Regional Growth in Medicare Spending, 1992–2010

Abstract

Objective. To determine if regions with high Medicare expenditures in a given setting remain high cost over time. Data Sources/Study Setting. One hundred percent of national Medicare Parts A and B fee-for-service beneficiary claims data and enrollment for 1992-2010. Study Design. Patients are classified into regions. Claims are price-standardized. Risk adjustment is performed at the beneficiary level using the CMS Hierarchical Condition Categories model. Correlation analyses are conducted. Data Collection/Extraction Methods. The data were obtained through a contract with CMS for a study performed for the Institute of Medicine. Principal Findings. High-cost regions in 1992 are likely to remain high cost in 2010. Stability in regional spending is highest in the home health, inpatient hospital, and outpatient hospital settings over this time period. Despite the persistence of a region's relative spending over time, a region's spending levels in all settings except home health tend to regress toward the mean. Conclusions. Relatively high-cost regions tend to remain so over long periods of time, even after controlling for patient health status and geographic price variation, suggesting that the observed effect reflects real differences in practice patterns.

Meaningful Use of Electronic Health Records and Medicare Expenditures: Evidence from a Panel Data Analysis of U.S. Health Care Markets, 2010–2013

“…This study contributes to understanding whether policy interventions such as EHR diffusion can alter the persistence of cost variation across HRRs (Chicklis et al. ).…”

“…Moreover, this variation has been shown to persist over time, such that relatively high‐cost hospital referral regions (HRRs) tend to remain high cost over recent decades (Chicklis et al. ). Waste likely results from a number of sources, including lack of widespread adoption of known best practices, failures of care coordination, and use of inappropriate treatments.…”

“…Some evidence for wasteful health care spending comes from the literature documenting large regional variation in health care spending that cannot be explained by health status, prices, or income (Skinner 2011). Moreover, this variation has been shown to persist over time, such that relatively high-cost hospital referral regions (HRRs) tend to remain high cost over recent decades (Chicklis et al 2015). Waste likely results from a number of sources, including lack of widespread adoption of known best practices, failures of care coordination, and use of inappropriate treatments.…”

Physician EHR Adoption and Potentially Preventable Hospital Admissions among Medicare Beneficiaries: Panel Data Evidence, 2010–2013

“…By focusing on market‐level measures of health care utilization and EHR diffusion, this study contributes to understanding whether policy interventions such as incentivizing EHR use can alter otherwise persistent variation in health care utilization that has been documented to occur across health care markets (Skinner ; Chicklis et al. ).…”

“…HRRs are defined by the Dartmouth Atlas of Health Care as regional markets based around hospitals providing major cardiovascular surgical procedures and neurosurgery to Medicare patients (Dartmouth Atlas of Health Care Working Group 1998). By focusing on market-level measures of health care utilization and EHR diffusion, this study contributes to understanding whether policy interventions such as incentivizing EHR use can alter otherwise persistent variation in health care utilization that has been documented to occur across health care markets (Skinner 2011;Chicklis et al 2015).…”