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1 Introduction and Overview
Pages 23-38

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From page 23... ... contracted with the IOM to conduct a 3-year consensus study to investigate geographic variation in health care spending and quality and to analyze Medicare payment polices that could encourage high-value care, including the adoption of a geographically based value index. This index would in principle account for both the health benefit obtained from health care services delivered and the cost of those services, as discussed later in this report. Read the entire page →
From page 24... ... Many IOM consensus reports and workshop summaries provide findings, conclusions, and recommendations on issues related to geographic variation, such as improving health care quality (IOM, 2001, 2002, 2003, 2006a) , reducing health care spending (IOM, 2010a; NRC, 2010) Read the entire page →
From page 25... ... Even as they threaten the welfare of patients, inefficiencies within the health care system divert limited resources from other national priorities, such as education, infrastructure, and debt reduction. MEDICARE PAYMENT POLICY REFORM AND GEOGRAPHIC VARIATION IN SPENDING AND QUALITY For more than three decades, experts at the Dartmouth Institute for Health Policy and Clinical Practice ("Dartmouth") Read the entire page →
From page 26... ... Examples of these arguments, presented at the public workshops held for this study, are offered later in this chapter. STUDY CHARGE AND SCOPE To conduct this study, the IOM convened the Committee on Geographic Variation in Health Care Spending and Promotion of High-Value Care, whose 19 members included experts in health economics, statistics, health care financing, value-based health care purchasing, health services research, health law, and health disparities. Read the entire page →
From page 27... ... The first step was to formulate an operational definition of value in health care. Then, to evaluate geographic variation in health care costs and quality and thereby value, the committee commissioned an extensive body of new statistical analyses and four papers from subject-matter experts and held two public workshops to complement its review of the existing literature. Read the entire page →
From page 28... ... The effects of relevant sections of the Affordable Care and Budget Reconciliation Acts of 2010 on variation in Medicare Parts A, B, and C spending will be taken into account and recommendations made for changes in Medicare Parts A, B, and C payments for items and services that include impacts on physicians and hospitals, beneficiary access to care, and Medicare spending (but excluding graduate medical educa tion, disproportionate share hospital, and health information technology add-ons) Read the entire page →
From page 29... ... In the context of Medicare, this includes general coverage determinations, as well as specific reimbursement rates for covered items and services. The goal of evaluating geographic variation in health care spending and quality imposed additional operational conditions on the definition of value. Read the entire page →
From page 30... ... Consequently, attributing specific health outcomes to specific health care services or to individual providers can be difficult, especially in the context of chronic diseases or conditions. Second, health is multidimensional. Read the entire page →
From page 31... ... , Medicaid, or the uninsured. To enhance current understanding of geographic variation, the committee commissioned empirical analyses of the complete database of Medicare beneficiaries, including Parts A, B, C, and D, as well as two nationwide commercial databases. Read the entire page →
From page 32... ... penditures related to graduate medical education, disproportionate share hospitals, and indirect medical education were excluded from all spending calculations. Additionally, because of issues of proprietary information and patient privacy, the committee was unable to access individual claims data used by the subcontractors. Read the entire page →
From page 33... ... At the second public workshop, the committee invited stakeholders to address the effects of geographic variation on their sectors or organizations. The 13 invited speakers represented the viewpoints of one or more of the following stakeholders: hospitals and health systems, clinicians, experts from organizations devoted to improving health care value, and consumers and purchasers. Read the entire page →
From page 34... ... We need your help devel oping data that we can trust, data that appropriately reflects differing circumstances among providers, so that we can hold everyone account · "Geographic Variation in Health Care Spending and Utilization in Subgroups: Medicaid, Uninsured, and Undocumented Popula tions," by Ellen Meara These papers contributed to the committee's deliberations and the evidentiary underpinnings of this report, although their perspectives and any implicit recommendations are solely those of the authors. These papers can be accessed on the IOM website at www.iom.edu/geovariationmaterials. Read the entire page →
From page 35... ... Literature Search In late 2010, the committee conducted an initial literature search of the following databases: MEDLINE, Embase, Scopus, Global Health, Web of Science, and Google Scholar, as well as several gray literature sources. Staff routinely updated the literature search and monitored electronic table of contents alerts from more than 20 journals throughout the course of this study. Read the entire page →
From page 36... ... Following this introduction and overview, Chapter 2 reports on the committee's commissioned statistical analyses and results, complemented by the findings of related literature on geographic variation in health care spending, utilization, and quality across the public and private health care sectors. Chapter 3 reviews proposals for adopting a geographically based value index for Medicare payments and presents the committee's statistical analytic findings that support rejection of the use of such an index. Read the entire page →
From page 37... ... Washington, DC: National Governors Association and the National Association of State Budget Officers. NRC (National Research Council) Read the entire page →
From page 38... ... 2010. Geographic variation in the quality of pre scribing. Read the entire page →

From page 23...

... contracted with the IOM to conduct a 3-year consensus study to investigate geographic variation in health care spending and quality and to analyze Medicare payment polices that could encourage high-value care, including the adoption of a geographically based value index. This index would in principle account for both the health benefit obtained from health care services delivered and the cost of those services, as discussed later in this report.

1 Introduction and Overview Pages 23-38

1 Introduction and Overview
Pages 23-38