Professional and Research Interests

 

I am interested in the study of competition and market structure, especially in health care.  Two essays in my dissertation examine trends in hospital employment of physicians and the factors that drive hospital-physician (vertical) integration. I focus on the effect of Medicare reimbursement policy on ownership structure in physician markets.  Other health care interests include pharmaceuticals, Medicare and Medicaid policy, and health policy. 

More generally, I am interested in health economics,  industrial organization, labor economics, and law and economics.  I have experience in personal injury and wrongful death litigation consulting where I acted as case manager and conducted research subsequent to case-specific issues.  Other consulting experience includes working for the Kentucky Transportation Center where projects focused on commercial vehicle tax enforcement and adjudication of traffic and safety violations for commercial vehicle drivers.


Job Market Paper

 

Forlines, Grayson L., "Drivers of Physician-Hospital Integration: The Role of Medicare Reimbursement" (Link to full paper)

Physicians are rapidly integrating with hospitals through practice acquisitions and direct employment, yet there has been little work done which examines the causes of physician-hospital vertical integration. I empirically estimate the responsiveness of physicians to Medicare "provider-based" billing policies, which differentially compensate integrated, hospital-owned and independent, free-standing physician practices for providing the same services. Results indicate that some physician specialties are responsive to increases in the relative price paid to integrated providers, and others are not. A 10 percent increase in the relative price paid to integrated providers results in a 1.9 percentage point increase in hospital ownership of physician practices for medical care specialties (cardiology, dermatology, and neurology). There is no significant response for primary care or surgical care physicians. Since acquired practices may bill higher rates to Medicare and private insurers without any subsequent changes in where or how health care services are delivered as well as refer patients to the acquiring hospital, I interpret this responsiveness as evidence that Medicare's provider-based billing policy overcompensates integrated physician practices and leads to an inefficiently high level of vertical integration between physician and hospitals.


Publications

 

Brookshire, Michael L., and Grayson L. Forlines, "Rejoinder: The P Problem Fallacy: A Second Attempt At Obfuscation Also Fails," The Rehabilitation Professional, 23(4), pp. 239-241, 2015.

Brookshire, Michael L., and Grayson L. Forlines, "Rejoinder: The Debunking Attempt is Bunkum With No `De'," The Rehabilitation Professional, 23(3), pp. 129-132, 2015.

Brookshire, Michael L., and Grayson L. Forlines, "The P Problem and and the Estimation of Worklife Expectancy Losses In Personal Injury Cases," The Rehabilitation Professional, 22(4), pp. 207-216, 2014.


Presentations

"Drivers of Physician-Hospital Integration: The Role of Medicare Reimbursement" (Link: presentation slides)

  • Presented at the Southern Economic Association, Graduate Students in Free Enterprise session, Tampa, FL, November 17, 2017.

  • Presented at the 18th Annual Southeastern Health Economics Study Group, Nashville, TN, October 13, 2017.

  • Presented at Centre College seminar series, Danville, KY, September 29, 2017.

 

"Outsourcing Fraud Enforcement-the Effects of Whistleblower Laws on Medicaid Expenditure" (Link: presentation slides)

  • Presented at the Southern Economic Association Graduate Student Awards Session, Tampa, FL, November 17, 2017.

  • Presented at the 2016 Conference for the Kentucky Economic Association, Lexington, KY, October 21, 2016.

  • Presented at the 2016 Bates White Life Sciences Conference in Washington, D.C., May 24, 2016.

 

"The P Problem and the Estimation of Worklife Expectancy Losses in Personal Injury Cases"

  • Presented at the National Association of Forensic Economics conference in Tampa, Florida, March 2013.


Other Papers

 

Forlines, Grayson L., and Aaron Yelowitz, "Outsourcing Fraud Enforcement-the Effects of Whistleblower Laws on Medicaid Expenditure"

This paper analyzes the effect of state anti-fraud enforcement activity on potentially fraudulent behavior through examining Medicaid program spending.  Using state-year variation in state False Claims Act (FCA) legislation-a civil anti-fraud "whistleblower" statute- we estimate the deterrent effects with a difference-in-differences model.  The presence of state FCAs has a sizable impact on prescription drug spending, reducing Medicaid spending per eligible individual by about 25 percent. Other spending categories which are arguably less lucrative for whistleblower lawsuits show little to no response to anti-fraud activity.  We find evidence that offlabel "prone" classes of drugs are more responsive to FCA legislation, consistent with the use of FCAs to target alleged illegal marketing of pharmaceutical manufacturers.  

Forlines, Grayson L., Valerie Keathley, and Andrew Martin, "Estimating the Benefits of Automated Commercial Vehicle Enforcement"

Automated enforcement of commercial vehicle regulations is one potential method through which states can generate revenue and improve safety compliance by more efficiently directing the attention of law enforcement and state DOT officials to non-compliant carriers and identifying carriers who may be evading taxes.  This paper estimates the potential benefits of remote enforcement of weight-distance tax regulations using data from camera-equipped Kentucky Automated Truck Screening (KATS) systems and PrePass weigh stations in Kentucky. We estimate that remote enforcement and identification of tax evaders could generate up to $11.5 million annually in revenue.  Implementation of KATS weigh stations increases monthly impounds by approximately $5,000.  Overall, our results indicate that remote enforcement can assist state DOTs and law enforcement agencies targeting non-compliant carriers and may be an effective tax enforcement tool for states.