Prices don't drive regional Medicare spending variations

Health Affairs

Volumn 29, Issue 3, 2010, Pages 537-543

  Gottlieb, Daniel J ^a   Zhou, Weiping ^a   Song, Yunjie ^a   Andrews, Kathryn Gilman ^d   Skinner, Jonathan S ^b   Sutherland, Jason M ^c  

^a DARTMOUTH INSTITUTE FOR HEALTH POLICY AND CLINICAL PRACTICE   (United States)

^b Dartmouth College   (United States)

^c UNIVERSITY OF BRITISH COLUMBIA   (Canada)

^d University of British Columbia ^*

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; HEALTH CARE COST; HEALTH INSURANCE; MEDICARE;

EID: 77957323637     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2009.0609     Document Type: Article

References (21)

1. Dartmouth Institute for Health Policy and Clinical Practice. Dartmouth atlas of health care [Internet]. Hanover (NH): Dartmouth Institute; [cited 2010 Jan 18]. Available from: http://www.dartmouthatlas.org
2. Internal documents from the Medicare Payment Advisory Commission (MedPAC).
3. For a published discussion of Med-PAC methods and results, see Medicare Payment Advisory Commission. Report to the Congress: variation and innovation in Medicare [Internet]. Washington (DC): MedPAC; 2003 Jun. [cited 2010 Jan 18]. Available from: http://www.medpac.gov/publications/congressional-reports/June03- Titlepg-Insidecov-Acknow.pdf
4. Hackbarth GM. Adjusting Medicare payments for local market input prices. Testimony before the Subcommittee on Health of the House Ways and Means Committee, 23 July 2002 [Internet]. Washington (DC): MedPAC; 2002 Jul. 23 [cited 2010 Jan 18]. Available from: http://www.medpac.gov/publications/congressional- testimony/072302 (WM) local-input-prices.pdf
5. Gawande A. The cost conundrum: what a Texas town can teach us about health care. New Yorker. 2009 Jun. 1.
6. Medicare Payment Advisory Commission. Measuring regional variation in service use [Internet]. Washington (DC): MedPAC; 2009 Dec. [cited 2010 Jan 18]. Available from: http://medpac.gov/documents/Dec09-RegionalVariation-report.pdf
7. Sutherland JM, Fisher ES, Skinner JS. Getting past denial-the high cost of health care in the United States. N Engl J Med. 2009;361:1227.
8. Gottlieb D, Zhou W, Song Y, Andrews K, Skinner J, Sutherland JM. A standardized method for adjusting Medicare expenditures for regional differences in prices. Hanover (NH): Dartmouth College; 2009.
9. Wennberg J, Cooper M, editors. Dartmouth atlas of health care Chicago (IL): American Hospital Association; 1996.
10. Medicare Payment Advisory Commission. Outpatient hospital services payment system [Internet]. Washington (DC): MedPAC; 2008 Oct. [cited 2010 Jan 18]. Available from: http://www.medpac.gov/documents/MedPAC-Payment-Basics-07- OPD.pdf
11. For example, psychiatric hospital adjustments were 76 percent and home health care, 77 percent, while inpatient hospital weights were just under 70 percent. See Medicare Payment Advisory Commission. Psychiatric hospital services payment system [Internet]. Washington (DC): MedPAC; 2008 [cited 2010 Jan 18]. Available from: http://www.medpac.gov/documents/MedPAC-Payment-Basics-08-psych. pdf
12. Medicare Payment Advisory Commission. Home health care services payment system [Internet]. Washington (DC): MedPAC; 2008 Oct. [cited 2010 Jan 18]. Available from: http://www.medpac.gov/documents/MedPAC-Payment-Basics-08-HHA.pdf
13. Medicare Payment Advisory Commission. Hospital acute inpatient services payment system [Internet]. Washington (DC): MedPAC; 2008 Oct. [cited 2010 Jan 18]. Available from: http://www.medpac.gov/documents/MedPAC-Payment-Basics-08- hospital.pdf
14. This adjustment factor was calculated for the entire Medicare program, including the population under age sixty-five.
15. The Online Appendix is available by clicking the Online Appendix link in the box to the right of the article online.
16. A recent Sixty Minutes television report focused on fraud in South Florida. Medicare fraud: a $60 billion crime [Internet]. Sixty Minutes (CBS). 2009 Oct. 25 [cited 2010 Jan 18]. Available from: http://www.cbsnews.com/ stories/2009/10/23/60minutes/main5414390.shtml
17. Morris L. Combating fraud in health care: an essential component of any cost containment strategy. Health Aff (Millwood). 2009;28(5):1351-6.
18. We are grateful to Jeff Stensland and Mark Miller of MedPAC for helpful discussions of their price adjustment methods.
19. Gilden D. McAllen: a tale of three counties. The Health Care Blog [blog on the Internet]. 2009 Jun. 25 [cited 2010 Jan 18]. Available from: http://www.thehealthcareblog.com/the-health-care-blog/2009/06/ mcallen-is-now-a-tale-of-threecounties.html Gilden's risk adjusters-based like the Hierarchical Condition Codes index on Medicare claims data-suggested that McAllen, Texas, was much sicker than El Paso.
20. Gawande A. Atul Gawande: the cost conundrum redux. News Desk [blog on the Internet]. 2009 Jun. 23 [cited 2010 Jan 18]. Available from: http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawandethe-cost- conundrum-redux.html Gawande did not find evidence that McAllen, Texas, differed from El Paso, Texas, with regard to objective health measures of the population.
21. Wennberg JE, et al. Tracking the care of patients with severe chronic illness; the Dartmouth atlas of health care 2008 [Internet]. Lebanon (NH): Dartmouth Institute; 2008 [cited 2010 Jan 18]. Available from: http://dartmouthatlas.org/atlases/2008-Chronic-Care-Atlas.pdf