer occurrence and rewards hospitals that meet performance standards. With little evidence of a validated prevention process, nurse managers are challenged to find evidence-based interventions. The aim of this study was to reduce the unit-acquired pressure ulcer (UAPU) rate on targeted intensive care and step-down units by 15% using Lean Six Sigma (LSS) methodology. An interdisciplinary team designed a pilot program using LSS methodology to test 4 interventions: standardized documentation, equipment monitoring, patient out-of-bed-to-chair monitoring, and a rounding checklist. During the pilot, the UAPU rate decreased from 4.4% to 2.8%, exceeding the goal of a 15% reduction. The rate remained below the goal through the program control phase at 2.9%, demonstrating a statistically significant reduction after intervention implementation. The program significantly reduced UAPU rates in high-risk populations. LSS methodologies are a sustainable approach to reducing hospital-acquired conditions that should be broadly tested and implemented.

26 CFR 1.163-10T - Qualified residence interest (temporary).

Code of Federal Regulations, 2013 CFR

2013-04-01

...)Example. (6)Highest principal balance. (7)Other methods provided by the Commissioner. (8)Anti-abuse rule... adjusted purchase price and fair market value. (1)Adjusted purchase price. (i)In general. (ii)Adjusted purchase price of a qualified residence acquired incident to divorce. (iii)Examples. (2)Fair market value...

26 CFR 1.163-10T - Qualified residence interest (temporary).

Code of Federal Regulations, 2014 CFR

2014-04-01

...)Example. (6)Highest principal balance. (7)Other methods provided by the Commissioner. (8)Anti-abuse rule... adjusted purchase price and fair market value. (1)Adjusted purchase price. (i)In general. (ii)Adjusted purchase price of a qualified residence acquired incident to divorce. (iii)Examples. (2)Fair market value...

26 CFR 1.163-10T - Qualified residence interest (temporary).

Code of Federal Regulations, 2012 CFR

2012-04-01

...)Example. (6)Highest principal balance. (7)Other methods provided by the Commissioner. (8)Anti-abuse rule... adjusted purchase price and fair market value. (1)Adjusted purchase price. (i)In general. (ii)Adjusted purchase price of a qualified residence acquired incident to divorce. (iii)Examples. (2)Fair market value...

41 CFR 101-26.501 - Purchase of new motor vehicles.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 41 Public Contracts and Property Management 2 2011-07-01 2007-07-01 true Purchase of new motor... SOURCES AND PROGRAM 26.5-GSA Procurement Programs § 101-26.501 Purchase of new motor vehicles. (a) It shall be the policy to procure commercially available motor vehicles, unless other vehicles are...

School Breakfast Program Participation and Rural Adolescents' Purchasing Behaviors in Food Stores and Restaurants

ERIC Educational Resources Information Center

Caspi, Caitlin Eicher; Wang, Qi; Shanafelt, Amy; Larson, Nicole; Wei, Susan; Hearst, Mary O.; Nanney, Marilyn S.

2017-01-01

Background: Little is known about adolescents' food purchasing behaviors in rural areas. This study examined whether purchasing food at stores/restaurants around schools was related to adolescents' participation in school breakfast programs and overall diet in rural Minnesota. Methods: Breakfast-skippers enrolled in a group-randomized intervention…

30 CFR 206.53 - How do I determine value for oil that I or my affiliate do(es) not sell under an arm's-length...

Code of Federal Regulations, 2010 CFR

2010-07-01

..., from the property where it is produced to the point where you or your affiliate purchase(s) it. You may..., for purchases or sales under arm's-length contracts. (1) When calculating that unit value, use only purchases or sales of other like-quality oil produced from the field (or the same area if you do not have...

48 CFR 213.7002 - Purchase orders.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Purchase orders. 213.7002... Acquisition Procedures Under the 8(a) Program 213.7002 Purchase orders. The contracting officer need not obtain a contractor's written acceptance of a purchase order or modification of a purchase order for an...

40 CFR 600.306-08 - Labeling requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... which has a combined FTP/HFET-based fuel economy value, as determined in § 600.513-08, at or below the...) Have not been delivered to the ultimate purchaser, and (B) Have a combined FTP/HFET-based model type...

SAGES quality initiative: an introduction.

PubMed

Lidor, Anne; Telem, Dana; Bower, Curtis; Sinha, Prashant; Orlando, Rocco; Romanelli, John

2017-08-01

The Medicare program has transitioned to paying healthcare providers based on the quality of care delivered, not on the quantity. In May 2015, SAGES held its first ever Quality Summit. The goal of this meeting was to provide us with the information necessary to put together a strategic plan for our Society over the next 3-5 years, and to participate actively on a national level to help develop valid measures of quality of surgery. The transition to value-based medicine requires that providers are now measured and reimbursed based on the quality of services they provide rather than the quantity of patients in their care. As of 2014, quality measures must cover 3 of the 6 available National Quality domains. Physician quality reporting system measures are created via a vigorous process which is initiated by the proposal of the quality measure and subsequent validation. Commercial, non-profit, and governmental agencies have now been engaged in the measurement of hospital performance through structural measures, process measures, and increasingly with outcomes measures. This more recent focus on outcomes measures have been linked to hospital payments through the Value-Based Purchasing program. Outcomes measures of quality drive CMS' new program, MACRA, using two formats: Merit-based incentive programs and alternative payment models. But, the quality of information now available is highly variable and difficult for the average consumer to use. Quality metrics serve to guide efforts to improve performance and for consumer education. Professional organizations such as SAGES play a central role in defining the agenda for improving quality, outcomes, and safety. The mission of SAGES is to improve the quality of patient care through education, research, innovation, and leadership, principally in gastrointestinal and endoscopic surgery.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lesher, W.G.; Eiler, D.A.

In 1976 Suffolk County initiated a farmland preservation program to manage residential growth through the public purchase of development rights on prime agricultural land. As currently envisioned, the program will acquire development rights on only about one-fourth of the agricultural land in the county. The most likely acreage for which development rights will be purchased is devoted now to land-extensive crops. On a per acre basis, these crops contribute little to gross farm receipts when compared to the more land-intensive enterprises. It also is possible that the program will increase, rather than decrease, the cost of agricultural production on themore » program acreage. Furthermore, it may encourage the development of small country estates on the land that is now in commercial agriculture. While the program may help to continue an open landscape in limited areas of eastern Suffolk County, it is unlikely that even without the program all of the agricultural land will be developed. With so little of the potentially developable land included in the program, it appears the purchase of development rights will have little effect on the county's population density. The program will result in cost savings in public services, but on a per acre basis the development rights will cost more than the present value of the most optimistic estimates of public service cost savings. Moreover, any tax savings experienced will benefit those taxpayers who live in close proximity to the preserved acreage at the expense of those who live in western Suffolk County. While it seems the program cannot be justified on an economic basis, the unique island geography limiting accessibility of alternative open space, the continuing concern about overpopulation, and the relative affluence of the residents may help explain local support for the program. The Suffolk County situation might be useful to other areas worried about controlling urban fringe growth. 24 references.« less

The Eye of the Beholder: A Discussion of Value and Quality From the Perspective of Families of Children and Youth With Special Health Care Needs.

PubMed

Anderson, Betsy; Beckett, Julie; Wells, Nora; Comeau, Meg

2017-05-01

There is broad agreement that increasing the cost-effectiveness and quality of health care services, thereby achieving greater value, is imperative given this country's current spiraling costs and poor health outcomes. However, how individuals or stakeholder groups define value may differ significantly. Discussion of value in the context of health care, in particular value-based purchasing and value-based insurance design, must acknowledge that there is no universal consensus definition as to what constitutes value. To date, the consumer perspective has been underrepresented in discussions of value-based strategies such as pay for performance, capitated and bundled payments, and high-deductible health plans, which have been driven primarily by payers and providers. This article will discuss 3 elements of value from the perspective of families of children and youth with special health care needs: the role of families in the delivery of care, consumer perspectives on what constitutes quality for children and youth with special health care needs, and health care and health care financing literacy, decision-making, and costs. The undervalued contributions made by family members in the delivery and oversight of pediatric care and the importance of partnering with them to achieve the goals of the Triple Aim are stressed. The article closes with a discussion of recommendations for a future policy and research agenda related to advancing the integration of the consumer perspective into value-based purchasing and value-based insurance design. Copyright © 2017 by the American Academy of Pediatrics.

A Competency-Based Program for Electronic Gaming Equipment Repair.

ERIC Educational Resources Information Center

Hardman, James R.

This program is designed to provide entry-level training to individuals (especially workers displaced from industry) who desire employment as "slot technicians" in the casino industry. The 96-hour course includes both classroom instruction and hands-on experience. Sources for direct purchase of required manuals are provided. The 13…

Strategies to Improve the Dietary Quality of Supplemental Nutrition Assistance Program (SNAP) Beneficiaries: An Assessment of Stakeholder Opinions

PubMed Central

Blumenthal, Susan J.; Hoffnagle, Elena E.; Leung, Cindy W.; Lofink, Hayley; Jensen, Helen H.; Foerster, Susan B.; Cheung, Lilian W.Y.; Nestle, Marion; Willet, Walter C.

2013-01-01

Objective To examine the opinions of stakeholders on strategies to improve dietary quality of Supplemental Nutrition Assistance Program (SNAP) participants. Design Participants answered a 38-item web-based survey assessing opinions and perceptions of SNAP and program policy changes. Setting U.S.A. Subjects Survey of 522 individuals with stakeholder interest in the Supplemental Nutrition Assistance Program (SNAP) conducted in October through December 2011. Results The top three barriers to improving dietary quality identified were: 1) unhealthy foods marketed in low-income communities; 2) the high cost of healthy foods; and 3) lifestyle challenges faced by low-income individuals. Many respondents (70%) also disagreed that current SNAP benefit levels were adequate to maintain a healthy diet. Stakeholders believed that vouchers, coupons, or monetary incentives for purchasing healthful foods might have the greatest potential for improving the diets of SNAP participants. Many respondents (78%) agreed that sodas should not be eligible for purchases with SNAP benefits. More than half (55%) believed retailers could easily implement such restrictions. A majority of respondents (58%) agreed that stores should stock a minimum quantity of healthful foods in order to be certified as a SNAP retailer, and most respondents (83%) believed that the USDA should collect data on the foods purchased with SNAP benefits. Conclusions Results suggest that there is broad stakeholder support for policies that align SNAP purchase eligibility with national public health goals of reducing food insecurity, improving nutrition and preventing obesity. PMID:24476898

Lease VS Purchase Analysis of Alternative Fuel Vehicles in the United States Marine Corps

DTIC Science & Technology

2009-10-30

the light-duty category and then apply a model that will compare the two alternatives based on their relative net present values. An aggregated view of... model that will compare the two alternatives based on their relative net present values. An aggregated view of several different light-duty AFV...Summary .......................................................................................32  IV.  The Model

Factors Influencing the Food Purchases of Early Care and Education Providers.

PubMed

Otten, Jennifer J; Hirsch, Tad; Lim, Catherine

2017-05-01

With the majority of US children enrolled in some form of early care and education, the settings for early care and education represent a valuable opportunity to positively impact young children's diets and their interactions with food. Little evidence exists on how early care and education providers make food purchasing and service decisions for this population of young children. Our aim was to explore the factors that influence early care and education providers' food purchasing and service decisions. A qualitative design consisting of individual, in-person, and semi-structured interviews with providers and on-site observations was used. Sixteen early care and education providers-selected across a variety of characteristics that might affect food selection (eg, size of site, participation in reimbursement programs, presence of staff assigned to foodservice) using maximum variation purposive sampling-based in the Puget Sound region, Washington, were interviewed from June to September 2014. Provider perspectives on food purchasing and service decisions. Inductive analysis of transcribed interviews using TAMS Analyzer software (GPL version 2, 2012) to identify themes. Ten main influencers emerged from the data. These were grouped into four categories based on an ecological framework: macro-level environments (ie, regulations; suppliers and vendors, including stores); physical environment and settings (ie, organizational mission, budget, and structure; the facility itself); social environments (ie, professional networks; peers; the site-specific parent and child community); and individual factors at both a provider and child-level (ie, providers' skills, behaviors, motivations, attitudes, knowledge, and values; child food preferences; and, child allergies). A model was then developed to identify potential pathways of intervention and underscore the need for a comprehensive approach to improve early care and education nutrition. This study suggests that a more system-based understanding and approach-one that accounts for an array of influencers and their interactions-is necessary to take advantage of opportunities and address barriers to improving early care and education-based nutrition. Copyright © 2017 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

78 FR 36508 - Notice of Sugar Purchase and Exchange for Re-Export Program Credits; and Notice of Re-Export...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-18

... DEPARTMENT OF AGRICULTURE Commodity Credit Corporation Office of the Secretary Notice of Sugar... to purchase sugar to be offered in exchange for Refined Sugar Re-export Program credits. CCC will purchase sugar from domestic sugarcane processors or beet processors under the Cost Reduction Options of...

30 CFR 1206.301 - Value basis for royalty computation.

Code of Federal Regulations, 2011 CFR

2011-07-01

... royalty computation. (a) The gross value for royalty purposes shall be the sale or contract unit price...) That a contract of sale or other business arrangement between the lessee and a purchaser of some or all... because it is based in whole or in part upon considerations other than the value of the commodities, or (2...

Waiting for Merlot: anticipatory consumption of experiential and material purchases.

PubMed

Kumar, Amit; Killingsworth, Matthew A; Gilovich, Thomas

2014-10-01

Experiential purchases (money spent on doing) tend to provide more enduring happiness than material purchases (money spent on having). Although most research comparing these two types of purchases has focused on their downstream hedonic consequences, the present research investigated hedonic differences that occur before consumption. We argue that waiting for experiences tends to be more positive than waiting for possessions. Four studies demonstrate that people derive more happiness from the anticipation of experiential purchases and that waiting for an experience tends to be more pleasurable and exciting than waiting to receive a material good. We found these effects in studies using questionnaires involving a variety of actual planned purchases, in a large-scale experience-sampling study, and in an archival analysis of news stories about people waiting in line to make a purchase. Consumers derive value from anticipation, and that value tends to be greater for experiential than for material purchases. © The Author(s) 2014.

Identifying acceptability and price points for purchasing micronutrient powders for children 2 to 5 years old in Nepal.

PubMed

Gunnala, Rajni; Perrine, Cria G; Subedi, Giriraj; Mebrahtu, Saba; Dahal, Pradiumna; Jefferds, Maria Elena

2017-01-01

Little is known about purchasing micronutrient powders (MNP) for children 2-5 years. We describe acceptability for purchasing and price points for MNP for children 2-5 years among caregivers living in districts where free MNP are distributed for children 6-23 months. Crosssectional surveys conducted 3 months after MNP program implementation in 2 districts; 15 months after implementation in 2 different districts. Chi square tests and logistic regression describe associations among sociodemographics and program exposure factors and acceptability of purchasing MNP among 1,261 mothers of children 6-23 months who had heard of MNP. Overall, 77.5% and 86.1% of mothers reported acceptability for purchasing MNP in the 3 and 15 month surveys, respectively. Positive pricing attitude (PPA) about paying 150 Nepali rupees for 60 sachets of MNP was reported by 66.3% and 73.4% of mothers. Acceptability for purchasing MNP in both time periods increased with higher wealth quintile and higher maternal education; PPA increased with higher maternal education. Controlling for socio-demographics, program exposure factors associated with acceptability for purchasing MNP included: lack of perceived barriers to MNP intake and health worker counselling (3 month surveys); knowledge of benefits of MNP intake and lack of perceived barriers to MNP intake (15 month surveys). Mothers reported acceptability for purchasing MNP and PPA for older children in Nepal. Differences in acceptability were found across socio-demographics and program exposures. Use of these results and further exploration into actual purchasing behaviour can inform future MNP distribution methods in Nepal.

Encouraging use of coupons to stimulate condom purchase.

PubMed Central

Dahl, D W; Gorn, G J; Weinberg, C B

1999-01-01

OBJECTIVES: This study examined the feasibility of using high-value coupons to induce condom purchase and evaluated execution factors that can influence the effectiveness of this form of promotion. METHODS: Two levels of coupon discount value (10% off and 75% off) were used to promote condom purchase among young adults. Coupons were distributed according to a widespread strategy or a more focused in-store disbursement method. RESULTS: Redemption of coupons distributed through the widespread disbursement strategy was negligible. In contrast, coupons from the in-store distribution method, particularly the higher value coupon, resulted in a high redemption rate. CONCLUSIONS: This research provides strong evidence that discount coupons, particularly high-value ones distributed at the purchase location, can be used successfully as a condom promotional incentive. PMID:10589320

"Whether something cool is good enough": The role of evidence, sales representatives and nurses' expertise in hospital purchasing decisions.

PubMed

Grundy, Quinn

2016-09-01

The emphasis on "value" within healthcare institutions has achieved unprecedented priority, particularly around the purchase of medical products and equipment. Health systems and institutions are implementing formal decision-making processes involving clinicians and supply chain professionals to rationalize purchasing and promote cost-effective investment. One particular form of this process is the "Value Analysis" process. Drawing from fieldwork (100 h), interviews (n = 51) and focus groups (n = 4) conducted from January 2012 to October 2014 at 4 acute care hospitals in the western United States, I analyze the ways that committee members constructed and evaluated a case for a product's value. Participants (n = 72) were a purposive sample including nurses, administrators, supply chain and industry professionals. Interpretive phenomenology served as the analytic approach to generating iterative themes. While trying to be evidence-based, Value Analysis committees lacked data related to a product's price or efficacy and relied heavily on local knowledge and expertise. Sales representatives were an integral part of the process, creating interest in the product and providing product information. As vehicles for cost-savings and quality improvement, purchasing committees need unique support that emphasizes local contexts and expertise, while maintaining rigor and minimizing bias. Drawing from participants' experiences, and principles of health technology assessment and economic evaluation, a guiding framework is proposed to support this decision-making. Copyright © 2016 Elsevier Ltd. All rights reserved.

U.S. Residential Photovoltaic (PV) System Prices, Q4 2013 Benchmarks: Cash Purchase, Fair Market Value, and Prepaid Lease Transaction Prices

DOE Office of Scientific and Technical Information (OSTI.GOV)

Davidson, C.; James, T. L.; Margolis, R.

The price of photovoltaic (PV) systems in the United States (i.e., the cost to the system owner) has dropped precipitously in recent years, led by substantial reductions in global PV module prices. This report provides a Q4 2013 update for residential PV systems, based on an objective methodology that closely approximates the book value of a PV system. Several cases are benchmarked to represent common variation in business models, labor rates, and module choice. We estimate a weighted-average cash purchase price of $3.29/W for modeled standard-efficiency, polycrystalline-silicon residential PV systems installed in the United States. This is a 46% declinemore » from the 2013-dollar-adjusted price reported in the Q4 2010 benchmark report. In addition, this report frames the cash purchase price in the context of key price metrics relevant to the continually evolving landscape of third-party-owned PV systems by benchmarking the minimum sustainable lease price and the fair market value of residential PV systems.« less

A point-of-purchase intervention featuring in-person supermarket education affects healthful food purchases.

PubMed

Milliron, Brandy-Joe; Woolf, Kathleen; Appelhans, Bradley M

2012-01-01

This study tested the efficacy of a multicomponent supermarket point-of-purchase intervention featuring in-person nutrition education on the nutrient composition of food purchases. The design was a randomized trial comparing the intervention with usual care (no treatment). A supermarket in a socioeconomically diverse region of Phoenix, AZ. One hundred fifty-three adult shoppers were recruited onsite. The intervention consisted of brief shopping education by a nutrition educator and an explanation and promotion of a supermarket point-of-purchase healthful shopping program that included posted shelf signs identifying healthful foods, sample shopping lists, tips, and signage. Outcomes included purchases of total, saturated, and trans fat (grams/1,000 kcal), and fruits, vegetables, and dark-green/yellow vegetables (servings/1,000 kcal) derived through nutritional analysis of participant shopping baskets. Analysis of covariance compared the intervention and control groups on food purchasing patterns while adjusting for household income. The intervention resulted in greater purchasing of fruit and dark-green/yellow vegetables. No other group differences were observed. Long-term evaluations of supermarket interventions should be conducted to improve the evidence base and to determine the potential for influence on food choices associated with decreased chronic disease incidence. Copyright © 2012 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

What do dental students think about mandatory laptop programs?

PubMed

Hendricson, William; Eisenberg, Elise; Guest, Gary; Jones, Pamela; Johnson, Lynn; Panagakos, Fotinos; McDonald, James; Cintron, Laura

2006-05-01

In spite of efforts by many dental schools to provide information technology resources for students, only a handful of studies have been conducted to determine what dental students think about these initiatives. There are no reports in the literature describing students' perceptions of mandatory laptop programs, which are now being implemented by at least 25 percent of North American dental schools. In schools that have implemented laptop programs, students are required either to enroll with their own laptops that meet specifications or to purchase a laptop from the school at matriculation. In some schools, students are also required to purchase curriculum support software that is bundled with the laptop. This study was conducted to determine students' opinions at U.S. dental schools with mandatory laptop programs about these aspects of this information technology initiative: frequency of use, perceived necessity of use, note-typing during lectures, effectiveness of training, influence on study habits, benefits, implementation problems, added value in relation to added tuition costs, impact on quality of dental education, overall rating of the laptop experience, and impact of the laptop on use of other electronic curriculum resources. Responses of students at schools that purchased packaged curriculum support software from a commercial vendor were compared with students' responses at schools where faculty provided their own educational software. Responses were also compared among freshmen, sophomores, and upperclassmen in a cross-sectional sample. In 2004, approximately 800 dental students at fourteen dental schools responded to eleven questions that requested their impressions and evaluation of mandatory laptop programs and associated educational software. These questions comprised one section of the IREC Students' Questionnaire (IREC=Institutional Readiness for Electronic Curriculum) that assessed students' perceptions of various aspects of information technology at their schools. The majority of students (63 percent) reported that the laptop and associated software were not essential for successful performance in their courses primarily because few instructors had modified their courses to take advantage of laptop capacities. Slightly more than half of the students reported their training was good or excellent, but felt that classroom-based "one size fits all" training was not effective. Less than 15 percent of the students reported that they had made substantial changes in their study habits as a consequence of the laptop program. The benefits perceived by students were primarily related to enhanced email communication with classmates and instructors and convenient access to the Internet and teachers' PowerPoint presentations. Implementation barriers included the inconvenience of carrying laptops to classes, lack of incentive to use the laptop and software because instructors did not require it, and poor quality software. Only 32 percent of students agreed that the value of the laptop and associated software was equal to the added tuition costs. Less than half of the students perceived that the laptop and software had improved the quality of their education, but more than 70 percent rated their overall experiences with laptops as "okay," "good," or "excellent." Freshmen expressed significantly more positive attitudes about the frequency of use, cost-effectiveness, educational value, and overall quality of laptops and bundled software than did upperclassmen. A significantly higher percentage of students at schools affiliated with a software vendor reported that laptops were essential in courses than students at schools with locally produced software, but students at vendor-supplied schools rated the cost-effectiveness significantly lower. Overall, students' assessment of mandatory laptop programs was mixed although freshmen provided significantly more positive responses than did upperclassmen. Incorporation of the e-curriculum into dental schools appears to be following a similar pattern as problem-based learning (PBL) in the 1980s and 1990s. Recommendations for enhancing future e-curricula are proposed based on lessons learned from both information technology and PBL implementation.

Identifying Procurement Fraud in Defense Agencies: An Analysis of the Government Purchase Card Program

DTIC Science & Technology

2011-04-30

fielding, contracting, interoperability, organizational behavior, risk management , cost estimating, and many others. Approaches range from... COSO ), (Whittington & Pany, 2012). In addition, the Federal Financial Management Improvement Act of 1996 identified internal control as an...fraud indicators within the DoD Government Purchase Card Programs and provides recommendations for improving the management of Government Purchase

24 CFR 35.170 - Noncompliance with the requirements of subparts B through R of this part.

Code of Federal Regulations, 2010 CFR

2010-04-01

... the Secretary, Department of Housing and Urban Development LEAD-BASED PAINT POISONING PREVENTION IN CERTAIN RESIDENTIAL STRUCTURES General Lead-Based Paint Requirements and Definitions for All Programs... who informs a potential purchaser or occupant of lead-based paint or possible lead-based paint hazards...

24 CFR 35.170 - Noncompliance with the requirements of subparts B through R of this part.

Code of Federal Regulations, 2014 CFR

2014-04-01

... the Secretary, Department of Housing and Urban Development LEAD-BASED PAINT POISONING PREVENTION IN CERTAIN RESIDENTIAL STRUCTURES General Lead-Based Paint Requirements and Definitions for All Programs... who informs a potential purchaser or occupant of lead-based paint or possible lead-based paint hazards...

24 CFR 35.170 - Noncompliance with the requirements of subparts B through R of this part.

Code of Federal Regulations, 2011 CFR

2011-04-01

... the Secretary, Department of Housing and Urban Development LEAD-BASED PAINT POISONING PREVENTION IN CERTAIN RESIDENTIAL STRUCTURES General Lead-Based Paint Requirements and Definitions for All Programs... who informs a potential purchaser or occupant of lead-based paint or possible lead-based paint hazards...

24 CFR 35.170 - Noncompliance with the requirements of subparts B through R of this part.

Code of Federal Regulations, 2012 CFR

2012-04-01

... the Secretary, Department of Housing and Urban Development LEAD-BASED PAINT POISONING PREVENTION IN CERTAIN RESIDENTIAL STRUCTURES General Lead-Based Paint Requirements and Definitions for All Programs... who informs a potential purchaser or occupant of lead-based paint or possible lead-based paint hazards...

24 CFR 35.170 - Noncompliance with the requirements of subparts B through R of this part.

Code of Federal Regulations, 2013 CFR

2013-04-01

... the Secretary, Department of Housing and Urban Development LEAD-BASED PAINT POISONING PREVENTION IN CERTAIN RESIDENTIAL STRUCTURES General Lead-Based Paint Requirements and Definitions for All Programs... who informs a potential purchaser or occupant of lead-based paint or possible lead-based paint hazards...

Start-Up and Ongoing Practice Expenses of Behavioral Health and Primary Care Integration Interventions in the Advancing Care Together (ACT) Program.

PubMed

Wallace, Neal T; Cohen, Deborah J; Gunn, Rose; Beck, Arne; Melek, Steve; Bechtold, Donald; Green, Larry A

2015-01-01

Provide credible estimates of the start-up and ongoing effort and incremental practice expenses for the Advancing Care Together (ACT) behavioral health and primary care integration interventions. Expenditure data were collected from 10 practice intervention sites using an instrument with a standardized general format that could accommodate the unique elements of each intervention. Average start-up effort expenses were $44,076 and monthly ongoing effort expenses per patient were $40.39. Incremental expenses averaged $20,788 for start-up and $4.58 per patient for monthly ongoing activities. Variations in expenditures across practices reflect the differences in intervention specifics and organizational settings. Differences in effort to incremental expenditures reflect the extensive use of existing resources in implementing the interventions. ACT program incremental expenses suggest that widespread adoption would likely have a relatively modest effect on overall health systems expenditures. Practice effort expenses are not trivial and may pose barriers to adoption. Payers and purchasers interested in attaining widespread adoption of integrated care must consider external support to practices that accounts for both incremental and effort expense levels. Existing knowledge transfer mechanisms should be employed to minimize developmental start-up expenses and payment reform focused toward value-based, Triple Aim-oriented reimbursement and purchasing mechanisms are likely needed. © Copyright 2015 by the American Board of Family Medicine.

78 FR 46799 - Use of Market Economy Input Prices in Nonmarket Economy Proceedings

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-02

...The Department of Commerce (``Department'') is modifying its regulation which states that the Department normally will use the price that a nonmarket economy (``NME'') producer pays to a market economy supplier when a factor of production is purchased from a market economy supplier and paid for in market economy currency, in the calculation of normal value (``NV'') in antidumping proceedings involving NME countries. The rule establishes a requirement that the input at issue be produced in one or more market economy countries, and a revised threshold requiring that ``substantially all'' (i.e., 85 percent) of an input be purchased from one or more market economy suppliers before the Department uses the purchase price paid to value the entire factor of production. The Department is making this change because it finds that a market economy input price is not the best available information for valuing all purchases of that input when market economy purchases of an input do not account for substantially all purchases of the input.

The Financial Effect of Value-Based Purchasing and the Hospital Readmissions Reduction Program on Safety-Net Hospitals in 2014: A Cohort Study.

PubMed

Gilman, Matlin; Hockenberry, Jason M; Adams, E Kathleen; Milstein, Arnold S; Wilson, Ira B; Becker, Edmund R

2015-09-15

Medicare's value-based purchasing (VBP) and the Hospital Readmissions Reduction Program (HRRP) could disproportionately affect safety-net hospitals. To determine whether safety-net hospitals incur larger financial penalties than other hospitals under VBP and HRRP. Cross-sectional analysis. United States in 2014. 3022 acute care hospitals participating in VBP and the HRRP. Safety-net hospitals were defined as being in the top quartile of the Medicare disproportionate share hospital (DSH) patient percentage and Medicare uncompensated care (UCC) payments per bed. The differences in penalties in both total dollars and dollars per bed between safety-net hospitals and other hospitals were estimated with the use of bivariate and graphical regression methods. Safety-net hospitals in the top quartile of each measure were more likely to be penalized under VBP than other hospitals (62.9% vs. 51.0% under the DSH definition and 60.3% vs. 51.5% under the UCC per-bed definition). This was also the case under the HRRP (80.8% vs. 69.0% and 81.9% vs. 68.7%, respectively). Safety-net hospitals also had larger payment penalties ($115 900 vs. $66 600 and $150 100 vs. $54 900, respectively). On a per-bed basis, this translated to $436 versus $332 and $491 versus $314, respectively. Sensitivity analysis setting the cutoff at the top decile rather than the top quartile decile led to similar conclusions with somewhat larger differences between safety-net and other hospitals. The quadratic fit of the data indicated that the larger effect of these penalties is in the middle of the distribution of the DSH and UCC measures. Only 2 measures of safety-net status were included in the analyses. Safety-net hospitals were disproportionately likely to be affected under VBP and the HRRP, but most incurred relatively small payment penalties in 2014. Patient-Centered Outcomes Research Institute.

76 FR 60459 - 36(b)(1) Arms Sales Notification

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-29

... Consideration for Purchase: continuation of a pilot training program and logistics support for F-16 aircraft at... program and logistics support for F-16 aircraft at Luke Air Force Base, Arizona to include flight training..., which will contribute to an acceptable military balance in the area. This proposed sale is consistent...

The attentional drift-diffusion model extends to simple purchasing decisions.

PubMed

Krajbich, Ian; Lu, Dingchao; Camerer, Colin; Rangel, Antonio

2012-01-01

How do we make simple purchasing decisions (e.g., whether or not to buy a product at a given price)? Previous work has shown that the attentional drift-diffusion model (aDDM) can provide accurate quantitative descriptions of the psychometric data for binary and trinary value-based choices, and of how the choice process is guided by visual attention. Here we extend the aDDM to the case of purchasing decisions, and test it using an eye-tracking experiment. We find that the model also provides a reasonably accurate quantitative description of the relationship between choice, reaction time, and visual fixations using parameters that are very similar to those that best fit the previous data. The only critical difference is that the choice biases induced by the fixations are about half as big in purchasing decisions as in binary choices. This suggests that a similar computational process is used to make binary choices, trinary choices, and simple purchasing decisions.

The Attentional Drift-Diffusion Model Extends to Simple Purchasing Decisions

PubMed Central

Krajbich, Ian; Lu, Dingchao; Camerer, Colin; Rangel, Antonio

2012-01-01

How do we make simple purchasing decisions (e.g., whether or not to buy a product at a given price)? Previous work has shown that the attentional drift-diffusion model (aDDM) can provide accurate quantitative descriptions of the psychometric data for binary and trinary value-based choices, and of how the choice process is guided by visual attention. Here we extend the aDDM to the case of purchasing decisions, and test it using an eye-tracking experiment. We find that the model also provides a reasonably accurate quantitative description of the relationship between choice, reaction time, and visual fixations using parameters that are very similar to those that best fit the previous data. The only critical difference is that the choice biases induced by the fixations are about half as big in purchasing decisions as in binary choices. This suggests that a similar computational process is used to make binary choices, trinary choices, and simple purchasing decisions. PMID:22707945

Identifying acceptability and price points for purchasing micronutrient powders for children 2 to 5 years old in Nepal

PubMed Central

Gunnala, Rajni; Perrine, Cria G; Subedi, Giriraj; Mebrahtu, Saba; Dahal, Pradiumna; Jefferds, Maria Elena

2017-01-01

Background and Objective Little is known about purchasing micronutrient powders (MNP) for children 2–5 years. We describe acceptability for purchasing and price points for MNP for children 2–5 years among caregivers living in districts where free MNP are distributed for children 6–23 months. Methods and Study Design Cross-sectional surveys conducted 3 months after MNP program implementation in 2 districts; 15 months after implementation in 2 different districts. Chi square tests and logistic regression describe associations among socio-demographics and program exposure factors and acceptability of purchasing MNP among 1,261 mothers of children 6–23 months who had heard of MNP. Results Overall, 77.5% and 86.1% of mothers reported acceptability for purchasing MNP in the 3 and 15 month surveys, respectively. Positive pricing attitude (PPA) about paying 150 Nepali rupees for 60 sachets of MNP was reported by 66.3% and 73.4% of mothers. Acceptability for purchasing MNP in both time periods increased with higher wealth quintile and higher maternal education; PPA increased with higher maternal education. Controlling for socio-demographics, program exposure factors associated with acceptability for purchasing MNP included: lack of perceived barriers to MNP intake and health worker counselling (3 month surveys); knowledge of benefits of MNP intake and lack of perceived barriers to MNP intake (15 month surveys). Conclusions Mothers reported acceptability for purchasing MNP and PPA for older children in Nepal. Differences in acceptability were found across socio-demographics and program exposures. Use of these results and further exploration into actual purchasing behaviour can inform future MNP distribution methods in Nepal. PMID:28049270

41 CFR 51-10.149 - Program accessibility: Discrimination prohibited.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Relating to Public Contracts COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED 10... FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED § 51-10.149 Program accessibility...

41 CFR 51-10.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Relating to Public Contracts COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED 10... FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED § 51-10.150 Program accessibility...

41 CFR 51-10.149 - Program accessibility: Discrimination prohibited.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Relating to Public Contracts COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED 10... FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED § 51-10.149 Program accessibility...

41 CFR 51-10.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Relating to Public Contracts COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED 10... FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED § 51-10.150 Program accessibility...

41 CFR 51-10.149 - Program accessibility: Discrimination prohibited.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Relating to Public Contracts COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED 10... FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED § 51-10.149 Program accessibility...

41 CFR 51-10.149 - Program accessibility: Discrimination prohibited.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Relating to Public Contracts COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED 10... FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED § 51-10.149 Program accessibility...

41 CFR 51-10.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Relating to Public Contracts COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED 10... FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED § 51-10.150 Program accessibility...

Parents' level of support for adults' purchase and consumption of alcohol at primary school events when children are present.

PubMed

Ward, Bernadette; Kippen, Rebecca; Buykx, Penny; Gilligan, Conor; Chapman, Kathy

2015-03-01

Environmental and societal factors are significant determinants of children's initiation to and use of alcohol. Schools are important settings for promoting well-being and substantial resources have been devoted to curriculum-based alcohol programs, but the effects of these in reducing the misuse of alcohol have been modest. Adults can and do consume alcohol at school events when students are present, but there is a dearth of evidence about parents' level of support for the practice. The aim of this study was to examine parents' level of support for the purchase and consumption of alcohol at primary school fundraising events when children are present. Four hundred seventy-nine Australian parents of children aged 0-12 years participated in an online survey. Logistic regression was used to assess the impact of parent characteristics on the level of agreement with parental purchase and consumption of alcohol at school fundraising events when children are present. The majority of parents (60%) disagreed/strongly disagreed with the practice of adults being able to purchase and consume alcohol at school fundraising events when children were present. The 21% of parents who supported the practice were more likely to be daily smokers and/or have higher (>6) Alcohol Use Disorders Identification Test-alcohol consumption scores. Despite the fact that the majority of parents disagree with this practice, published reports suggest that adults' use of alcohol at primary school events is an emerging issue. It is important that school decision-makers are mindful of the financial and educational value of fundraising activities. © 2014 Australasian Professional Society on Alcohol and other Drugs.

42 CFR 441.482 - Permissible purchases.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Permissible purchases. 441.482 Section 441.482... Optional Self-Directed Personal Assistance Services Program § 441.482 Permissible purchases. (a... assistance. (b) The services, supports and items that are purchased with a service budget must be linked to...

Comparison of Cooperative and Noncooperative Purchasing in School Nutrition Programs

ERIC Educational Resources Information Center

Rice, Beth W.; Strohbehn, Catherine; Shelly, Mark C.; Arendt, Susan; Gregoire, Mary

2010-01-01

Purpose/Objectives: The purpose of this study was to compare food cost and public school foodservice directors' satisfaction between districts participating in school foodservice cooperatives or group purchasing arrangements and districts purchasing independently. It also assessed the prevalence of purchasing cooperatives in school foodservice and…

Incentivizing Fruit and Vegetable Purchasers at Fresh Markets in Lower 9th Ward, New Orleans.

PubMed

Ferdinand, Rashida; Torres, Rosamar; Scott, Jennifer; Saeed, Imran; Scribner, Richard

2017-01-01

Disparities in fruit and vegetable consumption have been observed across income and race-ethnicity and shown to be associated with both access to fresh food venues and price. This study assesses the feasibility of increasing produce consumption by incentivizing fruit and vegetable purchases at local markets. We conducted analyses of a cross-sectional survey of program participants and point-of-sale reports on fruit and vegetable purchases at the fresh food markets. Five fresh food markets in the Lower Ninth Ward (LNW) of New Orleans, Louisiana. A total of 176 participants were enrolled in the "Veggie Dollars" program (VDP). From January to July 2016, Sankofa, our community partner, recruited patrons at its markets into the VDP, a fresh food incentive program. Participants received coupons worth $4 per week for fruit and vegetables over a six-week period. Total monthly gross, VDP, and SNAP benefit sales at the markets measured program participation. A survey (N=96) assessed the demographics and fruit and vegetable purchasing practices of participants. Participants were predominantly women (81%), African American (94%) and raising children at home (53%). Point-of-sales data indicated that VDP sales nearly doubled over the intervention period. Total market sales and SNAP benefit purchases also increased. The majority (63%) of VDP participants reported their produce purchases increased and 89% reported increasing their consumption of fruit and vegetables since entering the program. Monetary incentives were associated with increased fruit and vegetable purchases at local fresh food markets in a low-income minority community.

Informed Purchasing Can Stretch Short Dollars.

ERIC Educational Resources Information Center

Miller, John B.; Miller, Kathryn Madera

1979-01-01

Provides purchasing tips for programs on a tight budget. Topics include writing specifications for the merchandise needed, finding and developing sources (vendors), receiving and analyzing bids, writing purchase orders, and receiving merchandise. (CM)

Multi-Vendor Loyalty Programs: Influencing Customer Behavioral Loyalty?

PubMed

Villacé-Molinero, Teresa; Reinares-Lara, Pedro; Reinares-Lara, Eva

2016-01-01

Loyalty programs are a consolidated marketing instrument whose adoption in many sectors has not been associated with appropriate comprehension of either their management elements or their effects. The purpose of this research is to contribute to knowledge about the effect of loyalty programs on repeat purchase behavior. More specifically, it seeks to discover whether joining a program changes the buying behavior of its members, and, if so, to study the profile of those whose behavior changes most. The intention was also to provide new study variables pertaining to multi-vendor loyalty programs, such as where they are joined or purchases in associated outlets as a result of behavioral loyalty. Research was carried out using a sample of 1200 individuals (31,746 purchases) belonging to a multi-vendor loyalty program. The study period was 13 years, 4 months, and split into two phases: before and after the joining the program. Different methodological approaches, such as the use of transactional databases that included pre-program-enrollment data and of the same sampling units throughout the study, were incorporated into the research with the aim of advancing academic knowledge regarding multi-vendor loyalty programs. Moreover, a type of program and market hardly dealt with in the relevant literature was analyzed. The results showed while the loyalty program had managed to reduce the time between purchases, it had not affected purchase volume or average expenditure. They also demonstrated the existence of a differential profile of customers who had changed their buying behavior to a greater extent. Finally, recency was identified as being the decisive variable in behavioral change.

Multi-Vendor Loyalty Programs: Influencing Customer Behavioral Loyalty?

PubMed Central

Villacé-Molinero, Teresa; Reinares-Lara, Pedro; Reinares-Lara, Eva

2016-01-01

Loyalty programs are a consolidated marketing instrument whose adoption in many sectors has not been associated with appropriate comprehension of either their management elements or their effects. The purpose of this research is to contribute to knowledge about the effect of loyalty programs on repeat purchase behavior. More specifically, it seeks to discover whether joining a program changes the buying behavior of its members, and, if so, to study the profile of those whose behavior changes most. The intention was also to provide new study variables pertaining to multi-vendor loyalty programs, such as where they are joined or purchases in associated outlets as a result of behavioral loyalty. Research was carried out using a sample of 1200 individuals (31,746 purchases) belonging to a multi-vendor loyalty program. The study period was 13 years, 4 months, and split into two phases: before and after the joining the program. Different methodological approaches, such as the use of transactional databases that included pre-program-enrollment data and of the same sampling units throughout the study, were incorporated into the research with the aim of advancing academic knowledge regarding multi-vendor loyalty programs. Moreover, a type of program and market hardly dealt with in the relevant literature was analyzed. The results showed while the loyalty program had managed to reduce the time between purchases, it had not affected purchase volume or average expenditure. They also demonstrated the existence of a differential profile of customers who had changed their buying behavior to a greater extent. Finally, recency was identified as being the decisive variable in behavioral change. PMID:26941677

Gaps in vaccine financing for underinsured children in the United States.

PubMed

Lee, Grace M; Santoli, Jeanne M; Hannan, Claire; Messonnier, Mark L; Sabin, James E; Rusinak, Donna; Gay, Charlene; Lett, Susan M; Lieu, Tracy A

2007-08-08

The number of new vaccines recommended for children and adolescents has nearly doubled during the past 5 years, and the cost of fully vaccinating a child has increased dramatically in the past decade. Anecdotal reports from state policy makers and clinicians suggest that new gaps have arisen in financial coverage of vaccines for children who are underinsured (ie, have private insurance that does not cover all recommended vaccines). In 2000, approximately 14% of children were underinsured for vaccines in the United States. To describe variation among states in the provision of new vaccines to underinsured children and to identify barriers to state purchase and distribution of new vaccines. A 2-phase mixed-methods study of state immunization program managers in the United States. The first phase included 1-hour qualitative telephone interviews conducted from November to December 2005 with 9 program managers chosen to represent different state vaccine financing policies. The second phase incorporated findings from phase 1 to develop a national telephone and paper-based survey of state immunization program managers that was conducted from January to June 2006. Percentage of states in which underinsured children are unable to receive publicly purchased vaccines in the private or public sectors. Immunization program managers from 48 states (96%) participated in the study. Underinsured children were not eligible to receive publicly purchased meningococcal conjugate or pneumococcal conjugate vaccines in the private sector in 70% and 50% of states, respectively, or in the public sector in 40% and 17% of states, respectively. Due to limited financing for new vaccines, 10 states changed their policies for provision of publicly purchased vaccines between 2004 and early 2006 to restrict access to selected new vaccines for underinsured children. The most commonly cited barriers to implementation in underinsured children were lack of sufficient federal and state funding to purchase vaccines. The current vaccine financing system has resulted in gaps for underinsured children in the United States, many of whom are now unable to receive publicly purchased vaccines in either the private or public sectors. Additional strategies are needed to ensure financial coverage for all vaccines, particularly new vaccines, among this vulnerable population.

26 CFR 1.44-5 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... case of factory-made homes the adjusted basis includes furniture only where it is included in the base... the amount of the excess of the fair market value of such other property received over the amount, if... new car with a fair market value of $2,500 upon the purchase of a condominium apartment for a total...

78 FR 17383 - Notice of Availability of Environmental Assessment and Draft Finding of No Significant Impact...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-21

... standard Jet A aviation fuel in most aircraft could significantly reduce fuel transport distances and... Mobility Fuel Purchasing Programs AGENCY: Defense Logistics Agency Energy (DLA Energy), DoD. ACTION... fuel purchase programs. DLA Energy currently operates two programs for mobility fuel contracts, Direct...

The Supplemental Nutrition Assistance Program

PubMed Central

Pomeranz, Jennifer L.; Chriqui, Jamie F.

2015-01-01

Under the current version of the Supplemental Nutrition Assistance Program (SNAP), participants can purchase virtually any food or beverage (collectively, food). Research indicates that SNAP recipients may have worse dietary quality than income-eligible nonparticipants. Policymakers have urged the U.S. Department of Agriculture (USDA) to pilot SNAP purchasing restrictions intended to support a healthier diet, and state legislators have proposed similar bills. The USDA rejected these invitations, stating that it would be administratively and logistically difficult to differentiate among products, amid other concerns. However, the USDA’s Dietary Guidelines for Americans and the Supplemental Nutrition Program for Women, Infants, and Children (WIC) do just that. Further, state governments define and differentiate among foods and beverages for tax purposes. This paper reviews several factors intended to inform future policy decisions: the science indicating that SNAP recipients have poorer diet quality than income-eligible nonparticipants; the public’s support for revising the SNAP program; federal, state, and city legislators’ formal proposals to amend SNAP based on nutrition criteria and the USDA’s public position in opposition to these proposals; state bills to amend eligible foods purchasable with SNAP benefits; state retail food tax laws; and the retail administration and program requirements for both WIC and SNAP. The paper finds that the government has a clear ability to align SNAP benefits with nutrition science and operationalize this into law. PMID:26091926

7 CFR 624.10 - Floodplain easements.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) General. NRCS may purchase floodplain easements as an emergency measure. NRCS will only purchase easements... of NRCS, of the floodplain's functions and values; or (iii) The purchase of an easement would not... the right not to purchase an easement if the easement compensation for a particular easement would be...

Electric Vehicle Site Operator Program

NASA Astrophysics Data System (ADS)

1992-05-01

Kansas State University, with funding support from federal, state, public, and private companies, is participating in the Department of Energy's Electric Vehicle Site Operator Program. Through participation is this program, Kansas State is demonstrating, testing, and evaluating electric or hybrid vehicle technology. This participation will provide organizations the opportunity to examine the latest EHV prototypes under actual operating conditions. KSU proposes to purchase one electric or hybrid van and four electric cars during the first two years of this five year program. KSU has purchased one G-Van built by Conceptor Industries, Toronto, Canada and has initiated a procurement order to purchase two Soleq 1992 Ford EVcort stationwagons.

41 CFR 51-10.151 - Program accessibility: New construction and alterations.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Other Provisions Relating to Public Contracts COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR... CONDUCTED BY THE COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED § 51-10.151 Program...

41 CFR 51-10.151 - Program accessibility: New construction and alterations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Other Provisions Relating to Public Contracts COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR... CONDUCTED BY THE COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED § 51-10.151 Program...

41 CFR 51-10.151 - Program accessibility: New construction and alterations.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Other Provisions Relating to Public Contracts COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR... CONDUCTED BY THE COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED § 51-10.151 Program...

A point-of-purchase intervention featuring in-person supermarket education impacts healthy food purchases

PubMed Central

Woolf, Kathleen; Appelhans, Bradley M.

2011-01-01

Objective This study tested the efficacy of a multicomponent supermarket point-of-purchase (POP) intervention featuring in-person nutrition education on the nutrient composition of food purchases. Design The design was a randomized trial comparing the intervention to usual care (no treatment). Setting A supermarket in a socioeconomically diverse region of Phoenix, Arizona. Participants One-hundred fifty-three adult shoppers were recruited on-site. Intervention The intervention consisted of brief shopping education by a nutrition educator and an explanation and promotion of a supermarket POP healthy shopping program that included posted shelf signs identifying healthy foods, sample shopping lists, tips, and signage. Main Outcome Measures Outcomes included purchases of total, saturated, and trans fat (g/1000 kcals), and fruits, vegetables, and dark green and bright yellow vegetables (servings/1000 kcals) derived through nutritional analysis of participant shopping baskets. Analysis Analysis of covariance compared the intervention and control groups on food purchasing patterns while adjusting for household income. Results The intervention resulted in greater purchasing of fruit and green and yellow vegetables. No other group differences were observed. Conclusions and Implications Long-term evaluations of supermarket interventions should be conducted to improve the evidence base, and to determine the potential for impact on food choices associated with decreased chronic disease. PMID:22104016

How Can Adult Children Influence Parents’ Long-Term Care Insurance Purchase Decisions?

PubMed Central

Voils, Corrine I.; Coe, Norma B.; Konetzka, R. Tamara; Boles, Jillian; Van Houtven, Courtney Harold

2017-01-01

Abstract Purpose of the Study: Long-term care (LTC) poses a significant strain on public health insurance financing. In response, there is policy interest in bolstering the private long-term care insurance (LTCI) market. Although families are central to LTC provision, their role in LTCI demand remains unclear. The purpose of this study was to obtain in-depth information concerning: (a) How do older parents evaluate the need for LTCI, (b) what role do adult children play? and (c) How do families communicate about parents’ LTC preferences and plans, including LTCI purchase? Design and Methods: We conducted focus groups with older parents and adult children in diverse markets. Two groups were conducted with older parents who had purchased LTCI and two with parents who had not purchased LTCI. Four groups were conducted with adult children, mixed as to whether their parents had purchased LTCI. Probes were informed by published reasons for purchasing or not purchasing LTCI. We analyzed transcriptions using directed content analysis and constant comparative method. Results: Older parents valued autonomy for themselves and their children. Older parent purchasers regarded LTCI as supporting this value while nonpurchasers perceived limitations. Adult children described unstated expectations that they would care for their parents. Though discussions between parents and children about LTCI were rare, successful influence occurred when children appealed to shared values, specifically avoiding burden and remaining home. Implications: Messages that emphasize autonomy over LTC decisions and interventions that start the LTC conversation among families, with attention to shared values, could increase private LTCI uptake. PMID:25209446

DOE Office of Scientific and Technical Information (OSTI.GOV)

Thumann, A.

This book presents the detailed guidance on how to effectively purchase deregulated energy, based on first-hand reports from many of the nation`s most knowledgeable experts. It is designed to provide the kind of practical advice needed by professionals who are responsible for making energy purchasing decisions. The book gives a ten-step program to guide building owners in purchasing decision making, a state-by-state retail competition update, and guidelines for buying electricity and natural gas over the worldwide web. Other topics include contract renegotiation strategies, an assessment of power pools, the role of aggregators in the energy market, real time pricing issues,more » where cogeneration fits within today`s marketplace, and lessons learned from deregulation experiences in Scandinavia and England.« less

7 CFR 1435.312 - Establishment of acreage bases under proportionate shares.

Code of Federal Regulations, 2011 CFR

2011-01-01

...) COMMODITY CREDIT CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS SUGAR PROGRAM Flexible Marketing Allotments For Sugar § 1435.312 Establishment of acreage bases under proportionate... shares as the simple average of the acreage planted and considered planted for harvest for sugar or seed...

7 CFR 1435.312 - Establishment of acreage bases under proportionate shares.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) COMMODITY CREDIT CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS SUGAR PROGRAM Flexible Marketing Allotments For Sugar § 1435.312 Establishment of acreage bases under proportionate... shares as the simple average of the acreage planted and considered planted for harvest for sugar or seed...

7 CFR 1435.312 - Establishment of acreage bases under proportionate shares.

Code of Federal Regulations, 2014 CFR

2014-01-01

...) COMMODITY CREDIT CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS SUGAR PROGRAM Flexible Marketing Allotments For Sugar § 1435.312 Establishment of acreage bases under proportionate... shares as the simple average of the acreage planted and considered planted for harvest for sugar or seed...

7 CFR 1435.312 - Establishment of acreage bases under proportionate shares.

Code of Federal Regulations, 2012 CFR

2012-01-01

...) COMMODITY CREDIT CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS SUGAR PROGRAM Flexible Marketing Allotments For Sugar § 1435.312 Establishment of acreage bases under proportionate... shares as the simple average of the acreage planted and considered planted for harvest for sugar or seed...

7 CFR 1435.312 - Establishment of acreage bases under proportionate shares.

Code of Federal Regulations, 2013 CFR

2013-01-01

...) COMMODITY CREDIT CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS SUGAR PROGRAM Flexible Marketing Allotments For Sugar § 1435.312 Establishment of acreage bases under proportionate... shares as the simple average of the acreage planted and considered planted for harvest for sugar or seed...

44 CFR 152.6 - Application review and award process.

Code of Federal Regulations, 2010 CFR

2010-10-01

... location of the fire department. In these instances where we are making decisions based on geographic... regulations and guidelines with respect to typical costs for proposed apparatus and equipment purchases. (b) Our award decisions will be based on the stated priorities of the grant program first, then on the...

Should general practitioners purchase health care for their patients? The total purchasing experiment in Britain.

PubMed

Wyke, Sally; Mays, Nicholas; Street, Andrew; Bevan, Gwyn; McLeod, Hugh; Goodwin, Nick

2003-09-01

Until relatively recently, general practitioners (GPs) have been allowed to work independently, with no requirement to consider the resource implications of their referral and prescribing decisions. In order to align the interests of GPs with the overall objectives of health systems a number of countries have introduced primary care based capitation, funds pooling and budget holding either as experiments or as an overall policy. Are these experiments and policies likely to work? This paper presents evidence from the UK total purchasing experiment, which was the first major quasi-market development in the NHS to be independently evaluated from the outset. Total purchasing gave volunteer groups of practices freedom to purchase all hospital and community health services for their patients. The evidence suggests that whilst GPs have great potential as purchasers, they also have considerable limitations. The expectation that they will be able to improve the quality of patient experience of care, or to alter the use of resources, may not be generally realised. GP-based purchasing may be more appropriate where the task is to alter the balance or location of care between hospital and extramural settings. However, budgetary incentives are not 'magic potions' which have similar effects on behaviour wherever they are introduced. Holding budgets and having independent contracts, while important pre-requisites for being taken seriously in a quasi-market, were not sufficient for effective total purchasing. The paper concludes that health systems should not only value innovation and experimentation and encourage learning from evaluative research; they should also recognise the importance of supportive circumstances for any innovation to effect real and sustained change.

Mixed-methods study identifies key strategies for improving infant and young child feeding practices in a highly stunted rural indigenous population in Guatemala.

PubMed

Brown, Kelley; Henretty, Nicole; Chary, Anita; Webb, Meghan Farley; Wehr, Heather; Moore, Jillian; Baird, Caitlin; Díaz, Anne Kraemer; Rohloff, Peter

2016-04-01

Guatemala's rural indigenous population suffers from one of the highest rates of chronic child malnutrition (stunting) in the world. Successfully addressing stunting requires defining the barriers to and opportunities for new behaviour-change initiatives. We undertook a mixed-methods assessment of feeding practices and food purchasing behaviours around infants and young children aged 6-36 months in two rural indigenous Guatemalan communities. We found that most caregivers were aware only of acute forms of child malnutrition and that they greatly underestimated the local prevalence of malnutrition. Despite moderate adherence to exclusive breastfeeding and timing of complementary food introduction, diets had poor diversity and inadequate meal frequency. Furthermore, perceptions of food insecurity were high even in the presence of land ownership and agricultural production. Although fortified foods were highly valued, they were considered expensive. At the same time, proportionally equivalent amounts of money were spent on junk foods or other processed foods by most participants. Biological mothers often lacked autonomy for food purchasing and nutritional decisions because of the power exerted by husbands and paternal grandmothers. Our findings suggest several creative and community-based programming initiatives including education about the acute vs. chronic malnutrition distinction, engaging landowners in discussions about domestic food consumption, engaging with caregivers to redirect funds towards fortified foods rather than junk food purchases and directing behaviour-change initiatives towards all household stakeholders. © 2014 John Wiley & Sons Ltd.

The Supplemental Nutrition Assistance Program: Analysis of Program Administration and Food Law Definitions.

PubMed

Pomeranz, Jennifer L; Chriqui, Jamie F

2015-09-01

Under the current version of the Supplemental Nutrition Assistance Program (SNAP), participants can purchase virtually any food or beverage (collectively, food). Research indicates that SNAP recipients may have worse dietary quality than income-eligible nonparticipants. Policymakers have urged the U.S. Department of Agriculture (USDA) to pilot SNAP purchasing restrictions intended to support a healthier diet, and state legislators have proposed similar bills. The USDA rejected these invitations, stating that it would be administratively and logistically difficult to differentiate among products, amid other concerns. However, the USDA's Dietary Guidelines for Americans and the Supplemental Nutrition Program for Women, Infants, and Children (WIC) do just that. Further, state governments define and differentiate among foods and beverages for tax purposes. This paper reviews several factors intended to inform future policy decisions: the science indicating that SNAP recipients have poorer diet quality than income-eligible nonparticipants; the public's support for revising the SNAP program; federal, state, and city legislators' formal proposals to amend SNAP based on nutrition criteria and the USDA's public position in opposition to these proposals; state bills to amend eligible foods purchasable with SNAP benefits; state retail food tax laws; and the retail administration and program requirements for both WIC and SNAP. The paper finds that the government has a clear ability to align SNAP benefits with nutrition science and operationalize this into law. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

24 CFR 982.317 - Lease-purchase agreements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Lease-purchase agreements. 982.317...-purchase agreements. (a) A family leasing a unit with assistance under the program may enter into an agreement with an owner to purchase the unit. So long as the family is receiving such rental assistance, all...

Altering shoppers' supermarket purchases to fit nutritional guidelines: An interactive information system

PubMed Central

Winett, Richard A.; Geller, E. Scott; Mundy, Laurie L.; Moore, John F.; Wagner, Jana L.; Hite, Lee A.; Leahy, Michael; Neubauer, Tamara E.; Walberg, Janet L.; Walker, W. Bruce; Lombard, David

1991-01-01

This study reports the results of one effort to help supermarket shoppers alter food purchases to make purchases (and meals) that are lower in fat and higher in fiber. A prototype interactive information system using instructional video programs, feedback on purchases with specific goals for change, weekly programs, and the ability to track user interactions and intended purchases was evaluated. The major dependent measure was users' actual food purchases as derived from participants' highly detailed supermarket receipts. After a 5- to 7-week baseline phase, participants were randomly assigned to an experimental or control condition for the 7- to 8-week intervention phase. A follow-up phase began 5 to 8 weeks after participants completed the intervention and discontinued use of the system. The results indicated that experimental participants, when compared to control participants, decreased high fat purchases and increased high fiber purchases during intervention, with evidence for some maintenance of effect in follow-up. Plans for increasing the use and impact of the system are discussed. ImagesFigure 1 PMID:1647387

The accuracy of stated energy contents of reduced-energy, commercially prepared foods

USDA-ARS?s Scientific Manuscript database

The accuracy of stated energy contents of reduced calorie restaurant foods and frozen meals purchased from supermarkets was evaluated. Measured energy values of 29 quick-serve and sit-down restaurant foods averaged 18% more than stated values, and measured energy values of 10 frozen meals purchased ...

Evaluating group purchasing organizations.

PubMed

Kaldor, Dennis C; Kowalski, Jamie C; Tankersley, Mark A

2003-01-01

A formal evaluation process can help healthcare organizations assess the current and/or potential value of a group purchasing organization (GPO). Healthcare organizations should approach a GPO evaluation as if they were entering into a new relationship. The evaluation should include purchasing and financial services, value-added services, and corporate relations/business practices. Healthcare organizations should consider the potential economies of scale and other services offered by a GPO. Healthcare organizations should consider using acceptable substitutes for products currently used or seeking products through alternative sources if doing so achieves greater value.

Does school size affect interest for purchasing local foods in the midwest?

PubMed

Smith, Sylvia; Wleklinski, Danielle; Roth, Sara Long; Tragoudas, Ulrike

2013-04-01

Due to the recent surge in environmental consciousness and the need to address childhood obesity, Farm to School programs have gained momentum. Even though Farm to School programs have increased in popularity, many schools still fail to take advantage of the benefits from such programs. School food service employees' lack of familiarity with the benefits of Farm to School programs or the means to overcome obstacles to implement such programs, along with school size, may represent key variables that serve to explain why more schools do not purchase more local foods for their schools. This study used a convenience sampling methodology to gather information regarding food service employees' perceptions of the benefits and obstacles and their attitudes to purchasing and serving local foods in their schools. A self-administered questionnaire was used to collect data from school food service employees in southern Illinois. Data (n=151) were collected from 60 schools, representing 16 counties during the month of December, 2009. Purchasers from large- and medium-size schools perceived the "ability to know product sources" as a greater benefit to purchasing local food and perceived "cost of food," "adequate volume," "reliable supply of food quantity," "payment arrangement," and "packing material" as greater obstacles (p<0.05) compared to small schools. In addition, results indicated that food service employees were interested in receiving training to prepare and serve more local foods. Findings from this study indicate a need for continued education, development, and training to better prepare school food service purchasers in southern Illinois for how to buy more local foods to meet the 2020 legislation requiring schools to purchase at least 10% locally.

School Meal Programs: Competitive Foods Are Widely Available and Generate Substantial Revenues for Schools. Report to Congressional Requesters. GAO-05-563

ERIC Educational Resources Information Center

Bellis, David B.

2005-01-01

Recent increases in child obesity have sparked concerns about competitive foods--foods sold to students at school that are not part of federally reimbursable school meals. The nutritional value of these foods is largely unregulated, and students can often purchase these foods in addition to or instead of school meals. Nearly 9 out of 10 schools…

77 FR 31912 - Proposed Collection; Comment Request for Form 712

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-30

... gross estate and to determine the value of the policy for estate and gift tax purposes. The tax is based... of operation, maintenance, and purchase of services to provide information. Approved: May 22, 2012...

Evaluative Usage-Based Metrics for the Selection of E-Journals.

ERIC Educational Resources Information Center

Hahn, Karla L.; Faulkner, Lila A.

2002-01-01

Explores electronic journal usage statistics and develops three metrics and three benchmarks based on those metrics. Topics include earlier work that assessed the value of print journals and was modified for the electronic format; the evaluation of potential purchases; and implications for standards development, including the need for content…

A Community-Based Initiative to Reduce Children's Exposure to Toxics in Household Products

ERIC Educational Resources Information Center

Blackman, Anne Berlin; Luskin, Jack

2006-01-01

Purpose--The purpose of this paper is to explore the efficacy of a community-based outreach initiative, piloted in Worcester, Massachusetts, to reduce children's exposure to toxic chemicals in common household products by changing parental behavior regarding product purchase and use. Design/methodology/approach--The program model was based on the…

Notification: Fiscal Year 2015 Risk Assessment of EPA's Purchase Card and Convenience Check Programs

EPA Pesticide Factsheets

Project #OA-FY15-0064, August 26, 2015. The U.S. Environmental Protection Agency (EPA) Office oflnspector General (OIG) plans to begin the preliminary research phase ofauditing the agency's purchase card and convenience check programs.

Alternative to the traditional discount method of wholesaler purchasing.

PubMed

Lee, G F; Bair, J N; Piz, J W

1982-07-01

A program of purchasing drugs from wholesalers at the wholesaler's exact invoice cost plus a percentage is described and compared with the traditional method of average wholesale price (AWP) less a discount. The comparison was conducted by the pharmacy department of a 310-bed, teaching hospital that awarded a one-year contract to a wholesaler offering its items at the exact cost plus a pre-established percentage. Data collected from monthly wholesaler computer printouts gave the following information on each product: (1) list price per item, (2) actual cost to pharmacy per item, (3) percentage discount from AWP, and (4) quantity ordered. The net percentage discount from AWP for 12 months was calculated and compared to the former (traditional) discount rate. The net discount from AWP was 15.6% for purchases made by the hospital during the first 12 months of the program. When compared with the smaller discount the hospital traditionally received, the new program saved the hospital $5758 on annual purchases of $136,419. The actual dollar savings to an institution that changes from a traditional discount program to a cost-plus-percentage program depends on: (1) the negotiated percentage added to wholesaler cost, (2) the discount from AWP that the institution was previously receiving, and (3) the volume of wholesale purchases.

Program Manager: Journal of the Defense Systems Management College. Volume 18. Number 4, July-August 1989

DTIC Science & Technology

1989-08-01

Systems Dynamics and study delivered to the North Structured Thinking in American Defense IndustrialPolicy Analysis, Base Organization. Rol’ Clark r1...Therefore, DOD has in- estimated that Japan spent three times formed both Pratt & Whitney and the cost to produce F-15s through I think from studies that...purchase.2" The FSX will cost much ple, the study of the F-15 back in be made without the permission of the more to develop than a purchase of 1982, it

Purchasing habits of senior farmers' market shoppers: utilizing the theory of planned behavior.

PubMed

Middleton, Crystal; Smith, Sylvia

2011-01-01

The purpose of this study was to understand fresh fruit and vegetable purchasing habits among senior farmers' market shoppers using the theory of planned behavior. A survey instrument was developed to collect information on seniors' fruit and vegetable purchasing habits. A convenience sample of seniors shopping at farmers' markets was employed. A total of 184 surveys were collected. Respondents were divided into two groups based on response to a question of whether they received Senior Farmers' Market Nutritional Program (SFMNP) checks: 35 were on the SFMNP and 149 were not. Results indicated attitudes, subjective norms (SN), and perceived behavioral control (PBC) were all significantly correlated with intentions at the p < 0.01 level. Attitude had the strongest association with intentions (0.730), followed by PBC (0.666) and SN (0.587). Regression analysis was significant and explained 66% of the variance (F = 86.151, p < 0.001, adjusted R square = 0.656). Results indicated attitude to be the strongest predictor of seniors' intentions to purchase more fresh fruits and vegetables at farmers' markets. Senior programs may find this information useful when promoting fresh fruits and vegetables for senior citizens. These findings may also benefit farmers' markets while promoting fresh fruits and vegetables.

7 CFR 3560.505 - Agency loans to finance purchases of REO properties.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 15 2014-01-01 2014-01-01 false Agency loans to finance purchases of REO properties... Disposition of Real Estate Owned (REO) Properties § 3560.505 Agency loans to finance purchases of REO properties. (a) Agency loans to finance the purchase of REO property designated to be sold as program...

7 CFR 3560.505 - Agency loans to finance purchases of REO properties.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 15 2011-01-01 2011-01-01 false Agency loans to finance purchases of REO properties... Disposition of Real Estate Owned (REO) Properties § 3560.505 Agency loans to finance purchases of REO properties. (a) Agency loans to finance the purchase of REO property designated to be sold as program...

7 CFR 3560.505 - Agency loans to finance purchases of REO properties.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 15 2013-01-01 2013-01-01 false Agency loans to finance purchases of REO properties... Disposition of Real Estate Owned (REO) Properties § 3560.505 Agency loans to finance purchases of REO properties. (a) Agency loans to finance the purchase of REO property designated to be sold as program...

7 CFR 3560.505 - Agency loans to finance purchases of REO properties.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 15 2012-01-01 2012-01-01 false Agency loans to finance purchases of REO properties... Disposition of Real Estate Owned (REO) Properties § 3560.505 Agency loans to finance purchases of REO properties. (a) Agency loans to finance the purchase of REO property designated to be sold as program...

SEASAT economic assessment. Volume 10: The SATIL 2 program (a program for the evaluation of the costs of an operational SEASAT system as a function of operational requirements and reliability. [computer programs for economic analysis and systems analysis of SEASAT satellite systems

NASA Technical Reports Server (NTRS)

1975-01-01

The SATIL 2 computer program was developed to assist with the programmatic evaluation of alternative approaches to establishing and maintaining a specified mix of operational sensors on spacecraft in an operational SEASAT system. The program computes the probability distributions of events (i.e., number of launch attempts, number of spacecraft purchased, etc.), annual recurring cost, and present value of recurring cost. This is accomplished for the specific task of placing a desired mix of sensors in orbit in an optimal fashion in order to satisfy a specified sensor demand function. Flow charts are shown, and printouts of the programs are given.

Cooperative Purchasing Guidelines. Background and Research, Pros and Cons, Examples of Exemplary Programs, Sample Forms, and Organization Procedures.

ERIC Educational Resources Information Center

Association of School Business Officials, Chicago, IL.

Cooperative purchasing programs among school districts have grown rapidly in the past decade, but significant questions remain about the benefits and drawbacks of such programs. This document presents the results of a project sponsored by the Association of School Business Officials for the purpose of addressing these questions. Comprising…

How Can Adult Children Influence Parents' Long-Term Care Insurance Purchase Decisions?

PubMed

Sperber, Nina R; Voils, Corrine I; Coe, Norma B; Konetzka, R Tamara; Boles, Jillian; Van Houtven, Courtney Harold

2017-04-01

Long-term care (LTC) poses a significant strain on public health insurance financing. In response, there is policy interest in bolstering the private long-term care insurance (LTCI) market. Although families are central to LTC provision, their role in LTCI demand remains unclear. The purpose of this study was to obtain in-depth information concerning: (a) How do older parents evaluate the need for LTCI, (b) what role do adult children play? and (c) How do families communicate about parents' LTC preferences and plans, including LTCI purchase? We conducted focus groups with older parents and adult children in diverse markets. Two groups were conducted with older parents who had purchased LTCI and two with parents who had not purchased LTCI. Four groups were conducted with adult children, mixed as to whether their parents had purchased LTCI. Probes were informed by published reasons for purchasing or not purchasing LTCI. We analyzed transcriptions using directed content analysis and constant comparative method. Older parents valued autonomy for themselves and their children. Older parent purchasers regarded LTCI as supporting this value while nonpurchasers perceived limitations. Adult children described unstated expectations that they would care for their parents. Though discussions between parents and children about LTCI were rare, successful influence occurred when children appealed to shared values, specifically avoiding burden and remaining home. Messages that emphasize autonomy over LTC decisions and interventions that start the LTC conversation among families, with attention to shared values, could increase private LTCI uptake. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Notification: Review of the U.S. Environmental Protection Agency's Purchase Card and Convenience Check Program

EPA Pesticide Factsheets

Project #OA-FY13-0116, December 20, 2012. The U.S. Environmental Protection Agency, Office of Inspector General, plans to begin preliminary research for an audit of the agency’s purchase card and convenience check programs.

Nurse Bullying: A Review And A Proposed Solution.

PubMed

Castronovo, Marie A; Pullizzi, Amy; Evans, ShaKhira

2016-01-01

Nurse bullying is an extremely common phenomenon which has detrimental consequences to nurses, patients, health care institutions, and to the nursing profession itself. It has even been linked to increased patient mortality. This article demonstrates the critical need to resolve the issue of nurse bullying. It also shows that previous attempts of resolution have not been successful, which may be partly due to the fact that the problem is relatively unacknowledged outside the nursing profession. To resolve the problem of nurse bullying, we believe that the solution must include an incentive for institutions to implement the necessary interventions and to ensure that they are effective. We propose that a measurement pertaining to the level of nurse bullying be factored into the calculation of the value-based incentive payment in the Hospital Value-Based Purchasing program. To facilitate this, we propose that a survey be developed and implemented which is similar to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. However, whereas the HCAHPS survey measures patients' perspectives of hospital care, this survey would measure nurses' perspectives of workplace bullying. Copyright © 2015 Elsevier Inc. All rights reserved.

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); TRICARE Reserve Select; TRICARE Dental Program; Early Eligibility for TRICARE for Certain Reserve Component Members. Final rule.

PubMed

2015-09-15

TRICARE Reserve Select (TRS) is a premium-based TRICARE health plan available for purchase worldwide by qualified members of the Ready Reserve and by qualified survivors of TRS members. TRICARE Dental Program (TDP) is a premium-based TRICARE dental plan available for purchase worldwide by qualified Service members. This final rule revises requirements and procedures for the TRS program to specify the appropriate actuarial basis for calculating premiums in addition to making other minor clarifying administrative changes. For a member who is involuntarily separated from the Selected Reserve under other than adverse conditions this final rule provides a time-limited exception that allows TRS coverage in effect to continue for up to 180 days after the date on which the member is separated from the Selected Reserve and TDP coverage in effect to continue for no less than 180 days after the separation date. It also expands early TRICARE eligibility for certain Reserve Component members from a maximum of 90 days to a maximum of 180 days prior to activation in support of a contingency operation for more than 30 days.

Nutritional profile of Supplemental Nutrition Assistance Program household food and beverage purchases.

PubMed

Grummon, Anna H; Taillie, Lindsey Smith

2017-06-01

Background: The Supplemental Nutrition Assistance Program (SNAP), which is the largest federal nutrition assistance program in the United States, serves nearly 1 of 7 Americans. To date, few studies have examined food and beverage purchase behaviors in SNAP participants with the use of electronic purchase data. Objective: In this cross-sectional study, we examined household store purchases of key food, beverage, and nutrient groups in SNAP participants and nonparticipants. Design: Using a data set of US households' ( n = 98,256 household-by-quarter observations) packaged food and beverage purchases and SNAP status [current participant, income-eligible nonparticipant (income ≤130% of the Federal Poverty Level [FPL]), and higher-income nonparticipants (income >130% of the FPL)] from 3 quarters during 2012-2013, we estimated pooled ordinary least-squares models, clustered at the household level, to examine the association between SNAP status and purchases while controlling for sociodemographic characteristics. We examined purchases of health- and policy-relevant food and beverage groups [e.g., fruit and sugar-sweetened beverages (SSBs)] and nutrients (e.g., total calories and sodium). Results: Regardless of SNAP status, households had low mean purchases of fruit, vegetables, and fiber and high mean purchases of junk foods, saturated fat, and sodium. After adjustment for multiple comparisons and demographic characteristics, we found significant differences by SNAP status of purchases of fruit, processed meat, salty snacks, sweeteners and toppings, SSBs, and total calories, fiber, sugar, and sodium. Several of these differences were clinically important. For example, compared with income-eligible and higher-income nonparticipants, SNAP participants purchased an additional ∼15-20 kcal · person -1 · d -1 from SSBs ( P < 0.0001) and ∼174-195 mg total Na · person -1 · d -1 ( P <0.0001). Results were robust to corrections for sample-selection bias and to the exclusion of observations with potentially misreported SNAP status. Conclusions: American households, including SNAP households, show room for improvement in the nutritional quality of store purchases. New interventions and policies may be needed to improve food and beverage purchases in both SNAP and non-SNAP households. © 2017 American Society for Nutrition.

41 CFR 102-73.130 - When may Federal agencies consider acquiring leases with purchase options?

Code of Federal Regulations, 2010 CFR

2010-07-01

... consider leasing with a purchase option at or below fair market value, consistent with the lease-purchase... and other advantages to the Government and is consistent with the Government's goals. (b) The...

Alternative Fuels Data Center

Science.gov Websites

School Bus Replacement Grant Program The Ohio Environmental Protection Agency (EPA) supports the purchase of replacement school buses in eligible Ohio counties through the Diesel Emission Reduction Grant program. Purchases are also supported with state allocated grant funding from the U.S. Environmental

Increase the Government Purchase Card Limit

DTIC Science & Technology

2014-06-01

Acquisition BPA blanket purchase agreement CCPMD Consolidated Card Program Management Division COTS commercial, off-the-shelf CPI consumer price index...purchase agreements ( BPA ) or indefinite delivery/indefinite quantity (ID/IQ) contracts for repetitive orders. This authority is discussed further in...where they can purchase up to $150,000 in supplies from established mandatory sources and BPAs , for example. (3) Fewer commands have “ordering 2

Teaching Aids in Consumer Economics, 1970-71.

ERIC Educational Resources Information Center

New York State Council on Economic Education, Albany.

The document consists of 12 consumer education units for grade 12: Consumer Purchasing; Purchasing Food, Clothing, Furniture, and Appliances; Purchasing and Maintaining an Automobile; Housing; Consumer Credit; Money Management; Fraud, Quackery, and Deception; Banking and Savings; Investments; Life Insurance; Security Programs (Social Security,…

More Can Be Done to Improve the Department of Agriculture’s Commodity Donation Program.

DTIC Science & Technology

1981-07-09

the method it used is sound and not misleading. (See p. 23 and app. IV.) Tow Shoot v 4 i Contents Page DIGEST i CHAPTER INTRODUCTION 1 Program...vege- table purchases. Poultry--"Planned purchases of broilers under the Docket Proposal constitute about 0.75 percent of projected marketings and are...purchases of broilers under the Docket Mix would constitute less than 1 percent of the market during the period of pur- chase and are, hence, not

The Goldwater Nichols Act of 1986: 30 Years of Acquisition Reform

DTIC Science & Technology

2016-12-01

making it more difficult to purchase commercial items from a sole source when the value is above the simplified acquisition threshold; such language ...that private-sector witnesses supported language in the bill that proposed “an aggressive training program for the acquisition workforce” because “a...TECHNOLOGICAL EDGE ACT (2015) The most recent effort before the current sweeping reform language proposed in the 2017 NDAA was the Agile Acquisition to Retain

Dumbing Down the Net

NASA Astrophysics Data System (ADS)

Jamison, Mark A.; Hauge, Janice A.

It is commonplace for sellers of goods and services to enhance the value of their products by paying extra for premium delivery service. For example, package delivery services such as Federal Express and the US Postal Service offer shippers a variety of delivery speeds and insurance programs. Web content providers such as Yahoo! and MSN Live Earth can purchase web-enhancing services from companies such as Akamai to speed the delivery of their web content to customers.1

Barriers to comparing the usability of electronic health records.

PubMed

Ratwani, Raj M; Hettinger, A Zachary; Fairbanks, Rollin J

2017-04-01

Despite the widespread adoption of electronic health records (EHRs), usability of many EHRs continues to be suboptimal, with some vendors failing to meet usability standards, resulting in clinician frustration and patient safety hazards. In an effort to increase EHR vendor competition on usability, recommendations have been made and legislation drafted to develop comparison tools that would allow purchasers to better understand the usability of EHR products prior to purchase. Usability comparison can be based on EHR vendor design and development processes, vendor usability testing as part of the Office of the National Coordinator for Health Information Technology certification program, and usability of implemented products. Barriers exist within the current certified health technology program that prevent effective comparison of usability during each of these stages. We describe the importance of providing purchasers with improved information about EHR usability, barriers to making usability comparisons, and solutions to overcome these barriers. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

12 CFR 1.3 - Limitations on dealing in, underwriting, and purchase and sale of securities.

Code of Federal Regulations, 2013 CFR

2013-01-01

... security. (2) The aggregate par value of securities treated as investment securities under paragraph (i)(1... its own account, provided the aggregate par value of Type II securities issued by any one obligor held... may purchase and sell Type III securities for its own account, provided the aggregate par value of...

12 CFR 1.3 - Limitations on dealing in, underwriting, and purchase and sale of securities.

Code of Federal Regulations, 2011 CFR

2011-01-01

... the obligor will be able to satisfy its obligations under that security. (2) The aggregate par value... its own account, provided the aggregate par value of Type II securities issued by any one obligor held... may purchase and sell Type III securities for its own account, provided the aggregate par value of...

12 CFR 1.3 - Limitations on dealing in, underwriting, and purchase and sale of securities.

Code of Federal Regulations, 2014 CFR

2014-01-01

... security. (2) The aggregate par value of securities treated as investment securities under paragraph (i)(1... its own account, provided the aggregate par value of Type II securities issued by any one obligor held... may purchase and sell Type III securities for its own account, provided the aggregate par value of...

12 CFR 1.3 - Limitations on dealing in, underwriting, and purchase and sale of securities.

Code of Federal Regulations, 2012 CFR

2012-01-01

... the obligor will be able to satisfy its obligations under that security. (2) The aggregate par value... its own account, provided the aggregate par value of Type II securities issued by any one obligor held... may purchase and sell Type III securities for its own account, provided the aggregate par value of...

The Value of Timber Inventory Information.

Treesearch

B.E. Borders; W.M. Harrison; M.L. Clutter; B.D. Shiver; R.A. Souter

2008-01-01

Timber inventory data is the basis for many monetary transactions related to timber and timberland sale and (or) purchase as well as for development of timber management plans. The value of such data is well known and much appreciated for sale and (or) purchase of standing merchantable timber.  Unfortunatley, the value of timber inventory data for planning...

33 CFR 137.75 - The relationship of the purchase price to the value of the facility and the real property on...

Code of Federal Regulations, 2011 CFR

2011-07-01

... COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE POLLUTION FINANCIAL RESPONSIBILITY AND...-OWNER DEFENSE Standards and Practices § 137.75 The relationship of the purchase price to the value of...

33 CFR 137.75 - The relationship of the purchase price to the value of the facility and the real property on...

Code of Federal Regulations, 2014 CFR

2014-07-01

... COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE POLLUTION FINANCIAL RESPONSIBILITY AND...-OWNER DEFENSE Standards and Practices § 137.75 The relationship of the purchase price to the value of...

33 CFR 137.75 - The relationship of the purchase price to the value of the facility and the real property on...

Code of Federal Regulations, 2012 CFR

2012-07-01

... COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE POLLUTION FINANCIAL RESPONSIBILITY AND...-OWNER DEFENSE Standards and Practices § 137.75 The relationship of the purchase price to the value of...

33 CFR 137.75 - The relationship of the purchase price to the value of the facility and the real property on...

Code of Federal Regulations, 2010 CFR

2010-07-01

... COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE POLLUTION FINANCIAL RESPONSIBILITY AND...-OWNER DEFENSE Standards and Practices § 137.75 The relationship of the purchase price to the value of...

33 CFR 137.75 - The relationship of the purchase price to the value of the facility and the real property on...

Code of Federal Regulations, 2013 CFR

2013-07-01

... COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE POLLUTION FINANCIAL RESPONSIBILITY AND...-OWNER DEFENSE Standards and Practices § 137.75 The relationship of the purchase price to the value of...

Expect the unexpected: place-based protections can lead to unforeseen benefits

Treesearch

Rebecca L. Flitcroft; Daniel L. Bottom; Karen L. Haberman; Ken F. Bierly; Kim K. Jones; Charles A. Simenstad; Ayesha Gray; Kami S. Ellingson; Erin Baumgartner; Trevan J. Cornwell; Lance A. Campbell

2016-01-01

1. Protection of places important for aesthetic, ecological, and cultural values has been a goal of conservationists for over 150 years. Cornerstones of place-based conservation include legal designations, international agreements, and purchase by public or non-profit organizations.2. In the Salmon River catchment, Oregon, protections were initially...

48 CFR 201.603-2 - Selection.

Code of Federal Regulations, 2012 CFR

2012-10-01

... the following disciplines: accounting, business finance, law, contracts, purchasing, economics... additional requirements, based on the dollar value and complexity of the contracts awarded or administered in... appointed to a 3-year developmental position. Information on developmental opportunities is contained in DoD...

48 CFR 201.603-2 - Selection.

Code of Federal Regulations, 2011 CFR

2011-10-01

... the following disciplines: accounting, business finance, law, contracts, purchasing, economics... additional requirements, based on the dollar value and complexity of the contracts awarded or administered in... appointed to a 3-year developmental position. Information on developmental opportunities is contained in DoD...

48 CFR 201.603-2 - Selection.

Code of Federal Regulations, 2014 CFR

2014-10-01

... the following disciplines: accounting, business finance, law, contracts, purchasing, economics... additional requirements, based on the dollar value and complexity of the contracts awarded or administered in... appointed to a 3-year developmental position. Information on developmental opportunities is contained in DoD...

48 CFR 201.603-2 - Selection.

Code of Federal Regulations, 2013 CFR

2013-10-01

... the following disciplines: accounting, business finance, law, contracts, purchasing, economics... additional requirements, based on the dollar value and complexity of the contracts awarded or administered in... appointed to a 3-year developmental position. Information on developmental opportunities is contained in DoD...

Comparing the cost-effectiveness of simulation modalities: a case study of peripheral intravenous catheterization training.

PubMed

Isaranuwatchai, Wanrudee; Brydges, Ryan; Carnahan, Heather; Backstein, David; Dubrowski, Adam

2014-05-01

While the ultimate goal of simulation training is to enhance learning, cost-effectiveness is a critical factor. Research that compares simulation training in terms of educational- and cost-effectiveness will lead to better-informed curricular decisions. Using previously published data we conducted a cost-effectiveness analysis of three simulation-based programs. Medical students (n = 15 per group) practiced in one of three 2-h intravenous catheterization skills training programs: low-fidelity (virtual reality), high-fidelity (mannequin), or progressive (consisting of virtual reality, task trainer, and mannequin simulator). One week later, all performed a transfer test on a hybrid simulation (standardized patient with a task trainer). We used a net benefit regression model to identify the most cost-effective training program via paired comparisons. We also created a cost-effectiveness acceptability curve to visually represent the probability that one program is more cost-effective when compared to its comparator at various 'willingness-to-pay' values. We conducted separate analyses for implementation and total costs. The results showed that the progressive program had the highest total cost (p < 0.001) whereas the high-fidelity program had the highest implementation cost (p < 0.001). While the most cost-effective program depended on the decision makers' willingness-to-pay value, the progressive training program was generally most educationally- and cost-effective. Our analyses suggest that a progressive program that strategically combines simulation modalities provides a cost-effective solution. More generally, we have introduced how a cost-effectiveness analysis may be applied to simulation training; a method that medical educators may use to investment decisions (e.g., purchasing cost-effective and educationally sound simulators).

The effects of price and perceived quality on the behavioural economics of alcohol, amphetamine, cannabis, cocaine, and ecstasy purchases.

PubMed

Goudie, Andrew J; Sumnall, Harry R; Field, Matt; Clayton, Hannah; Cole, Jon C

2007-07-10

Behavioural economic models of substance use describe the relationship between changes in unit price and consumption. However, these models rarely take account of the perceived quality (i.e. potency) of controlled drugs. Therefore we investigated the effects of both price and quality on the decision to purchase controlled drugs by polysubstance misusers. Forty current polysubstance misusers (29 males, 11 females; mean age 23.8) were recruited into the study. Participants were asked to hypothetically purchase drugs from a price list of alcohol, amphetamine, cannabis, cocaine and ecstasy at different levels of quality and price (i.e. better quality drugs cost more money). The disposable income available for those purchases was systematically varied in order to determine the impact of income on the decision to purchase drugs. Demand for both normal and strong alcohol was income inelastic. Demand for both poor and average quality cannabis and ecstasy was income inelastic, but demand for good quality cannabis and ecstasy was income elastic. The demand for poor quality cocaine was income inelastic, with the demand for both average and good quality cocaine being income elastic. Participants reported too few purchases of amphetamine, which precluded behavioural economic analysis. These results suggest that, like other goods, controlled drugs are purchased based upon the consumer's interpretations of their relative value. Therefore, it is probable that the purchase and subsequent use of controlled drugs by polysubstance misusers will be heavily influenced by the economic environment.

Reaffirming Some Basic Principles in Purchasing and Maintenance.

ERIC Educational Resources Information Center

Throop, Harold L., Jr.

1985-01-01

Reaffirms necessary elements for the successful operation of college purchasing and maintenance programs (e.g., purchasing calendar, bidding procedures, vendor selection, contracting services, budgeting for maintenance, and workforce analysis). Discusses ways some colleges are saving on operating costs (e.g., solar energy, energy management,…

24 CFR 1715.4 - Contract requirements and revocation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... HOUSING AND URBAN DEVELOPMENT (INTERSTATE LAND SALES REGISTRATION PROGRAM) PURCHASERS' REVOCATION RIGHTS, SALES PRACTICES AND STANDARDS Purchasers' Revocation Rights § 1715.4 Contract requirements and... purchase or lease price of the lot (excluding interest owed) at the time of the default or breach of...

48 CFR 9904.416-60 - Illustrations.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) Instead of paying death benefits directly, contractor D purchases annual group term life insurance on... persons in the event the program is discontinued. The contractor also continues to purchase group term... purchase adequate insurance protection and must act as a self-insurer. There is a significant possibility...

Advertising, marketing and purchase behavior for energy-related products

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tiedemann, K.; Nelson, D.

Energy conservation programs have relied heavily on incentives and regulatory standards to reduce residential energy consumption. However, in the changing market environment characterized by competitive pressures, alternative mechanisms such as marketing and promotions may increase substantially in importance compared to the demand-side management programs which have been the focus of most research. This paper describes the role of marketing and promotions in encouraging energy efficiency at the household level in British Columbia. The paper examines three related issues: first, the purchase process for energy-related products; second, the criteria used by customers in making purchase decisions; and third, the impact andmore » effectiveness of alternative marketing tools. A key finding is the energy-related purchases do not fall into the impulse purchase category. There are two reasons for this: first, most of these products require installation and this requires a high level of commitment on the part of the purchaser; second, many energy-related products require a significant outlay of funds and this reduces impulse buying.« less

78 FR 15969 - Request for Nominations to Serve on Board of Trustees for the Cobell Education Scholarship Fund

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-13

... Education Scholarship Fund based on the dollar amount of land purchased through the Buy-Back Program. In... highest ethical standards, free of significant conflicts of interest that might not allow the proper...

Body Mass Index and Sociodemographic Predictors of School Lunch Purchase Behavior during a Year-Long Environmental Intervention in Middle School.

PubMed

Greece, Jacey A; Kratze, Alyssa; DeJong, William; Cozier, Yvette C; Quatromoni, Paula A

2015-06-10

Modifying the school food environment is on the national agenda as one strategy to improve the nutritional quality of children's diets. Because few environmental-level interventions have been rigorously evaluated, the evidence base to inform programs and policies is limited. Of concern is the impact that changes to cafeteria offerings will have on participation in school meal programs. This study evaluates school lunch participation in the setting of a year-long middle school cafeteria intervention by examining the association between body mass index (BMI), sociodemographics, and the purchases of school lunch meals. IMOVE meals were healthier choices that met stringent nutritional criteria and were offered alongside standard lunch meals. Students who were overweight had a significantly higher purchase rate for both types of meals compared to those with a healthy BMI. Non-white race, younger age, being male, and low-income status were also significantly associated with participation in school lunch. Results indicate that nutritionally vulnerable students participate in school lunch and are equally likely to buy healthy alternatives or standard meals. This behavioral observation has important implications for school foodservice programs and policies. These results are timely given recent federal legislation to improve the school food environment to influence students' food choice behaviors.

Body Mass Index and Sociodemographic Predictors of School Lunch Purchase Behavior during a Year-Long Environmental Intervention in Middle School

PubMed Central

Greece, Jacey A.; Kratze, Alyssa; DeJong, William; Cozier, Yvette C.; Quatromoni, Paula A.

2015-01-01

Modifying the school food environment is on the national agenda as one strategy to improve the nutritional quality of children’s diets. Because few environmental-level interventions have been rigorously evaluated, the evidence base to inform programs and policies is limited. Of concern is the impact that changes to cafeteria offerings will have on participation in school meal programs. This study evaluates school lunch participation in the setting of a year-long middle school cafeteria intervention by examining the association between body mass index (BMI), sociodemographics, and the purchases of school lunch meals. IMOVE meals were healthier choices that met stringent nutritional criteria and were offered alongside standard lunch meals. Students who were overweight had a significantly higher purchase rate for both types of meals compared to those with a healthy BMI. Non-white race, younger age, being male, and low-income status were also significantly associated with participation in school lunch. Results indicate that nutritionally vulnerable students participate in school lunch and are equally likely to buy healthy alternatives or standard meals. This behavioral observation has important implications for school foodservice programs and policies. These results are timely given recent federal legislation to improve the school food environment to influence students’ food choice behaviors. PMID:26067683

36 CFR 1207.31 - Real property.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Section 1207.31 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION GENERAL... original purchase to the fair market value of the property. However, in those situations where a grantee or... purchase of the real property to the current fair market value of the property. ...

41 CFR 109-26.501-51 - Used vehicles.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 41 Public Contracts and Property Management 3 2011-01-01 2011-01-01 false Used vehicles. 109-26...-PROCUREMENT SOURCES AND PROGRAM 26.5-GSA Procurement Programs § 109-26.501-51 Used vehicles. Normally, DOE does not purchase or authorize contractors to purchase used motor vehicles. However, the Director...

41 CFR 109-26.501-51 - Used vehicles.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 41 Public Contracts and Property Management 3 2012-01-01 2012-01-01 false Used vehicles. 109-26...-PROCUREMENT SOURCES AND PROGRAM 26.5-GSA Procurement Programs § 109-26.501-51 Used vehicles. Normally, DOE does not purchase or authorize contractors to purchase used motor vehicles. However, the Director...

41 CFR 109-26.501-51 - Used vehicles.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Used vehicles. 109-26...-PROCUREMENT SOURCES AND PROGRAM 26.5-GSA Procurement Programs § 109-26.501-51 Used vehicles. Normally, DOE does not purchase or authorize contractors to purchase used motor vehicles. However, the Director...

41 CFR 109-26.501-51 - Used vehicles.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 41 Public Contracts and Property Management 3 2014-01-01 2014-01-01 false Used vehicles. 109-26...-PROCUREMENT SOURCES AND PROGRAM 26.5-GSA Procurement Programs § 109-26.501-51 Used vehicles. Normally, DOE does not purchase or authorize contractors to purchase used motor vehicles. However, the Director...

41 CFR 109-26.501-51 - Used vehicles.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 41 Public Contracts and Property Management 3 2013-07-01 2013-07-01 false Used vehicles. 109-26...-PROCUREMENT SOURCES AND PROGRAM 26.5-GSA Procurement Programs § 109-26.501-51 Used vehicles. Normally, DOE does not purchase or authorize contractors to purchase used motor vehicles. However, the Director...

77 FR 15022 - Presidential Memorandum of February 21, 2012; Driving Innovation and Creating Jobs in Rural...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-14

...;and investigations, committee meetings, agency decisions and rulings, #0;delegations of authority... Affirmative Procurement Programs and Preferable Purchasing Programs, as applicable (as originally required by... emphasize biobased purchasing in the fiscal year 2012 and 2013 Sustainability/ Energy scorecard, which is...

Notification: Fiscal Year 2016 Risk Assessment of EPA’s Purchase Card and Convenience Check Program

EPA Pesticide Factsheets

Project #OA-FY16-0229, July 14, 2016. The EPA OIG plans to begin a risk assessment of the EPA’s purchase card and convenience check program with the Office of Acquisition Management (OAM) within the Office of Administration and Resources Management (OARM).

Value-based purchasing of medical devices.

PubMed

Obremskey, William T; Dail, Teresa; Jahangir, A Alex

2012-04-01

Health care in the United States is known for its continued innovation and production of new devices and techniques. While the intention of these devices is to improve the delivery and outcome of patient care, they do not always achieve this goal. As new technologies enter the market, hospitals and physicians must determine which of these new devices to incorporate into practice, and it is important these devices bring value to patient care. We provide a model of a physician-engaged process to decrease cost and increase review of physician preference items. We describe the challenges, implementation, and outcomes of cost reduction and product stabilization of a value-based process for purchasing medical devices at a major academic medical center. We implemented a physician-driven committee that standardized and utilized evidence-based, clinically sound, and financially responsible methods for introducing or consolidating new supplies, devices, and technology for patient care. This committee worked with institutional finance and administrative leaders to accomplish its goals. Utilizing this physician-driven committee, we provided access to new products, standardized some products, decreased costs of physician preference items 11% to 26% across service lines, and achieved savings of greater than $8 million per year. The implementation of a facility-based technology assessment committee that critically evaluates new technology can decrease hospital costs on implants and standardize some product lines.

Effects of a price increase on purchases of sugar sweetened beverages. Results from a randomized controlled trial.

PubMed

Waterlander, Wilma Elzeline; Ni Mhurchu, Cliona; Steenhuis, Ingrid H M

2014-07-01

Sugar sweetened beverage (SSB) taxes are receiving increased political interest. However, there have been no experimental studies of the effects of price increases on SSBs or the effects on close substitutes such as diet drinks, alcohol or sugary snacks. Therefore, the aim of this study was to examine the effects of a price increase on SSBs on beverage and snack purchases using a randomized controlled design within a three-dimensional web-based supermarket. The trial contained two conditions: experimental condition with a 19% tax on SSBs (to reflect an increase in Dutch value added tax from 6% to 19%); and a control condition with regular prices. N = 102 participants were randomized and purchased groceries on a single occasion at a three-dimensional Virtual Supermarket. Data were analysed using independent t-tests and regression analysis. Results showed that participants in the price increase condition purchased significantly less SSBs than the control group (B = -.90; 95% CI = -1.70 to -.10 L per household per week). There were no significant effects on purchases in other beverage or snack food categories. This means that the higher VAT rate was effective in reducing SSB purchases and had no negative side-effects. Copyright © 2014. Published by Elsevier Ltd.

7 CFR 760.104 - Risk management purchase requirements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 7 2011-01-01 2011-01-01 false Risk management purchase requirements. 760.104 Section... Agricultural Disaster Assistance Programs § 760.104 Risk management purchase requirements. (a) To be eligible... available from the USDA Risk Management Agency (RMA)) obtained catastrophic coverage or better under a...

48 CFR 2413.301 - Governmentwide commercial purchase card.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Commercial Credit Card Program. [60 FR 46155, Sept. 5, 1995. Redesignated at 64 FR 46095, Aug. 23, 1999] ... purchase card. 2413.301 Section 2413.301 Federal Acquisition Regulations System DEPARTMENT OF HOUSING AND... Acquisition Methods 2413.301 Governmentwide commercial purchase card. (c) HUD's procedures concerning the use...

48 CFR 2413.301 - Governmentwide commercial purchase card.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Commercial Credit Card Program. [60 FR 46155, Sept. 5, 1995. Redesignated at 64 FR 46095, Aug. 23, 1999] ... purchase card. 2413.301 Section 2413.301 Federal Acquisition Regulations System DEPARTMENT OF HOUSING AND... Acquisition Methods 2413.301 Governmentwide commercial purchase card. (c) HUD's procedures concerning the use...

48 CFR 2413.301 - Governmentwide commercial purchase card.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Commercial Credit Card Program. [60 FR 46155, Sept. 5, 1995. Redesignated at 64 FR 46095, Aug. 23, 1999] ... purchase card. 2413.301 Section 2413.301 Federal Acquisition Regulations System DEPARTMENT OF HOUSING AND... Acquisition Methods 2413.301 Governmentwide commercial purchase card. (c) HUD's procedures concerning the use...

48 CFR 2413.301 - Governmentwide commercial purchase card.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Commercial Credit Card Program. [60 FR 46155, Sept. 5, 1995. Redesignated at 64 FR 46095, Aug. 23, 1999] ... purchase card. 2413.301 Section 2413.301 Federal Acquisition Regulations System DEPARTMENT OF HOUSING AND... Acquisition Methods 2413.301 Governmentwide commercial purchase card. (c) HUD's procedures concerning the use...

48 CFR 2413.301 - Governmentwide commercial purchase card.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Commercial Credit Card Program. [60 FR 46155, Sept. 5, 1995. Redesignated at 64 FR 46095, Aug. 23, 1999] ... purchase card. 2413.301 Section 2413.301 Federal Acquisition Regulations System DEPARTMENT OF HOUSING AND... Acquisition Methods 2413.301 Governmentwide commercial purchase card. (c) HUD's procedures concerning the use...

7 CFR 760.104 - Risk management purchase requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 7 2010-01-01 2010-01-01 false Risk management purchase requirements. 760.104 Section... Agricultural Disaster Assistance Programs § 760.104 Risk management purchase requirements. (a) To be eligible... available from the USDA Risk Management Agency (RMA)) obtained catastrophic coverage or better under a...

78 FR 28467 - Regulations Enabling Elections for Certain Transactions Under Section 336(e)

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-15

... purchase new target stock from unrelated new target shareholders with cash equal to the fair market value... deemed distribution of new target stock and purchaser will have a fair market value basis in new target... percent of the voting power and value of the stock of a corporation (target) as a sale of all its...

Sustainability of quality improvement following removal of pay-for-performance incentives.

PubMed

Benzer, Justin K; Young, Gary J; Burgess, James F; Baker, Errol; Mohr, David C; Charns, Martin P; Kaboli, Peter J

2014-01-01

Although pay-for-performance (P4P) has become a central strategy for improving quality in US healthcare, questions persist about the effectiveness of these programs. A key question is whether quality improvement that occurs as a result of P4P programs is sustainable, particularly if incentives are removed. To investigate sustainability of performance levels following removal of performance-based incentives. Observational cohort study that capitalized on a P4P program within the Veterans Health Administration (VA) that included adoption and subsequent removal of performance-based incentives for selected inpatient quality measures. The study sample comprised 128 acute care VA hospitals where performance was assessed between 2004 and 2010. VA system managers set annual performance goals in consultation with clinical leaders, and report performance scores to medical centers on a quarterly basis. These scores inform performance-based incentives for facilities and their managers. Bonuses are distributed based on the attainment of these performance goals. Seven quality of care measures for acute coronary syndrome, heart failure, and pneumonia linked to performance-based incentives. Significant improvements in performance were observed for six of seven quality of care measures following adoption of performance-based incentives and were maintained up to the removal of the incentive; subsequently, the observed performance levels were sustained. This is a quasi-experimental study without a comparison group; causal conclusions are limited. The maintenance of performance levels after removal of a performance-based incentive has implications for the implementation of Medicare's value-based purchasing initiative and other P4P programs. Additional research is needed to better understand human and system-level factors that mediate sustainability of performance-based incentives.

12 CFR 703.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... an investment to a counterparty at a price above its current fair value and simultaneously purchasing or committing to purchase from the counterparty another investment at a price above its current fair... Obligation means a class of a collateralized mortgage obligation (CMO) that, at the time of purchase...

The manager and equipment decisions: the capital budget.

PubMed

McConnell, Charles R

2011-01-01

As part of his or her role in preparing a departmental budget, a manager must often become involved in budgeting for capital expenditures, those purchases that are of a type and sufficient dollar value to be capitalized and depreciated. Depending on the value of a proposed purchase, the department manager may have only a partial voice in the process; some significant purchases will require administrative approval, whereas some major acquisitions will require approval by the board of directors. Planning for possible capital purchases should begin well before the start of the annual budget exercise. Listing a capital item in the department's budget request does not imply approval; often, there are many more "needs" than there are capital funds available. Therefore, there must be a consistent process for identifying the proposed purchases that will be funded, such process necessarily including detailed specification of the need for a particular capital purchase, identification of all reasonable alternatives, consideration of any constraints, detailed financial comparison of alternatives, assessment of intangible factors, and a recommended choice.

The payers perspective on MIH-CP programs. How to make a case for funding your project.

PubMed

Zavadsky, Matt

2015-07-01

Here are some key points to consider when engaging in conversations with potential payers for EMS-based MIH-CP programs. The realignment of fiscal incentives within the healthcare system has created an environment that encourages providers and payers to work together to right-size utilization. Providers and payers are often unaware of the true value EMS agencies can bring to their patients through proactive and innovative patient navigation services. You need to tell them--or, better yet, show them. You may need to do a small demonstration project with a handful of patients to prove you can make a difference. In order to understand the new environment, you need to become well-versed in healthcare metrics, specifically as they relate to the partners to whom you'll be proposing. Be sure you know things like readmission rates and penalties, value-based purchasing penalties, HCAHPS scores, MSPB and other motivating factors you. can use to help build the business case for your audience. For many in EMS, crafting partnerships for. payment of services not related to ambulance transport is a new and scary thing. Hopefully the examples provided here from payers paying for MIH services have demonstrated that their perspective is not much different from ours. We are all trying to do the right things for our patients, improve their experience of care and reduce the cost of the healthcare system.

The need for speed: informed land acquisitions for conservation in a dynamic property market.

PubMed

McDonald-Madden, Eve; Bode, Michael; Game, Edward T; Grantham, Hedley; Possingham, Hugh P

2008-11-01

Land acquisition is a common approach to biodiversity conservation but is typically subject to property availability on the public market. Consequently, conservation plans are often unable to be implemented as intended. When properties come on the market, conservation agencies must make a choice: purchase immediately, often without a detailed knowledge of its biodiversity value; survey the parcel and accept the risk that it may be removed from the market during this process; or not purchase and hope a better parcel comes on the market at a later date. We describe both an optimal method, using stochastic dynamic programming, and a simple rule of thumb for making such decisions. The solutions to this problem illustrate how optimal conservation is necessarily dynamic and requires explicit consideration of both the time period allowed for implementation and the availability of properties.

7 CFR 1467.20 - Market-based conservation initiatives.

Code of Federal Regulations, 2011 CFR

2011-01-01

... CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS WETLANDS RESERVE PROGRAM § 1467... contract, or restoration cost-share agreement. NRCS asserts no direct or indirect interest in these credits... under a WRP easement, 30-year contract, or restoration cost-share agreement, participants are highly...

From State-controlled to Polycentric Governance in Forest Landscape Restoration: The Case of the Ecological Forest Purchase Program in Yong'an Municipality of China.

PubMed

Long, Hexing; Liu, Jinlong; Tu, Chengyue; Fu, Yimin

2018-07-01

Forest landscape restoration is emerging as an effective approach to restore degraded forests for the provision of ecosystem services and to minimize trade-offs between conservation and rural livelihoods. Policy and institutional innovations in China illustrate the governance transformation of forest landscape restoration from state-controlled to polycentric governance. Based on a case study of the Ecological Forest Purchase Program in Yong'an municipality, China's Fujian Province, this paper explores how such forest governance transformation has evolved and how it has shaped the outcomes of forest landscape restoration in terms of multi-dimensionality and actor configurations. Our analysis indicates that accommodating the participation of multiple actors and market-based instruments facilitate a smoother transition from state-centered to polycentric governance in forest landscape restoration. Governance transitions for forest landscape restoration must overcome a number of challenges including ensurance of a formal participation forum, fair participation, and a sustainable legislative and financial system to enhance long-term effectiveness.

Authorities and Mechanisms for Purchased Care at the Department of Veterans Affairs

PubMed Central

Greenberg, Michael D.; Batka, Caroline; Buttorff, Christine; Dunigan, Molly; Lovejoy, Susan L.; McGovern, Geoffrey; Pace, Nicholas M.; Pillemer, Francesca; Williams, Kayla M.; Apaydin, Eric; Aranibar, Clara; Buenaventura, Maya; Carter, Phillip; Cherney, Samantha; Davis, Lynn E.; Donohue, Amy Grace; Geyer, Lily; Hemler, Joslyn; Roshan, Parisa; Skrabala, Lauren; Simmons, Stephen; Thompson, Joseph; Welch, Jonathan; Hosek, Susan D.; Farmer, Carrie M.

2016-01-01

Abstract The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the authorities and mechanisms by which the Department of Veterans Affairs (VA) pays for health care services from non-VA providers. Purchased care accounted for 10 percent, or around $5.6 billion, of VA's health care budget in fiscal year 2014, and the amount of care purchased from outside VA is growing rapidly. VA purchases non-VA care through an array of programs, each with different payment processes and eligibility requirements for veterans and outside providers. A review and analysis of statutes, regulations, legislation, and literature on VA purchased care, along with interviews with expert stakeholders, a survey of VA medical facilities, and an evaluation of local-level policy documents revealed that VA's purchased care system is complex and decentralized. Inconsistencies in procedures, unclear goals, and a lack of cohesive strategy for purchased care could have ramifications for veterans' access to care. Adding to the complexity of VA's purchased care system is a lack of systematic data collection on access to and quality of care provided through VA's purchased care programs. The analysis also explored concepts of “episodes of care” and their implications for purchased care by VA. PMID:28083425

Strategies to improve the dietary quality of Supplemental Nutrition Assistance Program (SNAP) beneficiaries: an assessment of stakeholder opinions.

PubMed

Blumenthal, Susan J; Hoffnagle, Elena E; Leung, Cindy W; Lofink, Hayley; Jensen, Helen H; Foerster, Susan B; Cheung, Lilian Wy; Nestle, Marion; Willett, Walter C

2014-12-01

To examine the opinions of stakeholders on strategies to improve dietary quality of Supplemental Nutrition Assistance Program (SNAP) participants. Participants answered a thirty-eight-item web-based survey assessing opinions and perceptions of SNAP and programme policy changes. Survey of 522 individuals with stakeholder interest in SNAP, conducted in October through December 2011. The top three barriers to improving dietary quality identified were: (i) unhealthy foods marketed in low-income communities; (ii) the high cost of healthy foods; and (iii) lifestyle challenges faced by low-income individuals. Many respondents (70 %) also disagreed that current SNAP benefit levels were adequate to maintain a healthy diet. Stakeholders believed that vouchers, coupons or monetary incentives for purchasing healthful foods might have the greatest potential for improving the diets of SNAP participants. Many respondents (78 %) agreed that sodas should not be eligible for purchases with SNAP benefits. More than half (55 %) believed retailers could easily implement such restrictions. A majority of respondents (58 %) agreed that stores should stock a minimum quantity of healthful foods in order to be certified as a SNAP retailer, and most respondents (83 %) believed that the US Department of Agriculture should collect data on the foods purchased with SNAP benefits. Results suggest that there is broad stakeholder support for policies that align SNAP purchase eligibility with national public health goals of reducing food insecurity, improving nutrition and preventing obesity.

Hardware Testing and System Evaluation: Procedures to Evaluate Commodity Hardware for Production Clusters

DOE Office of Scientific and Technical Information (OSTI.GOV)

Goebel, J

2004-02-27

Without stable hardware any program will fail. The frustration and expense of supporting bad hardware can drain an organization, delay progress, and frustrate everyone involved. At Stanford Linear Accelerator Center (SLAC), we have created a testing method that helps our group, SLAC Computer Services (SCS), weed out potentially bad hardware and purchase the best hardware at the best possible cost. Commodity hardware changes often, so new evaluations happen periodically each time we purchase systems and minor re-evaluations happen for revised systems for our clusters, about twice a year. This general framework helps SCS perform correct, efficient evaluations. This article outlinesmore » SCS's computer testing methods and our system acceptance criteria. We expanded the basic ideas to other evaluations such as storage, and we think the methods outlined in this article has helped us choose hardware that is much more stable and supportable than our previous purchases. We have found that commodity hardware ranges in quality, so systematic method and tools for hardware evaluation were necessary. This article is based on one instance of a hardware purchase, but the guidelines apply to the general problem of purchasing commodity computer systems for production computational work.« less

78 FR 34160 - Proposed Collection; Comment Request; Office of Financial Stability

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-06

... Purchase Program (CPP) under which the Department has purchased qualifying capital in U.S. banking... Treasury has invested through the CPP. Consequently, the Treasury is seeking responses from banking..., maintenance, and purchase of services to provide information. Dated: June 3, 2013. Dawn D. Wolfgang, Treasury...

13 CFR 120.1708 - Pool Certificates.

Code of Federal Regulations, 2010 CFR

2010-01-01

... United States. (c) SBA purchase of a Loan Interest. SBA will determine whether to purchase a Loan... reserves the right to purchase a Loan Interest from a Pool at any time. (d) Self-liquidating. A Pool... market conditions and program experience, and will publish any such change in the Federal Register. (h...

The effects of purchasing alcohol and marijuana among adolescents at-risk for future substance use.

PubMed

Osilla, Karen Chan; Pedersen, Eric R; Ewing, Brett A; Miles, Jeremy N V; Ramchand, Rajeev; D'Amico, Elizabeth J

2014-09-18

Among high-risk youth, those who may be at increased risk for adverse alcohol and other drug (AOD) use outcomes may benefit from targeted prevention efforts; how youth acquire AOD may provide an objective means of identifying youth at elevated risk. We assessed how youth acquired alcohol and marijuana (purchasing vs. other means), demographics, AOD behaviors/consequences, and environment among adolescents referred to a diversion program called Teen Court (N = 180) at two time points (prior to the program and 180 days from baseline). Participants were predominantly White and Hispanic/Latino(a). In cross-sectional analyses among alcohol and marijuana users, purchasing marijuana was associated with more frequent marijuana use and consequences, time spent around teens who use marijuana, higher likelihood of substance use disorders, and lower resistance self-efficacy compared to non-purchasers. Teens who purchased both alcohol and marijuana experienced similar outcomes to those who purchased only marijuana, and also reported more frequent and higher quantity of drinking, greater alcohol-related consequences, time spent around teens who use other drugs, and prescription drug misuse. Longitudinally, purchasing alcohol and marijuana at baseline was associated with more frequent and higher quantity of drinking compared to non-purchasers at follow-up. Marijuana only purchasers had a greater likelihood of substance use disorders at follow-up compared to non-purchasers. In an era where drinking is commonplace and attitudes towards marijuana use are becoming more tolerant, it is essential to evaluate how accessibility to AOD and subsequent purchasing behaviors affect youth consumption and intervene accordingly to prevent future consequences.

Influence of information about specific absorption rate (SAR) upon customers' purchase decisions and safety evaluation of mobile phones.

PubMed

Wiedemann, Peter M; Schütz, Holger; Clauberg, Martin

2008-02-01

This study investigated whether the SAR value is a purchase-relevant characteristic of mobile phones for laypersons and what effect the disclosure of a precautionary SAR value has on laypersons' risk perception. The study consisted of two parts: Study part 1 used a conjoint analysis design to explore the relevance of the SAR value and other features of mobile phones for an intended buying decision. Study part 2 used an experimental, repeated measures design to examine the effect of the magnitude of SAR values and the disclosure of a precautionary SAR value on risk perception. In addition, the study included an analysis of prior concerns of the study participants with regard to mobile phone risks. Part 1 indicates that the SAR value has a high relevance for laypersons' purchase intentions. In the experimental purchase setting it ranks even before price and equipment features. The results of study part 2 show that providing information of a precautionary limit value does not influence risk perception. This result suggests that laypersons' underlying subjective "safety model" for mobile phones resembles more a "margin of safety" concept than a threshold concept. The latter observation holds true no matter how concerned the participants are. (c) 2007 Wiley-Liss, Inc.

No cost-saving target too small for this hospital's product reengineering program.

PubMed

1998-02-01

It pays to put every product purchase under the microscope. By creating a multidisciplinary value analysis committee to review staff ideas on potential savings for products, as well as internal services and processes, this New Jersey health care provider is slashing costs and standardizing products across clinical service lines. Learn how the committee operates and what it's doing to get vital employee participation, plus read about specific products targeted for cost reduction.

Serological diagnosis of bovine neosporosis: a Bayesian evaluation of two antibody ELISA tests for in vivo diagnosis in purchased and abortion cattle.

PubMed

Roelandt, S; Van der Stede, Y; Czaplicki, G; Van Loo, H; Van Driessche, E; Dewulf, J; Hooyberghs, J; Faes, C

2015-06-06

Currently, there are no perfect reference tests for the in vivo detection of Neospora caninum infection. Two commercial N caninum ELISA tests are currently used in Belgium for bovine sera (TEST A and TEST B). The goal of this study is to evaluate these tests used at their current cut-offs, with a no gold standard approach, for the test purpose of (1) demonstration of freedom of infection at purchase and (2) diagnosis in aborting cattle. Sera of two study populations, Abortion population (n=196) and Purchase population (n=514), were selected and tested with both ELISA's. Test results were entered in a Bayesian model with informative priors on population prevalences only (Scenario 1). As sensitivity analysis, two more models were used: one with informative priors on test diagnostic accuracy (Scenario 2) and one with all priors uninformative (Scenario 3). The accuracy parameters were estimated from the first model: diagnostic sensitivity (Test A: 93.54 per cent-Test B: 86.99 per cent) and specificity (Test A: 90.22 per cent-Test B: 90.15 per cent) were high and comparable (Bayesian P values >0.05). Based on predictive values in the two study populations, both tests were fit for purpose, despite an expected false negative fraction of ±0.5 per cent in the Purchase population and ±5 per cent in the Abortion population. In addition, a false positive fraction of ±3 per cent in the overall Purchase population and ±4 per cent in the overall Abortion population was found. British Veterinary Association.

26 CFR 1.1502-94 - Coordination with section 382 and the regulations thereunder when a corporation becomes a member...

Code of Federal Regulations, 2010 CFR

2010-04-01

....1502-91(d)(1). The testing period for L commences on August 1, Year 4. C's purchase of all the P stock... based on the value of the P stock immediately before the ownership change limits the amount of... allocation of income and loss). (2) Adjustment to value. Appropriate adjustments must be made to the extent...

The imperative of culture: a quantitative analysis of the impact of culture on workforce engagement, patient experience, physician engagement, value-based purchasing, and turnover.

PubMed

Owens, Katie; Eggers, Jim; Keller, Stephanie; McDonald, Audrey

2017-01-01

Current uncertainty for the future of the health care landscape is placing an increasing amount of pressure on leadership teams to be prepared to steer their organization forward in a number of potential directions. It is commonly recognized among health care leaders that culture will either enable or disable organizational success. However, very few studies empirically link culture to health care-specific performance outcomes. Nearly every health care organization in the US specifies its cultural aspirations through mission and vision statements and values. Ambitions of patient-centeredness, care for the community, workplace of choice, and world-class quality are frequently cited; yet, little definitive research exists to quantify the importance of building high-performing cultures. Our study examined the impact of cultural attributes defined by a culture index (Cronbach's alpha = 0.88) on corresponding performance with key health care measures. We mapped results of the culture index across data sets, compared results, and evaluated variations in performance among key indicators for leaders. Organizations that perform in the top quartile for our culture index statistically significantly outperformed those in the bottom quartile on all but one key performance indicator tested. The culture top quartile organizations outperformed every domain for employee engagement, physician engagement, patient experience, and overall value-based purchasing performance with statistical significance. Culture index top quartile performers also had a 3.4% lower turnover rate than the bottom quartile performers. Finally, culture index top quartile performers earned an additional 1% on value-based purchasing. Our findings demonstrate a meaningful connection between performance in the culture index and organizational performance. To best impact these key performance outcomes, health care leaders should pay attention to culture and actively steer workforce engagement in attributes that represent the culture index, such as treating patients as valued customers, having congruency between employee and organizational values, promoting employee pride, and encouraging the feeling that being a member of the organization is rewarding, in order to leverage culture as a competitive advantage.

The imperative of culture: a quantitative analysis of the impact of culture on workforce engagement, patient experience, physician engagement, value-based purchasing, and turnover

PubMed Central

Owens, Katie; Eggers, Jim; Keller, Stephanie; McDonald, Audrey

2017-01-01

Current uncertainty for the future of the health care landscape is placing an increasing amount of pressure on leadership teams to be prepared to steer their organization forward in a number of potential directions. It is commonly recognized among health care leaders that culture will either enable or disable organizational success. However, very few studies empirically link culture to health care-specific performance outcomes. Nearly every health care organization in the US specifies its cultural aspirations through mission and vision statements and values. Ambitions of patient-centeredness, care for the community, workplace of choice, and world-class quality are frequently cited; yet, little definitive research exists to quantify the importance of building high-performing cultures. Our study examined the impact of cultural attributes defined by a culture index (Cronbach’s alpha = 0.88) on corresponding performance with key health care measures. We mapped results of the culture index across data sets, compared results, and evaluated variations in performance among key indicators for leaders. Organizations that perform in the top quartile for our culture index statistically significantly outperformed those in the bottom quartile on all but one key performance indicator tested. The culture top quartile organizations outperformed every domain for employee engagement, physician engagement, patient experience, and overall value-based purchasing performance with statistical significance. Culture index top quartile performers also had a 3.4% lower turnover rate than the bottom quartile performers. Finally, culture index top quartile performers earned an additional 1% on value-based purchasing. Our findings demonstrate a meaningful connection between performance in the culture index and organizational performance. To best impact these key performance outcomes, health care leaders should pay attention to culture and actively steer workforce engagement in attributes that represent the culture index, such as treating patients as valued customers, having congruency between employee and organizational values, promoting employee pride, and encouraging the feeling that being a member of the organization is rewarding, in order to leverage culture as a competitive advantage. PMID:29355220

Evaluating and Optimizing Online Advertising: Forget the Click, but There Are Good Proxies.

PubMed

Dalessandro, Brian; Hook, Rod; Perlich, Claudia; Provost, Foster

2015-06-01

Online systems promise to improve advertisement targeting via the massive and detailed data available. However, there often is too few data on exactly the outcome of interest, such as purchases, for accurate campaign evaluation and optimization (due to low conversion rates, cold start periods, lack of instrumentation of offline purchases, and long purchase cycles). This paper presents a detailed treatment of proxy modeling, which is based on the identification of a suitable alternative (proxy) target variable when data on the true objective is in short supply (or even completely nonexistent). The paper has a two-fold contribution. First, the potential of proxy modeling is demonstrated clearly, based on a massive-scale experiment across 58 real online advertising campaigns. Second, we assess the value of different specific proxies for evaluating and optimizing online display advertising, showing striking results. The results include bad news and good news. The most commonly cited and used proxy is a click on an ad. The bad news is that across a large number of campaigns, clicks are not good proxies for evaluation or for optimization: clickers do not resemble buyers. The good news is that an alternative sort of proxy performs remarkably well: observed visits to the brand's website. Specifically, predictive models built based on brand site visits-which are much more common than purchases-do a remarkably good job of predicting which browsers will make a purchase. The practical bottom line: evaluating and optimizing campaigns using clicks seems wrongheaded; however, there is an easy and attractive alternative-use a well-chosen site-visit proxy instead.

25 CFR 700.183 - Determination of replacement housing benefit.

Code of Federal Regulations, 2010 CFR

2010-04-01

...; (1) The amount of the fair market value of the habitation and improvements purchased from an eligible... dwelling is less than the fair market value of the habitation and improvements purchased from an eligible... Four Family Dwelling Units). (2) The most recent Boecht Building Cost Modifier. (3) The experience of...

Enhancing the IT Infrastructure at Saint Philip's Hospital: Point-of-Care Solutions

ERIC Educational Resources Information Center

Naydenova, Iva; White, Bruce

2013-01-01

Healthcare has become a rapidly changing field. With the introduction of value-based purchasing to determine reimbursement of Medicare providers based on the quality of care in addition to outcomes in treatment, the environment is becoming ever more competitive. Saint Philip's Hospital is among the largest non-profit hospitals in the nation…

49 CFR Appendix B to Part 24 - Statistical Report Form

Code of Federal Regulations, 2011 CFR

2011-10-01

... ACQUISITION FOR FEDERAL AND FEDERALLY-ASSISTED PROGRAMS Pt. 24, App. B Appendix B to Part 24—Statistical... the purchase price for the property exceeded the amount offered as just compensation and efforts to... the fiscal year by project or program activities, and who purchased and moved to their replacement...

Perceived Risk and Risk Reduction Strategies in Study Abroad Programs

ERIC Educational Resources Information Center

Luethge, Denise J.

2004-01-01

The study abroad program (SAP) meets the criteria of a risky purchase, namely of being non-tangible, possessing hidden qualities, being expensive and cannot being able to be tested prior to purchase. In fact, SAPs may score highly on a number of risk components, especially financial risk (expensive), psychological risk (anxiety), physical risk…

Observations from Laboratory and Field-based Evaluations of Select Low Cost Sensor Performance

EPA Science Inventory

• Produces data of known value and highly reliable• Stationary- cannot be easily relocated• Instruments are often large and require a building to support their operation• Expensive to purchase and operate (typically > $20K each)• Requires frequent visi...

36 CFR 223.62 - Timber purchaser road construction credit.

Code of Federal Regulations, 2010 CFR

2010-07-01

... deposits for slash disposal and road maintenance. As used in this section estimated construction costs... 36 Parks, Forests, and Public Property 2 2010-07-01 2010-07-01 false Timber purchaser road... § 223.62 Timber purchaser road construction credit. Appraisal may also establish stumpage value as if...

7 CFR 4284.924 - Ineligible uses of grant and matching funds.

Code of Federal Regulations, 2013 CFR

2013-01-01

... or facility (including a processing facility); (d) Purchase, lease purchase, or install fixed equipment, including processing equipment; (e) Purchase or repair vehicles, including boats; (f) Pay for the... processing and marketing of the value-added product; (h) Fund research and development; (i) Fund political or...

7 CFR 4284.924 - Ineligible uses of grant and matching funds.

Code of Federal Regulations, 2014 CFR

2014-01-01

... or facility (including a processing facility); (d) Purchase, lease purchase, or install fixed equipment, including processing equipment; (e) Purchase or repair vehicles, including boats; (f) Pay for the... processing and marketing of the value-added product; (h) Fund research and development; (i) Fund political or...

7 CFR 4284.924 - Ineligible uses of grant and matching funds.

Code of Federal Regulations, 2012 CFR

2012-01-01

... or facility (including a processing facility); (d) Purchase, lease purchase, or install fixed equipment, including processing equipment; (e) Purchase or repair vehicles, including boats; (f) Pay for the... processing and marketing of the value-added product; (h) Fund research and development; (i) Fund political or...

43 CFR 5461.2 - Required payment schedule.

Code of Federal Regulations, 2013 CFR

2013-10-01

... officer signs the contract. A purchaser cannot apply any portion of the first installment to cover other payments due on the contract until either 60 percent of the total purchase price has been paid or road... of the total purchase price. The value of satisfactorily completed road construction required by the...

43 CFR 5461.2 - Required payment schedule.

Code of Federal Regulations, 2011 CFR

2011-10-01

... officer signs the contract. A purchaser cannot apply any portion of the first installment to cover other payments due on the contract until either 60 percent of the total purchase price has been paid or road... of the total purchase price. The value of satisfactorily completed road construction required by the...

43 CFR 5461.2 - Required payment schedule.

Code of Federal Regulations, 2012 CFR

2012-10-01

... officer signs the contract. A purchaser cannot apply any portion of the first installment to cover other payments due on the contract until either 60 percent of the total purchase price has been paid or road... of the total purchase price. The value of satisfactorily completed road construction required by the...

43 CFR 5461.2 - Required payment schedule.

Code of Federal Regulations, 2014 CFR

2014-10-01

... officer signs the contract. A purchaser cannot apply any portion of the first installment to cover other payments due on the contract until either 60 percent of the total purchase price has been paid or road... of the total purchase price. The value of satisfactorily completed road construction required by the...

Computerizing Your Program.

ERIC Educational Resources Information Center

Curtis, Rick

This paper summarizes information about using computer hardware and software to aid in making purchase decisions that are based on user needs. The two major options in hardware are IBM-compatible machines and the Apple Macintosh line. The three basic software applications include word processing, database management, and spreadsheet applications.…

Web-Based Job Submission Interface for the GAMESS Computational Chemistry Program

ERIC Educational Resources Information Center

Perri, M. J.; Weber, S. H.

2014-01-01

A Web site is described that facilitates use of the free computational chemistry software: General Atomic and Molecular Electronic Structure System (GAMESS). Its goal is to provide an opportunity for undergraduate students to perform computational chemistry experiments without the need to purchase expensive software.

FRAMEWORK FOR RESPONSIBLE DECISION-MAKING (FRED): A TOOL FOR ENVIRONMENTALLY PREFERABLE PRODUCTS

EPA Science Inventory

In support of the Environmentally Preferable Purchasing Program of the USEPA, a decision-making tool based on life cycle assessment has been developed. This tool, the Framework for Responsible Environmental Decision-making or FRED, streamlines LCA by choosing a minimum list of im...

Acquisition of Leisure Skills by a Severely Handicapped Adolescent: A Data Based Instructional Program.

ERIC Educational Resources Information Center

Schleien, Stuart J.; And Others

1984-01-01

A 16-year-old severely handicapped student was trained to bowl, purchase a drink from the concession, and use a vending machine in the bowling alley in six weeks. The subject successfully transferred the skill to similar environment and materials. (CL)

Off-line robot programming and graphical verification of path planning

NASA Technical Reports Server (NTRS)

Tonkay, Gregory L.

1989-01-01

The objective of this project was to develop or specify an integrated environment for off-line programming, graphical path verification, and debugging for robotic systems. Two alternatives were compared. The first was the integration of the ASEA Off-line Programming package with ROBSIM, a robotic simulation program. The second alternative was the purchase of the commercial product IGRIP. The needs of the RADL (Robotics Applications Development Laboratory) were explored and the alternatives were evaluated based on these needs. As a result, IGRIP was proposed as the best solution to the problem.

NASA SAVE Award Winner

NASA Image and Video Library

2012-01-09

NASA Goddard Space Flight Center Financial Manager and White House 2011 SAVE award winner Matthew Ritsko is seen during a television interview at NASA Headquarters shortly after meeting with President Obama at the White House on Monday, Jan. 9, 2011, in Washington. The Presidential Securing Americans' Value and Efficiency (SAVE) program gives front-line federal workers the chance to submit their ideas on how their agencies can save money and work more efficiently. Matthew's proposal calls for NASA to create a "lending library" where specialized space tools and hardware purchased by one NASA organization will be made available to other NASA programs and projects. Photo Credit: (NASA/Bill Ingalls)

31 CFR 50.13 - Offer, purchase, and renewal.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Section 50.13 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.13 Offer, purchase, and renewal. An insurer is deemed to be in compliance with the requirement of providing disclosure “at the time of offer, purchase...

49 CFR Appendix D to Part 599 - CARS Purchaser Survey

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 7 2014-10-01 2014-10-01 false CARS Purchaser Survey D Appendix D to Part 599 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY... RECYCLE AND SAVE ACT PROGRAM Pt. 599, App. D Appendix D to Part 599—CARS Purchaser Survey ER29JY09.008 ...

49 CFR Appendix D to Part 599 - CARS Purchaser Survey

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 7 2013-10-01 2013-10-01 false CARS Purchaser Survey D Appendix D to Part 599 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY... RECYCLE AND SAVE ACT PROGRAM Pt. 599, App. D Appendix D to Part 599—CARS Purchaser Survey ER29JY09.008 ...

49 CFR Appendix D to Part 599 - CARS Purchaser Survey

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 7 2012-10-01 2012-10-01 false CARS Purchaser Survey D Appendix D to Part 599 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY... RECYCLE AND SAVE ACT PROGRAM Pt. 599, App. D Appendix D to Part 599—CARS Purchaser Survey ER29JY09.008 ...

49 CFR Appendix D to Part 599 - CARS Purchaser Survey

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 7 2010-10-01 2010-10-01 false CARS Purchaser Survey D Appendix D to Part 599 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY... RECYCLE AND SAVE ACT PROGRAM Pt. 599, App. D Appendix D to Part 599—CARS Purchaser Survey ER29JY09.008 ...

49 CFR Appendix D to Part 599 - CARS Purchaser Survey

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 7 2011-10-01 2011-10-01 false CARS Purchaser Survey D Appendix D to Part 599 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY... RECYCLE AND SAVE ACT PROGRAM Pt. 599, App. D Appendix D to Part 599—CARS Purchaser Survey ER29JY09.008 ...

78 FR 38286 - Notice of Change to the CCC Sugar Purchase and Exchange To Include Certificates of Quota...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-26

... DEPARTMENT OF AGRICULTURE Commodity Credit Corporation Notice of Change to the CCC Sugar Purchase... TPA) in the sugar purchase and exchange announced on June 18, 2013. DATES: Effective date: June 26... (voice and TDD). SUPPLEMENTARY INFORMATION: USDA's Sugar Program and the Domestic Sugar Market Conditions...

7 CFR 1430.2 - Price support levels and purchase conditions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Program for Milk § 1430.2 Price support levels and purchase conditions. (a)(1) The level of price support provided to farmers marketing milk containing 3.67 percent milkfat from dairy cows is $9.90 per... for milk will be made available through CCC purchases of butter, nonfat dry milk, and Cheddar cheese...

75 FR 13217 - Energy Conservation Program for Consumer Products: Classifying Products as Covered Products

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-19

... determines that labeling will assist purchasers in making purchasing decisions and is economically and... Sept. 7, 2005), DOE has re-assessed its rulemaking procedures and scheduling decisions. DOE held a... the focus of the RECS. This behavior is a primary driver behind purchases and consumption of energy in...

78 FR 11967 - Supplemental Nutrition Assistance Program (SNAP): Updated Trafficking Definition and Supplemental...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-21

... disqualification of a SNAP client who intentionally obtains cash by purchasing, with SNAP benefits, products that... exchange for cash refund of deposit(s); or who intentionally resells or exchanges products purchased with... the SNAP client. Examples of the latter would be the purchase, by retailers, of products originally...

Theory of health insurance.

PubMed

Nyman, J A

1998-01-01

The conventional explanation for purchasing insurance is to transfer risk. Psychologists, however, have shown that this explanation does not match actual behavior. They find that people generally prefer the risk of no loss at all to the certainty of a smaller actuarially equivalent loss, a situation exactly opposite to the one represented by the purchase of insurance. Nevertheless, people do purchase insurance, so there must be an explanation other than risk transfer for purchasing it. Of the explanations so far advanced, however, none have yet developed a wide acceptance. Regardless of risk issues, people will be more likely to purchase insurance when the premium is low compared to the value of the coverage to the consumer. Moral hazard raises the premium, as does adverse selection. The presence of either makes the purchase of insurance less likely. With health insurance, the tax subsidy can reduce the effective premium to less than the actuarially fair cost of insurance. This would increase the likelihood that health insurance is purchased. Finally, because of the value we place on our health, we desire access to a full range of health care. Health insurance is often the only affordable way of gaining access to this care, given the high costs of many of these procedures.

Using the Internet to deliver health care value.

PubMed

MacStravic, S

2001-01-01

Beyond the popular uses of the Internet by HCOs--for recruiting employees, purchasing supplies and promoting brand and service awareness--lie a host of opportunities to add value to consumers online. All HCO programs can be enhanced through online initiatives: wellness and health promotion, risk reduction, prevention, early detection, symptom management, life event management, acute treatment and rehabilitation, disease management and end-of-life improvement. And beyond online initiatives in each of these categories lies the potential to use the Net for reminding consumers, individually and collectively, of the health and quality of life benefits they are gaining, thereby adding to the HCO's marketing and PR success.

15 CFR 16.2 - Description and goal of program.

Code of Federal Regulations, 2010 CFR

2010-01-01

... consumer purchasing decisions and enhance consumer satisfaction. It also educates consumers, distributors... include those for which incorrect purchase decision can result in financial loss, dissatisfaction, or...

31 CFR 360.10 - Amounts which may be purchased.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 2 2011-07-01 2011-07-01 false Amounts which may be purchased. 360.10 Section 360.10 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL... follows: (a) General annual limitation, $5,000 (par value). (b) Special limitation, $4,000 (par value...

31 CFR 360.10 - Amounts which may be purchased.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 2 2012-07-01 2012-07-01 false Amounts which may be purchased. 360.10 Section 360.10 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL... follows: (a) General annual limitation, $5,000 (par value). (b) Special limitation, $4,000 (par value...

Validation of the Consumer Values versus Perceived Product Attributes Model Measuring the Purchase of Athletic Team Merchandise

ERIC Educational Resources Information Center

Lee, Donghun; Byon, Kevin K.; Schoenstedt, Linda; Johns, Gary; Bussell, Leigh Ann; Choi, Hwansuk

2012-01-01

Various consumer values and perceived product attributes trigger consumptive behaviors of athletic team merchandise (Lee, Trail, Kwon, & Anderson, 2011). Likewise, using a principal component analysis technique on a student sample, a measurement scale was proposed that consisted of nine factors affecting the purchase of athletic team…

47 CFR 54.513 - Resale and transfer of services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... subpart shall not be sold, resold, or transferred in consideration of money or any other thing of value... over the Internet. There is no prohibition on the resale of services that are not purchased pursuant to... of money or any other thing of value, for a period of three years after purchase, except that...

Pediatric counseling and subsequent use of smoke detectors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Miller, R.E.; Reisinger, K.S.; Blatter, M.M.

Effects of a brief educational and purchase program concerning home fires and smoke detectors by two pediatricians were compared to ''routine'' counseling without such a program using two groups each of 120 patients of well children. Inspection performed four to six weeks after the office visits showed that of 55 experimental group parents without detectors prior to the program, 26 purchased and 19 installed them correctly. No control group parents did so.

Effects of reduced juice allowances in food packages for the women, infants, and children program.

PubMed

Andreyeva, Tatiana; Luedicke, Joerg; Tripp, Amanda S; Henderson, Kathryn E

2013-05-01

In 2009, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) implemented revisions to the composition and quantities of WIC food packages. Juice allowances were reduced by approximately half. This report describes changes in purchases of 100% juice and other beverages among WIC participants after the WIC revisions. Scanner data from a New England supermarket chain were used to assess juice and other beverage purchases among 2137 WIC-participating households during a 2-year period (N = 36 051 household-months). Purchased beverage amounts were compared before (January-September 2009) and after (January-September 2010) implementation of the revised WIC packages. Generalized estimating equation models were used. Before the revisions, WIC juice accounted for two-thirds of purchased juice volume among WIC households. After implementation of the revisions, WIC juice purchases were reduced on par with allowance changes (43.5% of juice volume, 95% confidence interval [CI] 41.9%-45.1%). This reduction was only partly compensated for by an increase of 13.6% (8.4%-19.0%) in juice purchases using personal and other non-WIC funds. In total, juice purchases declined by 23.5% (21.4%-25.4%) from an adjusted monthly total of 238 oz to 182 oz per household. WIC households increased purchases of fruit drinks by 20.9% (14.9%-27.3%) and other noncarbonated beverages by 21.3% (12.1%-31.2%) but purchased 12.1% (8.1%-15.0%) less soft drinks. After the WIC revisions, total purchases of 100% juice among WIC households declined by about a quarter, with little compensation occurring from non-WIC funds for juice and other beverages. The public health impact of the shift in beverage purchase patterns could be significant.

Re Thinking the Public Sector Role in Training: A B.C. College's Response.

ERIC Educational Resources Information Center

Witter, Susan

Prior to 1985, the British Columbia (Canada) community colleges relied heavily on institutional seat purchases (direct funding) to support ongoing vocational programs and, to a lesser extent, to implement new training programs. With the introduction of the Canada Job Strategy in 1985, many of the seat purchases were reduced in favor of indirect…

Purchasing and Accounting. MAS-116. Waste Isolation Division (WID). Management and Supervisor Training (MAST) Program.

ERIC Educational Resources Information Center

Westinghouse Electric Corp., Carlsbad, NM.

This learning module, which is part of a management and supervisor training program for managers and supervisors employed at the Department of Energy's Waste Isolation Division, is designed to prepare trainees to perform purchasing and accounting tasks efficiently and effectively. The first section is an introduction to the module. The next three…

Accountability for the Quality of Care Provided to People with Serious Illness

PubMed Central

Hudson Scholle, Sarah; Briefer French, Jessica

2018-01-01

Abstract Background: Care for patients with serious illness is an emerging practice area that has gained attention as value-based purchasing has increased. While the number of programs is growing, their impact on care quality and outcomes is unknown. Objective: With support from the Gordon and Betty Moore Foundation, the National Committee for Quality Assurance (NCQA) is assessing the feasibility of creating an accountability program focused on serious illness care. Methods: This article describes the process of developing an accountability program, findings from our initial work, and our plans to develop measures for a serious illness care accountability program. We focused on three questions: 1. What patient populations should be targeted for measurement?2. What entities have accountability for ensuring high-quality care for serious illness?3. What structures, processes, and outcomes should be evaluated in an accountability program for serious illness care? Results: Our environmental scan showed that the evidence base for specific patient populations or care models is not sufficiently mature to justify traditional structure and process measures. In visits to serious illness care programs, we observed different staffing models, care models, care settings, and payment structures. We found a gap between recommended inclusion criteria and services when compared to inclusion criteria and services offered by existing programs. Conclusions: To address the challenges, NCQA intends to develop outcome measures driven by patient and family priorities. Structure and process measures will focus on building organizations' capacity to measure outcomes, including patient engagement and outcomes, linked to patient goals. PMID:29313755

Independent practice associations: Advantages and disadvantages of an alternative form of physician practice organization.

PubMed

Casalino, Lawrence P; Chenven, Norman

2017-03-01

Value-based purchasing (VBP) favors provider organizations large enough to accept financial risk and develop care management infrastructure. Independent Practice Associations (IPAs) are a potential alternative for physicians to becoming employed by a hospital or large medical group. But little is known about IPAs. We selected four IPAs that vary in location, structure, and strategy, and conducted interviews with their president and medical director, as well as with a hospital executive and health plan executive familiar with that IPA. The IPAs studied vary in size and sophistication, but overall are performing well and are highly regarded by hospital and health plan executives. IPAs can grow rapidly without the cost of purchasing and operating physician practices and make it possible for physicians to remain independent in their own practices while providing the scale and care management infrastructure to make it possible to succeed in VBP. However, it can be difficult for IPAs to gain cooperation from hundreds to thousands of independent physicians, and the need for capital for growth and care management infrastructure is increasing as VBP becomes more prevalent and more demanding. Some IPAs are succeeding at VBP. As VBP raises the performance bar, IPAs will have to demonstrate that they can achieve results equal to more highly capitalized and tightly structured large medical groups and hospital-owned practices. Physicians should be aware of IPAs as a potential option for participating in VBP. Payers are aware of IPAs; the Medicare ACO program and health insurer ACO programs include many IPAs. Copyright © 2016 Elsevier Inc. All rights reserved.

Overcoming Barriers for "Niche" Learners through Distance Learning.

ERIC Educational Resources Information Center

Miller, Lawrence G.; And Others

For over 15 years, Tennessee's Chattanooga State Technical Community College has been offering non-traditional, distance education to reach "niches" of students who would otherwise find it difficult to attain a college education. Begun in 1979 with a laboratory-based independent study program offering a mix of purchased and…

7 CFR 1463.3 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS 2005-2014 TOBACCO TRANSITION PROGRAM Tobacco Transition... payments due on September 30, 2014, the adjusted market share will be the entity's share of a class of tobacco during the April 1-June 30, 2014 quarter. Base period means the period July 1 through June 30...

77 FR 21880 - Federal Housing Administration (FHA): Multifamily Accelerated Processing-Enhancing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-12

... applications for FHA multifamily mortgage insurance, which generally involve the refinance, purchase, new... to date through direct instructions to FHA-approved lenders under a MAP Guide. Given its experience... mortgage insurance programs. Based on HUD's experience to date with MAP, this proposed rule strives not...

Market power and state costs of HIV/AIDS drugs.

PubMed

Leibowitz, Arleen A; Sood, Neeraj

2007-03-01

We examine whether U.S. states can use their market power to reduce the costs of supplying prescription drugs to uninsured and underinsured persons with HIV through a public program, the AIDS Drug Assistance Program (ADAP). Among states that purchase drugs from manufacturers and distribute them directly to clients, those that purchase a greater volume pay lower average costs per prescription. Among states depending on retail pharmacies to distribute drugs and then claiming rebates from manufacturers, those that contract with smaller numbers of pharmacy networks have lower average costs. Average costs per prescription do not differ between the two purchase methods.

24 CFR 970.11 - Procedures for the offer of sale to established eligible organizations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... purchase the property; (d) Contents of initial written notification. The initial written notification to... opportunity to purchase the development, the development's value, and potential use; (5) A statement that... to purchase the property and to obtain a firm financial commitment, as defined in § 970.5. The...

7 CFR 1430.100 - Applicability.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS DAIRY PRODUCTS Dairy Product Price Support Program § 1430... cow's milk produced in the United States. Purchases are subject to the terms and conditions in CCC's...

7 CFR 1430.100 - Applicability.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS DAIRY PRODUCTS Dairy Product Price Support Program § 1430... cow's milk produced in the United States. Purchases are subject to the terms and conditions in CCC's...

7 CFR 1430.100 - Applicability.

Code of Federal Regulations, 2012 CFR

2012-01-01

... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS DAIRY PRODUCTS Dairy Product Price Support Program § 1430... cow's milk produced in the United States. Purchases are subject to the terms and conditions in CCC's...

7 CFR 1430.100 - Applicability.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS DAIRY PRODUCTS Dairy Product Price Support Program § 1430... cow's milk produced in the United States. Purchases are subject to the terms and conditions in CCC's...

7 CFR 1467.14 - Transfer of land.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS WETLANDS RESERVE PROGRAM § 1467.14 Transfer of land. (a... restoration cost-share agreement contract, including the landowner entering into a contract or purchase...

7 CFR 1467.14 - Transfer of land.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS WETLANDS RESERVE PROGRAM § 1467.14 Transfer of land. (a... restoration cost-share agreement contract, including the landowner entering into a contract or purchase...

Improving risk-stratification of Diabetes complications using temporal data mining.

PubMed

Sacchi, Lucia; Dagliati, Arianna; Segagni, Daniele; Leporati, Paola; Chiovato, Luca; Bellazzi, Riccardo

2015-01-01

To understand which factor trigger worsened disease control is a crucial step in Type 2 Diabetes (T2D) patient management. The MOSAIC project, funded by the European Commission under the FP7 program, has been designed to integrate heterogeneous data sources and provide decision support in chronic T2D management through patients' continuous stratification. In this work we show how temporal data mining can be fruitfully exploited to improve risk stratification. In particular, we exploit administrative data on drug purchases to divide patients in meaningful groups. The detection of drug consumption patterns allows stratifying the population on the basis of subjects' purchasing attitude. Merging these findings with clinical values indicates the relevance of the applied methods while showing significant differences in the identified groups. This extensive approach emphasized the exploitation of administrative data to identify patterns able to explain clinical conditions.

Campus sustainable food projects: critique and engagement.

PubMed

Barlett, Peggy F

2011-01-01

Campus sustainable food projects recently have expanded rapidly. A review of four components - purchasing goals, academic programs, direct marketing, and experiential learning - shows both intent and capacity to contribute to transformational change toward an alternative food system. The published rationales for campus projects and specific purchasing guidelines join curricular and cocurricular activities to evaluate, disseminate, and legitimize environmental, economic, social justice, and health concerns about conventional food. Emerging new metrics of food service practices mark a potential shift from rhetoric to market clout, and experiential learning builds new coalitions and can reshape relations with food and place. Campus projects are relatively new and their resilience is not assured, but leading projects have had regional, state, and national impact. The emergence of sustainability rankings in higher education and contract-based compliance around purchasing goals suggests that if support continues, higher education's leadership can extend to the broader agrifood system.

Analyzing The Impacts of the Biogas-to-Electricity Purchase Incentives on Electric Vehicle Deployment with the MA3T Vehicle Choice Model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Podkaminer, Kara; Xie, Fei; Lin, Zhenhong

This analysis represents the biogas-to-electricity pathway under the Renewable Fuel Standard (RFS) as a point of purchase incentive and tests the impact of this incentive on EV deployment using a vehicle consumer choice model. The credit value generated under this policy was calculated in a number of scenarios based on electricity use of each power train choice on a yearly basis over the 15 year vehicle lifetime, accounting for the average electric vehicle miles travelled and vehicle efficiency, competition for biogas-derived electricity among electric vehicles (EVs), the RIN equivalence value and the time value of money. The credit value calculationmore » in each of these scenarios is offered upfront as a point of purchase incentive for EVs using the Market Acceptance of Advanced Automotive Technologies (MA3T) vehicle choice model, which tracks sales, fleet size and energy use over time. The majority of the scenarios use a proposed RIN equivalence value, which increases the credit value as a way to explore the analysis space. Additional model runs show the relative impact of the equivalence value on EV deployment. The MA3T model output shows that a consumer incentive accelerates the deployment of EVs for all scenarios relative to the baseline (no policy) case. In the scenario modeled to represent the current biogas-to-electricity generation capacity (15 TWh/year) with a 5.24kWh/RIN equivalence value, the policy leads to an additional 1.4 million plug-in hybrid electric vehicles (PHEVs) and 3.5 million battery electric vehicles (BEVs) in 2025 beyond the no-policy case of 1.3 million PHEVs and 2.1 million BEVs when the full value of the credit is passed on to the consumer. In 2030, this increases to 2.4 million PHEVs and 7.3 million BEVs beyond the baseline. This larger impact on BEVs relative to PHEVs is due in part to the larger credit that BEVs receive in the model based on the greater percentage of electric vehicle miles traveled by BEVs relative to PHEVs. In this scenario 2025 also represents the last year in which biogas-derived electricity is able to fully supply the transportation electricity demand in the model. After 2025, the credit value declines on a per vehicle basis. At the same time a larger fraction of the credit may shift towards biogas producers in order to incent additional biogas production. The expanded 41 TWh/year biogas availability scenarios represent an increase beyond today s generation capacity and allow greater eRIN generation. With a 5.24kWh/RIN equivalence value, when all of the credit is directed towards reducing vehicle purchase prices, the 41 TWh/year biogas scenario results in 4.1 million additional PHEVs and 12.2 million additional BEVs on the road in 2030 beyond the baseline of 2.5 million PHEVs and 6.1 million BEVs. Under this expanded biogas capacity, biogas-derived electricity generation is able to fully supply electricity for a fleet of over 21 million EVs (15.6 million BEVs and 5.8 million PHEVs) on a yearly basis. In addition to assessing the full value credit scenarios described above, multiple scenarios were analyzed to determine the impact if only a fraction of the credit value was passed on to the consumer. In all of these cases, the EV deployment was scaled back as the fraction of the credit that was passed on to the consumer was reduced. These scenarios can be used to estimate the impact if the credit value is reduced in other ways as well, as demonstrated by the scenarios where the current (22.6 kWh/RIN) equivalence value was used. The EV deployment that results from an equivalence value of 22.6 kWh/RIN equivalence value is roughly equivalent to the EV deployment observed in the 25% case using the 5.24 kWh/RIN equivalence value. A higher equivalence value means that a smaller number of credits, and therefore value, is created for each kWh, and therefore the impact on EV deployment is reduced. This analysis shows several of the drivers that will impact eRIN generation and credit value, and tests the impact of an eRIN point of purchase incentive on EV deployment. This additional incentive can accelerate the deployment of EVs when it is used to reduce vehicle purchase prices. However, the ultimate impact of this policy, as modeled here, will be determined by future RIN prices, the extent to which eRIN credit value can be passed on to the consumer as a point of purchase incentive and the equivalence value.« less

A natural value unit—Econophysics as arbiter between finance and economics

NASA Astrophysics Data System (ADS)

Defilla, Steivan

2007-08-01

Foreign exchange markets show that currency units ( = accounting or nominal price units) are variables. Technical and economic progress evidences that the consumer baskets ( = purchasing power units or real price units) are also variables. In contrast, all physical measurement units are constants and either defined in the SI (=metric) convention or based upon natural constants ( = “natural” or Planck units). Econophysics can identify a constant natural value scale or value unit (natural numeraire) based upon Planck energy. In honor of the economist L. Walras, this “Planck value” could be called Walras (Wal), thereby using the SI naming convention. One Wal can be shown to have a physiological and an economic interpretation in that it is equal to the annual minimal real cost of physiological life of a reference person at minimal activity. The price of one Wal in terms of any currency can be estimated by hedonic regression techniques used in inflation measurement (axiometry). This pilot research uses official disaggregated Swiss Producer and Consumer Price Index (PPI and CPI) data and estimates the hedonic Walras price (HWP), quoted in Swiss francs in 2003, and its inverse, the physical purchasing power (PhPP) of the Swiss franc in 2003.

Evaluating local food programs: the case of Select Nova Scotia.

PubMed

Knight, Andrew J

2013-02-01

This study evaluated the effectiveness of the buy local food program Select Nova Scotia; a government program with the goal to increase awareness and consumption of Nova Scotia produced and processed agri-food products by Nova Scotians and visitors. The evaluation methodology was based on prior evaluation resources and local food consumer research. Data were gathered through a web panel survey; 877 respondents completed the survey in June 2010. The results suggest that the program is reaching a wider audience than just those predisposed to local food initiatives. In addition, awareness of Select Nova was related to perceptions of local benefits and barriers, as well as purchase motivation and behavior. Respondents who were aware of Select Nova Scotia rated societal benefits as more important and viewed location and price as less of a barrier; they were also more likely to be highly motivated to purchase local foods. This study also informs results found in previous consumer research studies and identifies marketing opportunities to enhance the effectiveness of local food programs. The results suggest that societal benefits might be used as a way to differentiate products with similar attributes. Copyright © 2012 Elsevier Ltd. All rights reserved.

24 CFR 906.25 - Ownership interests that may be conveyed to a purchaser.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Ownership interests that may be... § 906.25 Ownership interests that may be conveyed to a purchaser. A homeownership program may provide for sale to the purchasing family of any ownership interest that the PHA considers appropriate under...

13 CFR 108.825 - Purchasing securities from an underwriter or other third party.

Code of Federal Regulations, 2010 CFR

2010-01-01

... ADMINISTRATION NEW MARKETS VENTURE CAPITAL (âNMVCâ) PROGRAM Financing of Small Businesses by NMVC Companies Structuring Nmvc Company's Financing of Eligible Small Businesses § 108.825 Purchasing securities from an... within 90 days of the date the public offering is first made; (2) Your purchase price is no more than the...

Efforts to Improve School Lunch Programs--Are They Paying Off?

DTIC Science & Technology

1981-09-09

ingredients than other districts that purchase more ready-made lunch components. --The amount of special equipment (warming lights, dough mixers, bun slicers...components such as burritos, pizza, or peanut butter cookies . Very few lunch components were significantly short weight and, in all cases, shortages were...fruit and/or juice; potato chips, corn chips, or cookie ; and milk. All food served in the lunch program is prepared in the cafeterias. Nutrient-based

41 CFR 101-26.501-3 - Consolidated purchase program.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26-PROCUREMENT..., purchased in the aggregate by group to the extent practical. These procurements are designed to obtain the...

41 CFR 51-10.102 - Application.

Code of Federal Regulations, 2012 CFR

2012-07-01

... COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED 10-ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE COMMITTEE FOR PURCHASE FROM PEOPLE...

41 CFR 51-10.101 - Purpose.

Code of Federal Regulations, 2014 CFR

2014-07-01

... COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED 10-ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE COMMITTEE FOR PURCHASE FROM PEOPLE...

41 CFR 51-10.102 - Application.

Code of Federal Regulations, 2011 CFR

2011-07-01

... COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED 10-ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE COMMITTEE FOR PURCHASE FROM PEOPLE...

41 CFR 51-10.102 - Application.

Code of Federal Regulations, 2013 CFR

2013-07-01

... COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED 10-ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE COMMITTEE FOR PURCHASE FROM PEOPLE...

41 CFR 51-10.140 - Employment.

Code of Federal Regulations, 2013 CFR

2013-07-01

... COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED 10-ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE COMMITTEE FOR PURCHASE FROM PEOPLE...

41 CFR 51-10.111 - Notice.

Code of Federal Regulations, 2014 CFR

2014-07-01

... COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED 10-ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE COMMITTEE FOR PURCHASE FROM PEOPLE...

41 CFR 51-10.111 - Notice.

Code of Federal Regulations, 2011 CFR

2011-07-01

... COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED 10-ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE COMMITTEE FOR PURCHASE FROM PEOPLE...

41 CFR 51-10.111 - Notice.

Code of Federal Regulations, 2012 CFR

2012-07-01

... COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED 10-ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE COMMITTEE FOR PURCHASE FROM PEOPLE...

41 CFR 51-10.101 - Purpose.

Code of Federal Regulations, 2011 CFR

2011-07-01

... COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED 10-ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE COMMITTEE FOR PURCHASE FROM PEOPLE...

41 CFR 51-10.101 - Purpose.

Code of Federal Regulations, 2013 CFR

2013-07-01

... COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED 10-ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE COMMITTEE FOR PURCHASE FROM PEOPLE...

41 CFR 51-10.102 - Application.

Code of Federal Regulations, 2014 CFR

2014-07-01

... COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED 10-ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE COMMITTEE FOR PURCHASE FROM PEOPLE...

41 CFR 51-10.101 - Purpose.

Code of Federal Regulations, 2012 CFR

2012-07-01

... COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED 10-ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE COMMITTEE FOR PURCHASE FROM PEOPLE...

41 CFR 51-10.140 - Employment.

Code of Federal Regulations, 2012 CFR

2012-07-01

... COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED 10-ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE COMMITTEE FOR PURCHASE FROM PEOPLE...

41 CFR 51-10.111 - Notice.

Code of Federal Regulations, 2013 CFR

2013-07-01

... COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED 10-ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE COMMITTEE FOR PURCHASE FROM PEOPLE...

41 CFR 51-10.140 - Employment.

Code of Federal Regulations, 2011 CFR

2011-07-01

... COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED 10-ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE COMMITTEE FOR PURCHASE FROM PEOPLE...

Preserving an Incentive for Global Health R&D: The Priority Review Voucher Secondary Market.

PubMed

Robertson, Andrew S

2016-05-01

In December 2014, the United States government expanded the Priority Review Voucher ("PRV" or "voucher") program to include Ebola and other related Filoviruses. By doing so, lawmakers provided a potentially powerful incentive for drug companies to invest time and money in the development of novel medicines for terrifying diseases. This expansion is one of several additions made to the PRV programs since 2012. Many companies rely on voucher resale to recoup research and development ("R&D") costs; however, it is unclear whether the PRV program could be overextended, thereby diluting the value of the incentives. In this paper, I use historical approval data from the Food and Drug Administration ("FDA") and United States drug revenue data to better understand the secondary market value of a PRV. The data suggests that that purchase prices of a PRV could continue to climb; despite this, the market size for these vouchers is limited. The implications of these findings are discussed further.

5 CFR 180.108 - Settlement of claims.

Code of Federal Regulations, 2010 CFR

2010-01-01

... purchase or exchange. The amount payable will be determined by applying the principles of depreciation to the adjusted dollar value or other base price of property lost or damaged beyond economical repair; by... cost, condition when damaged beyond economical repair or lost, and the time elapsed between the date of...

A Theoretical Model of Team-Licensed Merchandise Purchasing (TLMP)

ERIC Educational Resources Information Center

Lee, Donghun; Trail, Galen

2011-01-01

Although it is evident that sales of team licensed merchandise (TLM) contribute to the overall consumption of sport, research efforts that comprehensively describe what triggers the consumption of TLM is lacking (Lee, Trail, Kwon, & Anderson, 2011). Therefore, based on multiple theories (i.e., values theory, identity theory, attitude theory, and…

Adverse selection and price sensitivity when low-income people have subsidies to purchase health insurance in the private market.

PubMed

Swartz, K; Garnick, D W

2000-01-01

Policymakers interested in subsidizing low-income people's purchase of private insurance face two major questions: will such subsidies lead to adverse selection, and how large do the subsidies have to be to induce large numbers of eligible people to purchase the insurance? This study examines New Jersey's short-lived experience with a premium subsidy program, Health Access New Jersey (Access Program). The program was for people in families with incomes below 250% of the poverty level who were not eligible for health insurance provided by an employer, or Medicaid or Medicare, and who wished to purchase policies in the state's individual health insurance market, the Individual Health Coverage Program. Surveying a random sample of Access Program policyholders, we compared their demographic and socioeconomic characteristics, as well as their health status, to those of other New Jersey residents who had family incomes below 250% of the poverty level to determine whether there was any evidence of adverse selection among the people who enrolled in the Access Program. The people who enrolled were not in worse health than uninsured people with incomes below 250% of the poverty level, but they were quite price sensitive. Most enrollees had incomes within the low end of the income eligibility distribution, reflecting the structure of rapidly declining subsidies as income increased.

Highly Insulating Windows Volume Purchase Program Final Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

2013-04-01

This report documents the development, execution outcomes and lessons learned of the Highly Insulating Windows Volume Purchase (WVP) Program carried out over a three-year period from 2009 through 2012. The primary goals of the program were met: 1) reduce the incremental cost of highly insulating windows compared to ENERGY STAR windows; and 2) raise the public and potential buyers’ awareness of highly insulating windows and their benefits. A key outcome of the program is that the 2013 ENERGY STAR Most Efficient criteria for primary residential windows were adopted from the technical specifications set forth in the WVP program.

Accounting issues: should the merger be treated as purchase or pooling?

PubMed

Finkler, S A

1985-05-01

Under accounting rules, a merger or consolidation can be treated as either a purchase or pooling. A purchase causes an adjustment in the selling hospital's asset basis to fair market value with goodwill often resulting. Such an adjustment is usually favorable for a taxable acquisition but not a tax-free reorganization. A pooling, on the other hand, results in the assets of the two organizations being merged together with no adjustment in asset values or increase in goodwill. The requirements for pooling are strict but the result is the carryover of assets at historical cost, usually favorable for reporting EPS.

The Boston Middle School-Corner Store Initiative: Development, Implementation, and Initial Evaluation of a Program Designed to Improve Adolescents' Beverage-Purchasing Behaviors

ERIC Educational Resources Information Center

Hoffman, Jessica A.; Morris, Vivien; Cook, John

2009-01-01

The Boston Middle School Corner Store Initiative (CSI) brought together schools, businesses, and community partners to develop, implement, and evaluate a multicomponent pilot program designed to promote healthier beverage purchasing at corner stores among 3,500 middle school students living in Boston, Massachusetts. Healthy drinks were defined for…

Analysis of Army Contracting Command Contract Specialist Vacancy Announcements

DTIC Science & Technology

2010-09-01

program CPCM Certified Professional Contracts Manager CPM Certified Purchasing Manager CPOL Civilian Personnel Online CPSM Certified...experience, a Bachelor’s degree and the applicant is 28 required to pass three CPSM examinations. (2) The Certified Purchasing Manager Program ( CPM ...is currently being phased out and is available only for recertification. The CPM required five years of full time professional supply management

Alternative Fuels Data Center

Science.gov Websites

Hydrogen and Plug-In Electric Vehicle (PEV) Rebate The Hydrogen and Electric Automobile Purchase Rebate Program (CHEAPR) offers rebates for the incremental cost of the purchase or lease of a hydrogen

Pathways for Off-site Corporate PV Procurement

DOE Office of Scientific and Technical Information (OSTI.GOV)

Heeter, Jenny S

Through July 2017, corporate customers contracted for more than 2,300 MW of utility-scale solar. This paper examines the benefits, challenges, and outlooks for large-scale off-site solar purchasing through four pathways: power purchase agreements, retail choice, utility partnerships (green tariffs and bilateral contracts with utilities), and by becoming a licensed wholesale seller of electricity. Each pathway differs based on where in the United States it is available, the value provided to a corporate off-taker, and the ease of implementation. The paper concludes with a discussion of future pathway comparison, noting that to deploy more corporate off-site solar, new procurement pathways aremore » needed.« less

Determinants of Private Long-Term Care Insurance Purchase in Response to the Partnership Program.

PubMed

Lin, Haizhen; Prince, Jeffrey T

2016-04-01

To assess three possible determinants of individuals' response in their private insurance purchases to the availability of the Partnership for Long-Term Care (PLTC) insurance program: bequest motives, financial literacy, and program awareness. The health and retirement study (HRS) merged with data on states' implementation of the PLTC program. Individual-level decision on private long-term care insurance is regressed on whether the PLTC program is being implemented for a given state-year, asset dummies, policy determinant variable, two-way and three-way interactions of these variables, and other controls, using fixed effects panel regression. Analysis used a sample between 50 and 69 years of age from 2002 to 2010, resulting in 12,695 unique individuals with a total of 39,151 observations. We find mild evidence that intent to bequest influences individual purchase of insurance. We also find that program awareness is necessary for response, while financial literacy notably increases responsiveness. Increasing response to the PLTC program among the middle class (the stated target group) requires increased efforts to create awareness of the program's existence and increased education about the program's benefits, and more generally, about long-term care risks and needs. © Health Research and Educational Trust.

The value of group purchasing organizations in the United States.

PubMed

Rooney, Curtis

2011-01-01

This article examines the valuable role of group purchasing organizations (GPOs) in hospital purchasing in the United States. For over 100 years old GPOs have helped hospitals and other health care providers realize savings and create contracting efficiencies by aggregating purchasing volume to negotiate discounts with manufacturers, distributors and other vendors. The US has recently enacted a series of healthcare reforms to correct some of the historical concerns regarding cost, quality and access. GPOs are expected to continue to play a critical role in the business of hospital purchasing and may potential export that other countries may wish to examine.

77 FR 3292 - Main Street Capital Corporation, et al.; Notice of Application

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-23

... of the Company at the time of the Purchases, shareholders of the Company will not experience dilution... Company to purchase equity interests in Main Street Capital II, LP (``MSC'') from certain persons who are.... Since the Exchange Offer, the Company has purchased an additional 0.5% of the total dollar value of...

Relationships between consumption of alcoholic beverages and healthy foods: the French supermarket cohort of 196,000 subjects.

PubMed

Hansel, Boris; Roussel, Ronan; Diguet, Vincent; Deplaude, Amandine; Chapman, M John; Bruckert, Eric

2015-02-01

Moderate alcohol consumption is associated with reduced risk of cardiovascular disease. Related dietary habits and lifestyle may bias assessment of the relationship between alcohol intake and health status. We examined the relationship between key features relating to the consumption of alcoholic beverages and individual profiles of objective food purchases. Data were collected on regular clients of a large supermarket chain implanted across France (n = 196,604). Food items purchased were classified into three categories: (1) healthy foods; (2) unhealthy foods; and (3) others. Wine consumers favoured purchase of healthy foods more often than others, whereas the lowest level of healthy food purchasers was associated with consumption of beer and aniseed-based beverages. Bordeaux wine purchasers spent less in their average budget than the whole population for nine out of the 11 unhealthy food categories. Conversely, the budget was markedly higher in non-alcohol purchasers as compared to the whole population for seven out of the 11 unhealthy foods. The ratio of the budget for healthy to that for unhealthy foods was also distinct between the groups, being highest for wine and lowest for beer. In the subgroup of non-alcohol consumers, this ratio was intermediate but significantly lower relative to values in the five subcategories of wine purchasers. Marked differences in the profile of the purchase of healthy versus unhealthy food products as a function of the subcategory of alcoholic beverage consumed were documented, revealing a critical unidentified confounding feature in analyses of the potential relationship between alcohol consumption and protection against cardiovascular disease. © The European Society of Cardiology 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Priority setting and evidence based purchasing.

PubMed

Frith, L

1999-01-01

The purpose of this paper is to consider the role that values play in priority setting through the use of EBP. It is important to be clear about the role of values at all levels of the decision making process. At one level, society as a whole has to make decisions about the kind of health provision that it wants. As is generally accepted, these priority setting questions cannot be answered by medical science alone but involve important judgements of value. However, as I hope to show values come into priority setting questions at another level, one not often explicitly recognised in much of the literature: that of the very definition of the effectiveness of treatments. This has important consequences for patient care. If we do not recognise that the effectiveness of a treatment involve subjective elements--a patient's own assessment of the value of the treatment--then this could lead to the belief that we can purchase one treatment that is the most effective for all patients. This might result in a detrimental reduction in the range of options that a patient is given with some patients not receiving the treatment that is most effective for them.

Financial support of graduate programs in Brazil: quo vadis?

PubMed

Helene, A F; Xavier, G F

2006-07-01

Graduate programs provide the highest level of formal education and thus are crucial for the development of any country. However, official Brazilian data clearly show a dramatic decrease in the number and values of scholarships available to graduate programs in Brazil over the last few years, despite the importance and growth of such programs. Between 1995 and 2004, investment by the Coordenadoria de Aperfeiçoamento de Pessoal do Ensino Superior (CAPES, subordinate to the Ministry of Education and Culture) in funding scholarships, corrected for inflation in the period, actually decreased by 51%. In addition, during the period between 1994 and 2004, there was a loss of about 60% in the purchasing power of the graduate scholarships provided by CAPES and the National Council for Science and Technology (CNPq). To reverse this trend, we propose the development of sectorial funding for Brazilian graduate programs to guarantee the availability and continuity of financial support for this strategic activity.

The effect of new purchase criteria on food procurement for the Brazilian school feeding program.

PubMed

Soares, Panmela; Davó-Blanes, M Carmen; Martinelli, Suellen Secchi; Melgarejo, Leonardo; Cavalli, Suzi Barletto

2017-01-01

To explore the effect of the school feeding program purchase criteria on the quantity, variety and origin of food products acquired for school meals in a municipality in Brazil. Analysis of purchase lists for two years prior and two years after implementation of the purchase criteria (2010). The origin (family farms (FF)/other providers (OP)) and nutritional characteristics (recommended/controlled) of food products were studied, registering annual varieties (n) and daily quantities (kg/day); contrast of proportions was applied. The acquisition of recommended products increased, and the quantity of controlled products decreased (p = 0.005). Purchase of legumes and vegetables (p < 0.05) increased and high sugar foods decreased (p = 0.02). The majority of food products in 2010 and 2011 were acquired from OP (64% and 61%), although FF provided the greatest proportion of legumes and vegetables. Ten new varieties of recommended products were incorporated, 9 of which were acquired from FF. The criteria of direct purchase from family farms resulted in an increase in the variety and quantity of healthy foods in the schools in the municipality. Copyright © 2016 Elsevier Ltd. All rights reserved.

75 FR 70950 - Request for Certification of Compliance-Rural Industrialization Loan and Grant Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-19

... buildings, purchase mining equipment, and to create working capital. The office and mine are to be located... enterprise is: 212112 Bituminous Coal Underground Mining. DATES: All interested parties may submit comments... process. Comments should address the two bases for certification and, if possible, provide data to assist...

Pupil Personnel Services: Material Review List Recommendations.

ERIC Educational Resources Information Center

Cardinale, Anthony

This list of materials provides recommendations to counselors and guidance personnel for the purchase of materials for pupil personnel services programs in the Department of Defense Dependents Schools (DDDS). The listing, based on staff reviews in each of the six DDDS regions, is divided into 10 content areas: (1) assessment and evaluation; (2)…

Web-Based Portfolio Assessment: Validation of an Open Source Platform

ERIC Educational Resources Information Center

Collins, Regina; Elliot, Norbert; Klobucar, Andrew; Deek, Fadi P.

2013-01-01

Assessment of educational outcomes through purchased tests is commonplace in the evaluation of individual student ability and of educational programs. Focusing on the assessment of writing performance in a longitudinal study of first-time, full-time students (n = 598), this research describes the design, use, and assessment of an open-source…

17 CFR 240.15c3-1d - Satisfactory Subordination Agreements (Appendix D to 17 CFR 240.15c3-1).

Code of Federal Regulations, 2010 CFR

2010-04-01

... market value of commodity options purchased by option customers subject to the rules of a contract market, each such deduction not to exceed the amount of funds in the option customer's account), if greater. No... regulations thereunder (less the market value of commodity options purchased by option customers subject to...

Relying on Your Own Best Judgment: Imputing Values to Missing Information in Decision Making.

ERIC Educational Resources Information Center

Johnson, Richard D.; And Others

Processes involved in making estimates of the value of missing information that could help in a decision making process were studied. Hypothetical purchases of ground beef were selected for the study as such purchases have the desirable property of quantifying both the price and quality. A total of 150 students at the University of Iowa rated the…

Exploring risk profiles and emergency frequency of purchasers and non-purchasers of personal emergency alarms: a prospective cohort study.

PubMed

De San Miguel, Kristen; Lewin, Gill; Burton, Elissa; Toye, Christine; Boldy, Duncan; Howat, Peter

2015-10-27

Personal alarms support independent living and have the potential to reduce serious consequences after a fall or during a medical emergency. While some Australian states have government funded personal alarm programs, others do not; but user-pays services are available. Although several studies have examined the profiles of alarm users, little is known about the risk profile of non-users. Specifically, whether there are "at risk" individuals who are unable, or choose not to purchase a service, who experience a home-based emergency in which an alarm could have mitigated an adverse outcome. This study aimed to describe the 'risk profile' of purchasers and non-purchasers of alarms; explore the reasons behind the decision to purchase or not to purchase and identify how often emergency assistance was needed and why. Purchasers and non-purchasers were followed for one year in this prospective cohort study. Demographic, decision-making and risk factor data were collected at an initial face-to-face interview, while information about emergencies was collected by monthly calls. One hundred and fifty-seven purchasers and sixty-five non-purchasers completed the study. The risk profiles between the groups were similar in terms of gender, living arrangements, fall history and medical conditions. Purchasers (Mean = 82.6 years) were significantly older than non-purchasers (Mean = 79.3 years), (t(220) = -3.38, p = 0.000) and more functionally dependent on the IADL (z = -2.57, p = 0.010) and ADL (z = -2.45 p = 0.014) function scores. Non-purchasers (Mean = 8.04, SD = 3.57) were more socially isolated with significantly fewer family networks than purchasers (Mean = 9.46, SD = 3.25) (t(220) = -2.86, p = 0.005). Both groups experienced similarly high numbers of emergencies, 38.2 % of purchasers and 41.5 % of non-purchasers had at least one emergency where an alarm could have assisted. Main reasons for non-purchase were: cost (77 %), limited alarm range (51 %), no need (39 %) and lack of suitable contacts (30 %). There are older individuals who are at high risk of an emergency who are choosing, often for financial and lack of family support reasons, not to purchase a personal alarm service. Greater availability of government funded subsidy schemes would enable these individuals to access a service. Increasing the range over which alarms work could increase their appeal to a broader range of older persons living in the community. Future research should consider how strategies that improve social isolation from family and challenge clients' beliefs about their own health and independence can support increased access to personal alarm services.

From Policy to Compliance: Federal Energy Efficient Product Procurement

DOE Office of Scientific and Technical Information (OSTI.GOV)

DeMates, Laurèn; Scodel, Anna

Federal buyers are required to purchase energy-efficient products in an effort to minimize energy use in the federal sector, save the federal government money, and spur market development of efficient products. The Federal Energy Management Program (FEMP)’s Energy Efficient Product Procurement (EEPP) Program helps federal agencies comply with the requirement to purchase energy-efficient products by providing technical assistance and guidance and setting efficiency requirements for certain product categories. Past studies have estimated the savings potential of purchasing energy-efficient products at over $500 million per year in energy costs across federal agencies.1 Despite the strong policy support for EEPP and resourcesmore » available, energy-efficient product purchasing operates within complex decision-making processes and operational structures; implementation challenges exist that may hinder agencies’ ability to comply with purchasing requirements. The shift to purchasing green products, including energy-efficient products, relies on “buy in” from a variety of potential actors throughout different purchasing pathways. Challenges may be especially high for EEPP relative to other sustainable acquisition programs given that efficient products frequently have a higher first cost than non-efficient ones, which may be perceived as a conflict with fiscal responsibility, or more simply problematic for agency personnel trying to stretch limited budgets. Federal buyers may also face challenges in determining whether a given product is subject to EEPP requirements. Previous analysis on agency compliance with EEPP, conducted by the Alliance to Save Energy (ASE), shows that federal agencies are getting better at purchasing energy-efficient products. ASE conducted two reviews of relevant solicitations for product and service contracts listed on Federal Business Opportunities (FBO), the centralized website where federal agencies are required to post procurements greater than $25,000. In 2010, ASE estimated a compliance rate of 46% in 2010, up from an estimate of 12% in 2008. Our work updates and expands on ASE’s 2010 analysis to gauge agency compliance with EEPP requirements.« less

Assessing the impact of a cattle risk-based trading scheme on the movement of bovine tuberculosis infected animals in England and Wales.

PubMed

Adkin, A; Brouwer, A; Downs, S H; Kelly, L

2016-01-01

The adoption of bovine tuberculosis (bTB) risk-based trading (RBT) schemes has the potential to reduce the risk of bTB spread. However, any scheme will have cost implications that need to be balanced against its likely success in reducing bTB. This paper describes the first stochastic quantitative model assessing the impact of the implementation of a cattle risk-based trading scheme to inform policy makers and contribute to cost-benefit analyses. A risk assessment for England and Wales was developed to estimate the number of infected cattle traded using historic movement data recorded between July 2010 and June 2011. Three scenarios were implemented: cattle traded with no RBT scheme in place, voluntary provision of the score and a compulsory, statutory scheme applying a bTB risk score to each farm. For each scenario, changes in trade were estimated due to provision of the risk score to potential purchasers. An estimated mean of 3981 bTB infected animals were sold to purchasers with no RBT scheme in place in one year, with 90% confidence the true value was between 2775 and 5288. This result is dependent on the estimated between herd prevalence used in the risk assessment which is uncertain. With the voluntary provision of the risk score by farmers, on average, 17% of movements was affected (purchaser did not wish to buy once the risk score was available), with a reduction of 23% in infected animals being purchased initially. The compulsory provision of the risk score in a statutory scheme resulted in an estimated mean change to 26% of movements, with a reduction of 37% in infected animals being purchased initially, increasing to a 53% reduction in infected movements from higher risk sellers (score 4 and 5). The estimated mean reduction in infected animals being purchased could be improved to 45% given a 10% reduction in risky purchase behaviour by farmers which may be achieved through education programmes, or to an estimated mean of 49% if a rule was implemented preventing farmers from the purchase of animals of higher risk than their own herd. Given voluntary trials currently taking place of a trading scheme, recommendations for future work include the monitoring of initial uptake and changes in the purchase patterns of farmers. Such data could be used to update the risk assessment to reduce uncertainty associated with model estimates. Crown Copyright © 2015. Published by Elsevier B.V. All rights reserved.

Notification: Purchase Card and Convenience Check Audit

EPA Pesticide Factsheets

Project #OA-FY13-0116, April 11, 2013. The U.S. Environmental Protection Agency, Office of Inspector General, is beginning the fieldwork phase of its audit of the agency’s purchase card and convenience check programs.

7 CFR 4290.825 - Purchasing securities from an underwriter or other third party.

Code of Federal Regulations, 2010 CFR

2010-01-01

... BUSINESS INVESTMENT COMPANY (âRBICâ) PROGRAM Financing of Enterprises by RBICs Structuring Rbic Financing of Eligible Enterprises-Types of Financings § 4290.825 Purchasing securities from an underwriter or...

7 CFR 1944.512 - Authorized representative of the applicant.

Code of Federal Regulations, 2010 CFR

2010-01-01

... construction contracts; purchase of the furnishings, fixtures or equipment; or purchase and/or development of... the primary point of contact for all matters relating to the TSA program and as the office responsbile...

48 CFR 801.690-1 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... purchasing agents; contracting officers warranted above the micro-purchase threshold; program and project... statement includes information on experience, education, training, and pertinent contracting authority... experience leading to the fulfillment of core competencies in acquisition-related disciplines. Selection...

16 CFR 233.4 - Bargain offers based upon the purchase of other merchandise.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Bargain offers based upon the purchase of... PRACTICE RULES GUIDES AGAINST DECEPTIVE PRICING § 233.4 Bargain offers based upon the purchase of other... given a customer on the condition that he purchase a particular article at the price usually offered by...

The Value of Competitive Contracting

DTIC Science & Technology

2014-09-01

Research & Engineering) BBP Better Buying Power BOA basic ordering agreement BPA basic purchase agreement CAE Component Acquisition Executive CDSA...competitive procedures for the following contract actions:” a. Contract and purchase orders b. Orders and calls under part 13 Basic Purchase Agreement ( BPA ...Basic Ordering Agreement (BOA) c. Government wide acquisition contracts and IDIQ contracts d. BPAs and BPA calls under Federal Supply Schedules

43 CFR 30.271 - How must the tribe pay for the interests it purchases?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false How must the tribe pay for the interests it purchases? 30.271 Section 30.271 Public Lands: Interior Office of the Secretary of the Interior... the tribe pay for the interests it purchases? (a) A tribe must pay the full fair market value of the...

43 CFR 30.271 - How must the tribe pay for the interests it purchases?

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 1 2011-10-01 2011-10-01 false How must the tribe pay for the interests it purchases? 30.271 Section 30.271 Public Lands: Interior Office of the Secretary of the Interior... the tribe pay for the interests it purchases? (a) A tribe must pay the full fair market value of the...

Nutrition education at the point of purchase: the foods for health project evaluated.

PubMed

Ernst, N D; Wu, M; Frommer, P; Katz, E; Matthews, O; Moskowitz, J; Pinsky, J L; Pohl, S; Schreiber, G B; Sondik, E

1986-01-01

Foods for Health, a nutrition education and research program sponsored by the National Heart, Lung, and Blood Institute and Giant Food, Inc., was designed to demonstrate the feasibility of cardiovascular nutrition education at the point of purchase, specifically, in the supermarket. To evaluate the program's effectiveness, measures of consumer awareness, knowledge, and food purchases were determined before, during, and after the campaign. The program was conducted in the Washington, D.C., area, with Baltimore, Maryland, area stores serving as controls. At the conclusion of the campaign, Washington shoppers showed a significant increase in knowledge scores, while these scores decreased in the Baltimore area. The gain in correct knowledge scores for Washington shoppers compared with Baltimore shoppers was 9% for food fat and cholesterol content and 11% for the relationship between dietary fat and blood cholesterols levels. The food sales data indicate no apparent differences attributable to the intervention. Issues that might account for the lack of a significant change in food purchases, such as cost and the markets' individual sales promotion campaigns, are discussed, and recommendations for the design of future projects are made.

Markets for individual health insurance: can we make them work with incentives to purchase insurance?

PubMed

Swartz, K

2001-01-01

Simple income-based incentives to purchase health insurance (tax credits or deductions, or subsidies) are unlikely to succeed in significantly reducing the number of uninsured because income is not a good predictor of the extent to which individuals use medical service. Proposals to provide incentives to low-income people so they will purchase individual health insurance need to address the inherent tension between the interests of low-risk and high-risk people who rely on individual coverage. If carriers are forced to cover all applicants and to community rate premiums, low-risk people will drop coverage or not apply for it because premiums will exceed their expected need for insurance. Concern for people who currently have access to individual coverage calls for careful examination of options to permit incentive programs to succeed with the individual insurance markets. In particular, attention should focus on using alternatives to simple income-based subsidies to spread the burden of high-risk people's costs broadly, rather than impose the costs on low-risk people who purchase individual coverage. This paper describes three such alternatives. One uses risk adjustments and two rely on reinsurance so that carriers are compensated for the higher costs of covering high-risk people who use incentives to buy insurance. One alternative also permits risk selection by insurance carriers.

UK consumer perceptions of a novel till-receipt 'traffic-light' nutrition system.

PubMed

Cole, Matthew; Peek, Hayden; Cowen, Daniel

2018-03-26

Front-of-pack (FoP) traffic light nutrition labelling has been widely proposed as a tool to improve public health nutrition. Current evidence suggests that whilst consumers generally find them to be useful and an important source of information about a particular food or ingredient, this may have limited value in isolation when considering a person's overall nutritional intake. This study sought to examine UK consumers' use of existing FoP traffic light food labelling and ascertain public perception of a novel 'till-receipt' summary providing nutritional information about consumers entire shopping purchases. In total, 237 respondents completed an online questionnaire between May and June 2016. Almost two-thirds were female (n = 152, 64.1%) and the largest proportion of responses were received from those aged 25-32 years (n = 53, 22.4%) and 41-50 years (n = 53, 22.4%). About 83.5% of respondents suggested that they currently use traffic light information to inform their food purchases and 'health' was reported as the most important factor influencing food choice (42.2%; n = 100). Notably, 54.4% of respondents indicated that the novel till-receipt system could provide a solution to the potential limitations of existing FoP labelling and could help inform healthier food purchases. Our findings strengthen the existing evidence base to suggest that traffic light information is a useful tool to aid consumer food purchases. Moreover, our outcomes propose that consumers may benefit from a new receipt-based traffic light system which provides a more holistic summary of their entire food purchases.

Children's purchase behavior in the snack market: Can branding or lower prices motivate healthier choices?

PubMed

Hartmann, Monika; Cash, Sean B; Yeh, Ching-Hua; Landwehr, Stefanie C; McAlister, Anna R

2017-10-01

Children's dietary-related diseases and their associated costs have expanded dramatically in many countries, making children's food choice a policy issue of increasing relevance. As children spend a considerable amount of money on energy-dense, nutrient-poor (EDNP) products, a better understanding of the main drivers of children's independent food purchase decisions is crucial to move this behavior toward healthier options. The objective of the study is to investigate the role of branding and price in motivating children to choose healthier snack options. The study investigates snack choices of children ages 8 to 11, using a survey and a purchase experiment. The research took place in after-school programs of selected schools in the Boston area. Participants included 116 children. Products in the choice experiment differed on three factors: product type, brand, and price. Data were analyzed using aggregated and mixed logit models. Children's purchase decisions are primarily determined by product type (Importance Value (IV) 56.6%), while brand (IV 22.8%) and price (IV 20.6%) prove to be of less relevance. Only those children who state that they like the familiar brand reveal a preference for the branded product in their purchase decision. Price is a significant predictor of choice when controlling for whether or not children obtain an allowance. It is not simple brand awareness but a child's liking of the brand that determines whether a brand is successful in motivating a child to choose a product. The extent of children's experience with money influences their price responsiveness. To the extent that children who receive an allowance are primarily the ones buying food snacks, higher prices for EDNP snacks could be successful in motivating children to choose a healthier option. Copyright © 2017 Elsevier Ltd. All rights reserved.

School Breakfast Program Participation and Rural Adolescents' Purchasing Behaviors in Food Stores and Restaurants.

PubMed

Caspi, Caitlin Eicher; Wang, Qi; Shanafelt, Amy; Larson, Nicole; Wei, Susan; Hearst, Mary O; Nanney, Marilyn S

2017-10-01

Little is known about adolescents' food purchasing behaviors in rural areas. This study examined whether purchasing food at stores/restaurants around schools was related to adolescents' participation in school breakfast programs and overall diet in rural Minnesota. Breakfast-skippers enrolled in a group-randomized intervention in 2014 to 2015 (N = 404 from 8 schools) completed 24-hour dietary recalls and pre/post surveys assessing food establishment purchase frequency. Healthy Eating Index Scores (HEI-2010) were calculated for each student. Student-level school breakfast participation (SBP) was obtained from school food service records. Mixed-effects regression models estimated: (1) whether SBP was associated with store/restaurant use at baseline, (2) whether an increase in SBP was associated with a decrease in store/restaurant use, and (3) whether stores/restaurant use was associated with HEI-2010 scores at baseline. Students with increased SBP were more likely to decrease fast-food restaurant purchases on the way home from school (OR 1.017, 95% CI 1.005, 1.029), but were less likely to decrease purchases at food stores for breakfast (OR 0.979, 95% CI 0.959, 0.999). Food establishment use was associated with lower HEI-2010 dairy component scores (p = .017). Increasing participation in school breakfast may result in modest changes in purchases at food establishments. © 2017, American School Health Association.

Participant Satisfaction with a Food Benefit Program with Restrictions and Incentives.

PubMed

Rydell, Sarah A; Turner, Rachael M; Lasswell, Tessa A; French, Simone A; Oakes, J Michael; Elbel, Brian; Harnack, Lisa J

2018-02-01

Policy makers are considering changes to the Supplemental Nutrition Assistance Program (SNAP). Proposed changes include financially incentivizing the purchase of healthier foods and prohibiting the use of funds for purchasing foods high in added sugars. SNAP participant perspectives may be useful in understanding the consequences of these proposed changes. To determine whether food restrictions and/or incentives are acceptable to food benefit program participants. Data were collected as part of an experimental trial in which lower-income adults were randomly assigned to one of four financial food benefit conditions: (1) Incentive: 30% financial incentive on eligible fruits and vegetables purchased using food benefits; (2) Restriction: not allowed to buy sugar-sweetened beverages, sweet baked goods, or candies with food benefits; (3) Incentive plus Restriction; or (4) Control: no incentive/restriction. Participants completed closed- and open-ended questions about their perceptions on completion of the 12-week program. Adults eligible or nearly eligible for SNAP were recruited between 2013 and 2015 by means of events or flyers in the Minneapolis/St Paul, MN, metropolitan area. Of the 279 individuals who completed baseline measures, 265 completed follow-up measures and are included in these analyses. χ 2 analyses were conducted to assess differences in program satisfaction. Responses to open-ended questions were qualitatively analyzed using principles of content analysis. There were no statistically significant or meaningful differences between experimental groups in satisfaction with the program elements evaluated in the study. Most participants in all conditions found the food program helpful in buying nutritious foods (94.1% to 98.5%) and in buying the kinds of foods they wanted (85.9% to 95.6%). Qualitative data suggested that most were supportive of restrictions, although a few were dissatisfied. Participants were uniformly supportive of incentives. Findings suggest a food benefit program that includes incentives for purchasing fruits and vegetables and/or restrictions on the use of program funds for purchasing foods high in added sugars appears to be acceptable to most participants. Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Behavioral Targeting—Consumer Tracking

NASA Astrophysics Data System (ADS)

Srimani, P. K.; Srinivas, A.

2011-12-01

Behavioral targeting is an online marketing method that collects data on the browsing activities of consumers, in order to `target' more relevant online advertising. Behavioral targeting enables marketers to reach in-market consumers and increases the value of publisher inventory. At the heart of behavioral targeting is a learning-based investigation of consumer behaviors. It helps marketers understand consumers' purchase patterns over time, mapping out a customer's activities based not only on a single purchase but also on an annual or even lifetime basis. As marketers increasingly appreciate the importance of customer lifetime value, behavioral targeting can be a foundation for creating a continuous analytical study of consumer trends and patterns. But as behavioural-targeting systems become more sophisticated and invasive, it is vital that the companies behind them are open with users about what is going on, and give them control over their personal information. The aim of this paper is to explore the various tools and techniques of behavioral targeting and its benefits to online marketing. A multiple—case study approach was used for exploring the effectiveness and acceptance of online marketing in the area of the online marketing.

Community food environments and healthy food access among older adults: A review of the evidence for the Senior Farmers' Market Nutrition Program (SFMNP).

PubMed

O'Dare Wilson, Kellie

2017-04-01

Although an array of federal, state, and local programs exist that target food insecurity and the specific nutritional needs of seniors, food insecurity among older adults in the United States remains a persistent problem, particularly in minority and rural populations. Food insecurity is highly predictive of inadequate fresh fruit and vegetable (FFV) consumption in particular. The Senior Farmers' Market Nutrition Program (SFMNP) is a community-based program to help seniors purchase FFVs at farmer's markets in their neighborhoods. The SFMNP continues to grow; however, little is known about the effectiveness of the program. The purposes of this article are to (1) highlight the importance of community and neighborhood based food insecurity programs, specifically emphasizing the importance of FFV access for seniors, (2) review the current state of the evidence on the SFMNP, and (3) provide recommendations for researchers and policy-makers wishing to continue to advance the knowledge base in neighborhood-based food security among older adults.

Communication Module for the Micro-Based Small Purchase Contracting Program

DTIC Science & Technology

1992-03-01

SUISISTUCI 2 3 SANDWICH COOKIES 3 CREAM FILLING, CHOCOLATE FLAVOR, VANILLA FLAVOR, OR 3 COM INATION BASE CAKES , ADCOP. 2 2 VARIATION PROVISIONS SAE AS CLII...SUBJECT TERMS (continue on reverse if necessary and identify by block number) FIELD I GROUP SUBGROUP Procurement Automation Telecommunications System...Information Management System 19 ABSTRACT (continue on reverse if necessary and identify by block number) This thesis conducted research and development of

United Nations Environment Program - Sustainable Purchasing Guidance Profile

EPA Pesticide Factsheets

To help you find the resource that is right for your organization, EPA conducted a scan of the landscape and developed summary profiles of some of the leading sources of sustainable purchasing guidance around the globe.

Qualitative Measurement of Environmentally Preferable Purchasing Among Federal Employees in 2000

EPA Pesticide Factsheets

The U.S. Environmental Protection Agency’s (EPA’s) Environmentally Preferable Purchasing (EPP) program is mandated by Executive Order 13101 to green the federal government. This was a study to determine federal attitudes.

Alternative Fuels Data Center

Science.gov Websites

Oregon Department of Environmental Quality (DEQ) will establish a state rebate program for the purchase air pollution will be eligible for an additional rebate of up to $2,500 for the purchase or lease of a

Value-based formulas for purchasing. Does managed care offer value to society?

PubMed

Priester, R

1997-01-01

To assess whether managed care is, all things considered, a good investment for our society, we can measure its performance relative to five essential health care goals: promote efficiency; expand access; improve quality; preserve freedom of choice; and protect patient advocacy. These goals, which have shaped and continue to shape health care policy, define what is important to us in our health care system. Concerns about managed care's ability to advance these goals and thus to offer value are heightened if recently observed trends continue.

Mindful Climate Action: Health and Environmental Co-Benefits from Mindfulness-Based Behavioral Training

PubMed Central

Barrett, Bruce; Grabow, Maggie; Middlecamp, Cathy; Mooney, Margaret; Checovich, Mary M.; Converse, Alexander K.; Gillespie, Bob; Yates, Julia

2016-01-01

Greenhouse gases from human activities are causing climate change, creating risks for people around the globe. Behaviors involving transportation, diet, energy use, and purchasing drive greenhouse gas emissions, but are also related to health and well-being, providing opportunity for co-benefits. Replacing shorter automobile trips with walking or cycling, or eating plants rather than animals, for example, may increase personal health, while also reducing environmental impact. Mindfulness-based practices have been shown to enhance a variety of health outcomes, but have not been adapted towards environmental purposes. We designed the Mindful Climate Action (MCA) curriculum to help people improve their health while simultaneously lowering their carbon footprints. Combining mindfulness-based practices with the Stages of Change theory, the MCA program aims to: (1) improve personal health and well-being; (2) decrease energy use; (3) reduce automobile use; (4) increase active transport; (5) shift diet towards plant-based foods; and (6) reduce unnecessary purchasing. Mindfulness practices will foster attentional awareness, openness, and response flexibility, supporting positive behavior change. We plan to test MCA in a randomized controlled trial, with rigorous assessment of targeted outcomes. Our long-term goal is to refine and adapt the MCA program to a variety of audiences, in order to enhance public health and environmental sustainability. PMID:28008371

47 CFR 54.615 - Obtaining services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... provided under § 54.621, that the requester cannot obtain toll-free access to an Internet service provider... thing of value; (6) If the service or services are being purchased as part of an aggregated purchase...

Evaluation of critical indicators in the process of acquiring supplies and services LAC-UFPE

NASA Astrophysics Data System (ADS)

Caetano, V. F.; Ferreira, C. V.; dos Santos, M. J.; Honorato, F. A.

2015-01-01

In laboratories linked to public universities and accredited by the NBR ISO/IEC 17025, to meet efficiently item 4.6 (procurement of supplies and services) is a challenge that can be accomplished by programming based on historical purchases and services. In this study, we evaluated the critical procurement items to meet the quality management system of the LAC-UFPE: reagents, certified reference material, of equipment parts, maintenance and calibration of equipment and instruments. It was found that the most critical item is the certified reference material, the purchase or repair of which must be expedited within 125 days prior to the receipt to occur within the desired period.

Value-Based Emergency Management.

PubMed

Corrigan, Zachary; Winslow, Walter; Miramonti, Charlie; Stephens, Tim

2016-02-01

This article touches on the complex and decentralized network that is the US health care system and how important it is to include emergency management in this network. By aligning the overarching incentives of opposing health care organizations, emergency management can become resilient to up-and-coming changes in reimbursement, staffing, and network ownership. Coalitions must grasp the opportunity created by changes in value-based purchasing and impending Centers for Medicare and Medicaid Services emergency management rules to engage payers, physicians, and executives. Hope and faith in doing good is no longer enough for preparedness and health care coalitions; understanding how physicians are employed and health care is delivered and paid for is now necessary. Incentivizing preparedness through value-based compensation systems will become the new standard for emergency management.

Making care affordable.

PubMed

Solomon, S

1999-01-01

The YRG Centre for AIDS Research and Education (CARE) in Chennai, India runs an integrated care program ensuring appropriate and affordable care to everyone who needs it. The program includes both voluntary counseling/testing and hospital/home-based care. YRG CARE developed several strategies for the care program, which include 1) different fees for an HIV test, 2) free counseling service, 3) different charges for other care services, 4) a subsidized pharmacy (involving purchasing drugs directly from manufacturers and wholesalers, ordering free samples from manufacturers, and acquiring drugs through the drug component of its clinical research projects, from overseas hospitals, and from YRG CARE hospital and community-based patients who have not used them), and 5) subsidized meals.

The Accuracy of Stated Energy Contents of Reduced-Energy, Commercially Prepared Foods

PubMed Central

Urban, Lorien E.; Dallal, Gerard E.; Robinson, Lisa M.; Ausman, Lynne M.; Saltzman, Edward; Roberts, Susan B.

2010-01-01

The accuracy of stated energy contents of reduced-energy restaurant foods and frozen meals purchased from supermarkets was evaluated. Measured energy values of 29 quick-serve and sit-down restaurant foods averaged 18% more than stated values, and measured energy values of 10 frozen meals purchased from supermarkets averaged 8% more than originally stated. These differences substantially exceeded laboratory measurement error but did not achieve statistical significance due to considerable variability in the degree of underreporting. Some individual restaurant items contained up to 200% of stated values and, in addition, free side dishes increased provided energy to an average of 245% of stated values for the entrees they accompanied. These findings suggest that stated energy contents of reduced-energy meals obtained from restaurants and supermarkets are not consistently accurate, and in this study averaged more than measured values, especially when free side dishes were taken into account. If widespread, this phenomenon could hamper efforts to self-monitor energy intake to control weight, and could also reduce the potential benefit of recent policy initiatives to disseminate information on food energy content at the point of purchase. PMID:20102837

A roadmap for improving healthcare service quality.

PubMed

Kennedy, Denise M; Caselli, Richard J; Berry, Leonard L

2011-01-01

A data-driven, comprehensive model for improving service and creating long-term value was developed and implemented at Mayo Clinic Arizona (MCA). Healthcare organizations can use this model to prepare for value-based purchasing, a payment system in which quality and patient experience measures will influence reimbursement. Surviving and thriving in such a system will require a comprehensive approach to sustaining excellent service performance from physicians and allied health staff (e.g., nurses, technicians, nonclinical staff). The seven prongs in MCA's service quality improvement model are (1) multiple data sources to drive improvement, (2) accountability for service quality, (3) service consultation and improvement tools, (4) service values and behaviors, (5) education and training, (6) ongoing monitoring and control, and (7) recognition and reward. The model was fully implemented and tested in five departments in which patient perception of provider-specific service attributes and/or overall quality of care were below the 90th percentile for patient satisfaction in the vendor's database. Extent of the implementation was at the discretion of department leadership. Perception data rating various service attributes were collected from randomly selected patients and monitored over a 24-month period. The largest increases in patient perception of excellence over the pilot period were realized when all seven prongs of the model were implemented as a comprehensive improvement approach. The results of this pilot may help other healthcare organizations prepare for value-based purchasing.

Study on Stochastic Optimal Electric Power Procurement Strategies with Uncertain Market Prices

NASA Astrophysics Data System (ADS)

Sakchai, Siripatanakulkhajorn; Saisho, Yuichi; Fujii, Yasumasa; Yamaji, Kenji

The player in deregulated electricity markets can be categorized into three groups of GENCO (Generator Companies), TRNASCO (Transmission Companies), DISCO (Distribution Companies). This research focuses on the role of Distribution Companies, which purchase electricity from market at randomly fluctuating prices, and provide it to their customers at given fixed prices. Therefore Distribution companies have to take the risk stemming from price fluctuation of electricity instead of the customers. This entails the necessity to develop a certain method to make an optimal strategy for electricity procurement. In such a circumstance, this research has the purpose for proposing the mathematical method based on stochastic dynamic programming to evaluate the value of a long-term bilateral contract of electricity trade, and also a project of combination of the bilateral contract and power generation with their own generators for procuring electric power in deregulated market.

Examining the Relationship Between Perceived Quality of Care and Actual Quality of Care as Measured by 30-Day Readmission Rates.

PubMed

Salinas, Stanley R

To test the relationship between patient experience, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), and actual quality of care, as measured by 30-day readmission rates. Both HCAHPS data and outcome data reported to the Centers of Medicare & Medicaid Services (CMS). This secondary, nationwide (N = 4060), hospital-level study focused only on acute care hospitals. HCAHPS question 22 "Would you recommend this hospital to your friends and family?" was used to determine level of overall satisfaction, and 30-day readmission rates, as reported to the CMS, was used as a proxy for actual quality of care. A statistically significant relationship was found between patient experience and actual quality outcomes. The results of this study reinforce the inclusion of patient experience in Medicare's Value Based Purchasing program as a matter of good public policy.

Second Servings and a La Carte Sales to Elementary Children in the National School Lunch Program and Potential Implications for Childhood Obesity

ERIC Educational Resources Information Center

Wilder, Amanda J.

2012-01-01

The sale of second servings and/or a la carte purchases made by elementary students participating in the National School Lunch Program (NSLP) was investigated in this mixed methods case study. The percentage of elementary students in one school district who purchase second servings and/or a la carte items, in addition to the regularly purchased…

If you build it, will they eat it? Consumer preferences for plant-based and cultured meat burgers.

PubMed

Slade, Peter

2018-06-01

In a hypothetical choice experiment consumers were given the option of purchasing burgers that were made from beef, plant-based protein, or cultured meat. Willingness to purchase plant-based and cultured meat burgers is linked to age, sex, views of other food technologies, and attitudes towards the environment and agriculture. Although consumers were told that all burgers tasted the same, there was a marked preference for beef burgers. A mixed-logit model predicts that, if prices were equal, 65% of consumers would purchase the beef burger, 21% would purchase the plant-based burger, 11% would purchase the cultured meat burger, and 4% would make no purchase. Preferences for plant-based and cultured meat burgers are found to be highly, but not perfectly, correlated. Copyright © 2018 Elsevier Ltd. All rights reserved.

Web-based Factors Affecting Online Purchasing Behaviour

NASA Astrophysics Data System (ADS)

Ariff, Mohd Shoki Md; Sze Yan, Ng; Zakuan, Norhayati; Zaidi Bahari, Ahamad; Jusoh, Ahmad

2013-06-01

The growing use of internet and online purchasing among young consumers in Malaysia provides a huge prospect in e-commerce market, specifically for B2C segment. In this market, if E-marketers know the web-based factors affecting online buyers' behaviour, and the effect of these factors on behaviour of online consumers, then they can develop their marketing strategies to convert potential customers into active one, while retaining existing online customers. Review of previous studies related to the online purchasing behaviour in B2C market has point out that the conceptualization and empirical validation of the online purchasing behaviour of Information and Communication Technology (ICT) literate users, or ICT professional, in Malaysia has not been clearly addressed. This paper focuses on (i) web-based factors which online buyers (ICT professional) keep in mind while shopping online; and (ii) the effect of web-based factors on online purchasing behaviour. Based on the extensive literature review, a conceptual framework of 24 items of five factors was constructed to determine web-based factors affecting online purchasing behaviour of ICT professional. Analysis of data was performed based on the 310 questionnaires, which were collected using a stratified random sampling method, from ICT undergraduate students in a public university in Malaysia. The Exploratory factor analysis performed showed that five factors affecting online purchase behaviour are Information Quality, Fulfilment/Reliability/Customer Service, Website Design, Quick and Details, and Privacy/Security. The result of Multiple Regression Analysis indicated that Information Quality, Quick and Details, and Privacy/Security affect positively online purchase behaviour. The results provide a usable model for measuring web-based factors affecting buyers' online purchase behaviour in B2C market, as well as for online shopping companies to focus on the factors that will increase customers' online purchase.

Effects of Subsidies and Prohibitions on Nutrition in a Food Benefit Program

PubMed Central

Harnack, Lisa; Oakes, J. Michael; Elbel, Brian; Beatty, Timothy; Rydell, Sarah; French, Simone

2018-01-01

IMPORTANCE Strategies to improve the nutritional status of those participating in the Supplemental Nutrition Assistance Program (SNAP) are of interest to policymakers. OBJECTIVE To evaluate whether the proposed policy of incentivizing the purchase of fruits and vegetables and prohibiting the purchase of less nutritious foods in a food benefit program improves the nutritional quality of participants’ diets. DESIGN, SETTING, AND PARTICIPANTS Lower income participants (n = 279) not currently enrolled in SNAP were randomized to 1 of 4 experimental financial food benefit conditions: (1) incentive (30% financial incentive for fruits and vegetables purchased using food benefits); (2) restriction (not allowed to buy sugar sweetened beverages, sweet baked goods, or candies with food benefits); (3) incentive plus restriction (30% financial incentive on fruits and vegetables and restriction of purchase of sugar sweetened beverages, sweet baked goods, or candy with food benefits); or (4) control (no incentive or restrictions on foods purchased with food benefits). Participants in all conditions were given a study-specific debit card where funds were added every 4 weeks for a 12-week period. Outcome measures were collected at baseline and in the final 4 weeks of the experimental period. MAIN OUTCOMES AND MEASURES Primary outcomes (from 24-hour dietary recalls) included intake of energy, discretionary calories, and overall diet quality. RESULTS A number of favorable changes were observed in the incentive plus restriction condition that were significantly different from changes in the control condition. These included (1) reduced intake of energy (−96 kcal/d, standard error [SE], 59.9); (2) reduced intake of discretionary calories (−64 kcal/d, SE 26.3); (3) reduced intake of sugar sweetened beverages, sweet baked goods, and candies (−0.6 servings/d, SE 0.2); (4) increased intake of solid fruit (0.2 servings/d, SE 0.1); and (5) improved Healthy Eating Index score (4.1 points, SE 1.4). Fewer improvements were observed in the incentive only and restriction only arms. CONCLUSIONS AND RELEVANCE A food benefit program that pairs incentives for purchasing more fruits and vegetables with restrictions on the purchase of less nutritious foods may reduce energy intake and improve the nutritional quality of the diet of participants compared with a program that does not include incentives or restrictions. CLINICAL TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02643576 PMID:27653735

Effects of Subsidies and Prohibitions on Nutrition in a Food Benefit Program: A Randomized Clinical Trial.

PubMed

Harnack, Lisa; Oakes, J Michael; Elbel, Brian; Beatty, Timothy; Rydell, Sarah; French, Simone

2016-11-01

Strategies to improve the nutritional status of those participating in the Supplemental Nutrition Assistance Program (SNAP) are of interest to policymakers. To evaluate whether the proposed policy of incentivizing the purchase of fruits and vegetables and prohibiting the purchase of less nutritious foods in a food benefit program improves the nutritional quality of participants' diets. Lower income participants (n = 279) not currently enrolled in SNAP were randomized to 1 of 4 experimental financial food benefit conditions: (1) incentive (30% financial incentive for fruits and vegetables purchased using food benefits); (2) restriction (not allowed to buy sugar sweetened beverages, sweet baked goods, or candies with food benefits); (3) incentive plus restriction (30% financial incentive on fruits and vegetables and restriction of purchase of sugar sweetened beverages, sweet baked goods, or candy with food benefits); or (4) control (no incentive or restrictions on foods purchased with food benefits). Participants in all conditions were given a study-specific debit card where funds were added every 4 weeks for a 12-week period. Outcome measures were collected at baseline and in the final 4 weeks of the experimental period. Primary outcomes (from 24-hour dietary recalls) included intake of energy, discretionary calories, and overall diet quality. A number of favorable changes were observed in the incentive plus restriction condition that were significantly different from changes in the control condition. These included (1) reduced intake of energy (-96 kcal/d, standard error [SE], 59.9); (2) reduced intake of discretionary calories (-64 kcal/d, SE 26.3); (3) reduced intake of sugar sweetened beverages, sweet baked goods, and candies (-0.6 servings/d, SE 0.2); (4) increased intake of solid fruit (0.2 servings/d, SE 0.1); and (5) improved Healthy Eating Index score (4.1 points, SE 1.4). Fewer improvements were observed in the incentive only and restriction only arms. A food benefit program that pairs incentives for purchasing more fruits and vegetables with restrictions on the purchase of less nutritious foods may reduce energy intake and improve the nutritional quality of the diet of participants compared with a program that does not include incentives or restrictions. clinicaltrials.gov Identifier: NCT02643576.

The Impact of Nursing Home Pay-for-Performance on Quality and Medicare Spending: Results from the Nursing Home Value-Based Purchasing Demonstration.

PubMed

Grabowski, David C; Stevenson, David G; Caudry, Daryl J; O'Malley, A James; Green, Lisa H; Doherty, Julia A; Frank, Richard G

2017-08-01

To evaluate the impact of the Nursing Home Value-Based Purchasing demonstration on quality of care and Medicare spending. Administrative and qualitative data from Arizona, New York, and Wisconsin nursing homes over the base-year (2008-2009) and 3-year (2009-2012) demonstration period. Nursing homes were randomized to the intervention in New York, while the comparison facilities were constructed via propensity score matching in Arizona and Wisconsin. We used a difference-in-difference analysis to compare outcomes across the base-year relative to outcomes in each of the three demonstration years. To provide context and assist with interpretation of results, we also interviewed staff members at participating facilities. Medicare savings were observed in Arizona in the first year only and Wisconsin for the first 2 years; no savings were observed in New York. The demonstration did not systematically impact any of the quality measures. Discussions with nursing home administrators suggested that facilities made few, if any, changes in response to the demonstration, leading us to conclude that the observed savings likely reflected regression to the mean rather than true savings. The Federal nursing home pay-for-performance demonstration had little impact on quality or Medicare spending. © Health Research and Educational Trust.

Does the active use of nutrition labeling reduce the risk of diabetes mellitus? Results of insulin resistance using Korean National Health and Nutrition Examination Survey.

PubMed

Han, Kyu-Tae; Kim, Seung Ju; Kim, Dong Jun; Kim, Sun Jung

2018-05-29

In 1995, nutrition labeling became mandatory in South Korea. These regulations help consumers make reasonable choices when purchasing food based on nutritional value by providing the nutritional properties of processed foods. We investigated the association between perceptions about nutrition labeling and insulin resistance (IR) in people with no diagnosis of diabetes mellitus (DM). This study used data from the sixth Korea National Health and Nutrition Examination Survey (KNHANES VI-3 in 2015, n=2931). We used multiple regression analysis to investigate the relationship between perceptions about nutrition labeling and the homeostatic model assessment for insulin resistance (HOMA-IR). 75.2% of participants were aware of nutrition labeling and 24.8% of participants checked nutrition labeling and actively used the information. "Actively checked and used the nutrition labeling" was inversely associated with HOMA-IR scores (check nutrition facts and make labeling-dependent purchase decisions: β=-0.108, p=0.0164). These associations were more significant in people who were obese or paid more attention to their health. High levels of perceptions about nutrition labeling and active use of such information could have positive effects on reducing IR and preventing DM. Therefore, it is necessary to improve public perception for effective implementation of healthcare programs. Copyright © 2018 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Analysis of cigarette purchase task instrument data with a left-censored mixed effects model.

PubMed

Liao, Wenjie; Luo, Xianghua; Le, Chap T; Chu, Haitao; Epstein, Leonard H; Yu, Jihnhee; Ahluwalia, Jasjit S; Thomas, Janet L

2013-04-01

The drug purchase task is a frequently used instrument for measuring the relative reinforcing efficacy (RRE) of a substance, a central concept in psychopharmacological research. Although a purchase task instrument, such as the cigarette purchase task (CPT), provides a comprehensive and inexpensive way to assess various aspects of a drug's RRE, the application of conventional statistical methods to data generated from such an instrument may not be adequate by simply ignoring or replacing the extra zeros or missing values in the data with arbitrary small consumption values, for example, 0.001. We applied the left-censored mixed effects model to CPT data from a smoking cessation study of college students and demonstrated its superiority over the existing methods with simulation studies. Theoretical implications of the findings, limitations of the proposed method, and future directions of research are also discussed.

Effects of disputes and easement violations on the cost-effectiveness of land conservation

PubMed Central

Arcese, Peter

2015-01-01

Conservation initiatives to protect and restore valued species communities in human-dominated landscapes face challenges linked to their potential costs. Conservation easements on private land may represent a cost-effective alternative to land purchase, but long-term costs to monitor and enforce easements, or defend legal challenges, remain uncertain. We explored the cost-effectiveness of conservation easements, defined here as the fraction of the high-biodiversity landscape potentially protected via investment in easements versus land purchase. We show that easement violation and dispute rates substantially affect the estimated long-term cost-effectiveness of an easement versus land purchase strategy. Our results suggest that conservation easements can outperform land purchase as a strategy to protect biodiversity as long as the rate of disputes and legal challenges is low, pointing to a critical need for monitoring data to reduce costs and maximize the value of conservation investments. PMID:26413430

Analysis of Cigarette Purchase Task Instrument Data with a Left-Censored Mixed Effects Model

PubMed Central

Liao, Wenjie; Luo, Xianghua; Le, Chap; Chu, Haitao; Epstein, Leonard H.; Yu, Jihnhee; Ahluwalia, Jasjit S.; Thomas, Janet L.

2015-01-01

The drug purchase task is a frequently used instrument for measuring the relative reinforcing efficacy (RRE) of a substance, a central concept in psychopharmacological research. While a purchase task instrument, such as the cigarette purchase task (CPT), provides a comprehensive and inexpensive way to assess various aspects of a drug’s RRE, the application of conventional statistical methods to data generated from such an instrument may not be adequate by simply ignoring or replacing the extra zeros or missing values in the data with arbitrary small consumption values, e.g. 0.001. We applied the left-censored mixed effects model to CPT data from a smoking cessation study of college students and demonstrated its superiority over the existing methods with simulation studies. Theoretical implications of the findings, limitations of the proposed method and future directions of research are also discussed. PMID:23356731