Geographic variation in fee-for-service medicare beneficiaries' medical costs is largely explained by disease burden

Medical Care Research and Review

Volumn 70, Issue 5, 2013, Pages 542-563

  Reschovsky, James D ^a   Hadley, Jack ^b   Romano, Patrick S ^c  

^a CENTER FOR STUDYING HEALTH SYSTEM CHANGE   (United States)

^b GEORGE MASON UNIVERSITY   (United States)

^c UNIVERSITY OF CALIFORNIA   (United States)

Author keywords

casemix adjustment; geographic variations; Medicare costs; risk adjustment

Indexed keywords

ACUTE DISEASE; AGED; BILLING AND CLAIMS; CHRONIC DISEASE; CLINICAL PRACTICE; DEATH; DISEASE BURDEN; DISEASE CLASSIFICATION; GENERAL ASPECTS OF DISEASE; GROUPS BY AGE; HEALTH CARE COST; HOSPITAL PURCHASING; HUMAN; INJURY; MAJOR CLINICAL STUDY; MEDICAL FEE; MEDICAL SPECIALIST; MEDICARE; MORTALITY; PATIENT REFERRAL; PHYSICIAN; RACE DIFFERENCE; REVIEW; SEX DIFFERENCE;

CASEMIX ADJUSTMENT; GEOGRAPHIC VARIATIONS; MEDICARE COSTS; RISK ADJUSTMENT;

COST OF ILLNESS; FEE-FOR-SERVICE PLANS; FEMALE; HUMANS; MALE; MEDICARE; RISK ADJUSTMENT; UNITED STATES;

EID: 84885171110     PISSN: 10775587     EISSN: 15526801     Source Type: Journal    
DOI: 10.1177/1077558713487771     Document Type: Review

References (34)

1. Bach P. B.. A map to bad policy - Hospital efficiency measures in the Dartmouth Atlas. New England Journal of Medicine. 2010 ; 362: 569-574
2. Bach P. B., Schrag D., Begg C. B.. Resurrecting treatment histories of dead patients: A study design that should be laid to rest. Journal of the American Medical Association. 2004 ; 292: 2765-2770
3. Baicker K., Chandra A.. Medicare spending, the physician workforce, and beneficiaries' quality of care. Health Affairs. 2004 ; 23: 184-197
4. Barnato A. E., Anthony D. L., Skinner J., Gallagher P. M., Fisher E. S.. Racial and ethnic differences in preferences for end-of-life treatment. Journal of General Internal Medicine. 2009 ; 24: 695-701
5. BernsteinJ.ReschovskyJ. D.WhiteC. (2011). Geographic variation in health care: Changing policy directions (Policy Analysis No. 4). Washington, DC: National Institute for Health Care Reform. Retrieved from http://www.nihcr.org/ Geographic-Variation.html
6. Chassin M. R.. Explaining geographic variations: the enthusiasm hypothesis. Medical Care. 1993 ; 31: YS37 - YS44
7. Geographic variation in health care spending. Washington, DC: Author ; 2008 :
8. Dartmouth Atlas Project. (2007). Supply sensitive care (Topic brief). Hanover, NH: Center for the Evaluative Clinical Sciences, Dartmouth Medical School. Retrieved from http://www.dartmouthatlas.org/downloads/reports/supply- sensitive.pdf
9. FisherE. S.WennbergD. E.StukelT. A.GottliebD. J.LucasF. L.PinderE. L. (2003). The implications of regional variations in Medicare spending, Part 1: The content, quality, and accessibility of care. Annals of Internal Medicine, 138, 273-287. Appendix available at www.annals.org.
10. Gottlieb D. J., Zhou W., Song Y., Andrews K. G., Skinner J. S., Sutherland J. M.. Prices don't drive regional Medicare spending variations. Health Affairs. 2010 ; 29: 537-543
11. Kaestner R., Silber J. H.. Evidence on the efficacy of inpatient spending on Medicare patients. Milbank Quarterly. 2010 ; 88: 560-594
12. Martin A. B., Whittle L., Heffler S., Barron M. C., Sisko A., Washington B.. Health spending by state of residence, 1991-2004. Health Affairs. 2007 ; 26: w651 - w663
13. Report to the Congress: Increasing the value of Medicare. Washington, DC: Author ; 2006 :
14. Report to Congress: Regional variation in Medicare service use. Washington, DC: Author ; 2011 :
15. Metcalf C. E., Kemper P., Kohn L. T., Pickreign J. D. Site definition and sample design for the Community Tracking Study. Washington, DC: Center for Studying Health System Change ; 1996 :
16. Neuberg G. W.. The cost of end-of-life care: A new efficiency measure falls short of AHA/ACC standards. Circulation Cardiovascular Quality and Outcomes. 2009 ; 2: 127-133
17. Pope G. C., Ellis R. P., Ash A. S., Ayanian J. Z., Bates D. W., Burstin H., Wu B. Diagnostic cost group hierarchical condition category models for Medicare risk adjustment. Boston, MA: Health Economics Research, Inc ; 2000 :
18. Pope G. C., Kautter J., Ellis R. P., Ash A. S., Ayanian A. Z., Iezzoni L. I., Robst J.. Risk adjustment of Medicare capitation payments using the CMS-HCC model. Health Care Financing Review. 2004 ; 25: 119-142
19. Reschovsky J. D., Hadley J., Saiontz-Martinez J. C., Boukus E.. Following the money: Factors associated with the cost of treating high-cost Medicare beneficiaries. Health Services Research. 2011 ; 46: 997-1021
20. Reschovsky J. D., Hadley J., O'Malley A. J., Landon B. E.. Geographic variations in the cost of treating condition-specific episodes of care among Medicare Patients. Health Services Research. 2013 ;:
21. Restuccia J. D.. The effect of concurrent feedback in reducing inappropriate hospital utilization. Medical Care. 1982 ; 20 (1). 46-62
22. Restuccia J. D., Shwartz M., Ash A., Payne S.. High hospital admission rates and inappropriate care. Health Affairs. 1997 ; 15: 156-163
23. Romley J. A., Jena A. B., Goldman D. P.. Hospital spending and inpatient mortality: Evidence from California. An observational study. Annals of Internal Medicine. 2011 ; 154: 160-167
24. Shwartz M., Peköz E. A., Ash A. S., Posner M. A., Restuccia J. D., Iezzoni L. I.. Do variations in disease prevalence limit the usefulness of population-based hospitalization rates for studying variations in hospital admissions?. Medical Care. 2005 ; 43 (1). 4-11
25. SkinnerJ.FisherE. (2010). Reflections on geographic variations in the U.S. health care (The Dartmouth Institute for Health Policy and Clinical Practice). Retrieved from http://www.dartmouthatlas.org/downloads/press/Skinner- Fisher-DA-05-10.pdf
26. Song Y., Skinner J., Bynum J., Sutherland J. M., Wennberg J. E., Fisher E. S.. Regional variations in diagnostic practices. New England Journal of Medicine. 2010 ; 363: 45-53
27. Sutherland J. M., Fisher E. S., Skinner J. S.. Getting past denial - The high cost of health care in the United States. New England Journal of Medicine. 2009 ; 361: 1227-1230
28. Welch H. C., Sharp S. M., Gottlieb D. J., Skinner J. S., Wennberg J. E.. Geographic variation in diagnosis frequency and risk of death among Medicare beneficiaries. Journao of the American Medical Association. 2011 ; 305: 1113-1118
29. Wennberg J. E., Cooper M. C. The Dartmouth atlas of health care. Lebanon, NH: Dartmouth Institute for Health Policy and Clinical Practice ; 1996 :
30. Wennberg J. E., Cooper M. C. The Dartmouth Atlas of Health Care. Lebanon, NH: Dartmouth Institute for Health Policy and Clinical Practice ; 1998 :
31. Wennberg J. E., Cooper M. C. The quality of medical care in the United States: A report on the Medicare program. Lebanon, NH: Center for the Evaluative Clinical Sciences, Dartmouth Medical School ; 1999 :
32. Wennberg J. E., Fisher E. S., Skinner J. S.. Geography and the debate over Medicare reform. Health Affairs. 2002 ; 23: W96 - W114
33. Williams S., Potter F., Diaz-Tena N. S., Strouse R. C Community tracking study physician survey methodology report, 2004-05 (Round four). Washington, DC: Center for Studying Health System Change ; 2006 :
34. Zuckerman S., Waidmann T., Berenson R., Hadley J.. Clarifying sources of geographic differences in Medicare spending. New England Journal of Medicine. 2010 ; 363: 54-62