Variation in Health Care Spending ― Target Decision Making, Not Geography

The Institute of Medicine's Committee on Geographic Variation in Health Care Spending and Promotion of High-Value Care examined geographic variation in health care spending and quality for Medicare beneficiaries, Medicaid, privately insured, and uninsured populations in the US, to make recommendations for changes in Medicare payment systems under the Patient Protection and Affordable Care Act and address whether Medicare payments for physicians and hospitals should be adjusted by a value index that is based on geographic area performance. This report presents findings from analyses of traditional, fee-for-service Medicare (and Medicare Part C) and commercial insurance. Separate analyses of variation in Medicaid and uninsured populations are not provided. It evaluates variation in hospital service areas, hospital referral regions, and metropolitan core-based statistical areas, and the geographic variation in spending, utilization, and quality across various populations, payers, and geographic units; known factors that account for variation, such as patient health status and demographic characteristics, health plan, and price and market factors; and the types of services with disproportionately high rates of variation that drive total variation. It reviews proposals for adopting a geographically based value index and presents findings that support rejection of an index, and considers payment interventions for improving value throughout the US system. Committee members are specialists in health economics, statistics, health care financing, value-based health care purchasing, health services research, health law, and health disparities. There is no index. Annotation c2013 Book News, Inc., Portland, OR (booknews.com)