Variation in Health Care Spending Target Decision Making, Not Geography (2013) / Chapter Skim
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Appendix C: Summary of Empirical Modeling Methodology
Appendix C: Summary of Empirical Modeling Methodology
Pages 131-136
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From page 131... ...
The population-specific studies conducted by Acumen, LLC, The Lewin Group, and Harvard University were carried out using the research framework outlined in Table C-1.1 Precision Health Economics' methodological approach in synthesizing these results and evaluating geographic variation in total health spending is then summarized. The complete methodological details are available in the subcontractor reports.2 1 This table only presents the methodology for the Medicare 2007-2009 analysis and does not show the Medicaid 2007-2009 analysis, the Medicare 1992-2010 growth analysis, or the Medicare Advantage 2007-2009 analysis, all of which use variations on this methodological approach.
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From page 132... ...
Measurement • Total all-cause spending includes • Total all-cause spending includes • Total all-cause spending includes of Spending all costs incurred by Medicare and all costs of all facility, provider all costs of all medical and the patient in covering inpatient, and prescription drug costs prescription drug costs incurred outpatient, hospice, home health, incurred by payer, secondary by payer, secondary payer, and skilled nursing, carrier, durable payer and patient. patient.
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From page 133... ...
Multiple Regression Analyses Dependent Variables • OLS Regression without area • OLS Regression with area fixed • OLS Regression without area of Spending and fixed effects; estimated area level effects: fixed effects; estimated area level Utilization effects as average of residuals effects as average of residuals from first model estimation from first model estimation (Sen • Did not "shrink" estimates sitivity analysis showed 0.98 corre lation to fixed effects model) • Empirical Bayes framework of "shrinking" estimates used to cor 133 rect for small sample size variation continued
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From page 134... ...
. Quality Analyses • Conducted logistic regression • Conducted logistic regressions • Used logistic models for "rare" for the IQI and PSI, and OLS for the PSI and PQIs, predicted quality outcomes, and linear regression for the PQI composites.
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From page 135... ...
"Between" Analysis Reported Pearson correlation of: Reported Pearson and Spearman Examines correlations of: • Medicare beneficiary utilization correlations of: • HRR spending and rankings across across clinical condition cohorts • HRR spending and rankings across clinical condition cohorts • Medicare beneficiary utilization clinical condition cohorts • Correlation of spending and and quality, across condition • HRR quality and rankings across quality measures cohorts and in aggregate clinical condition cohorts • Correlation of quality across population • Correlation of spending and qual- cohorts ity measures 135
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From page 136... ...
In order to examine variation "within" HRRs, PHE conducted a random effects regression of spending at utilization at the HSA level, with the random effects at the HRR level. Additionally, PHE created a measure of total health care spending, attempting to account for the total United States population by including spending for Medicare, Medicaid, commercially insured, and uninsured populations.
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