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MedPAC staff finds that use of Medicare services substantially varies by region
The MedPAC findings both support and differ from those released by the Dartmouth Atlas Project.
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The preliminary results of a recent Medicare Payment Advisory Commission (MedPAC) report show a substantial variation in the use of health care services among Medicare beneficiaries across the country.
The report, which was released during a recent public MedPAC meeting, found roughly a 30% difference in the utilization between areas with the most-intense use of services and those with the least intense use. The MedPAC staff also found little correlation between the regional level of service use and the rate of growth in service use.
“Therefore, policies that aim to make Medicare more substantial should constrain both growth and variation in the service use levels,” MedPAC senior analyst Daniel Zabinski, PhD, said during the meeting.
Other key findings of the report included:
- less variation in the use of Medicare services than Medicare spending;
- urban and rural areas can have high- or low-service use; and
- areas with high service use can have low growth rates and those with low service use can have high growth rates.
Outside factors noted
The results were based on data for areas that fell between the 10th and 90th percentiles for service use. The investigators adjusted for factors such as the health status of beneficiaries, certain physician bonuses and special payments to providers and rural hospitals.
The report did not include information for areas in the lowest 10th percentile for service use (Hawaii) and the highest 10th percentile (Miami). Jeffrey Stensland, PhD, a MedPAC principal policy analyst, noted that the outliers were excluded because the distribution of service use in these areas may be driven by factors other than health care organization and delivery.
Variation
MedPAC commissioner Robert A. Berenson, MD, noted that the work both supported and differed from that of Dartmouth Atlas Project researchers which found a smaller, yet still significant difference in the use of health care services. Other commissioners noted that the Dartmouth group used different methods and adjusters to reach their conclusions.
“Maybe we do need to be content with [the fact that] there is variation,” MedPAC commissioner Karen R. Borman, MD, said.
Glenn M. Hackbarth, JD, chair of the commission, congratulated the MedPAC staff on its work.
“I think the work we have done has been very helpful on advancing this as an analytic tool for thinking about policy,” he said. “I think the step of trying to isolate differences in service use as opposed to just total expenditures raises an important set of questions.”
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