Government
Medicare use, spending found to vary across country
■ A MedPAC study explains that areas with the highest rates of Medicare use don't always have the highest rates of spending.
By Chris Silva — Posted Dec. 18, 2009
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Washington -- Regional variations in the use of Medicare services across the U.S. do not directly translate to regional variations in spending, the Medicare Payment Advisory Commission noted in a Dec. 1 study.
"The two should not be confused," MedPAC stated in the report compiled for Congress, which has been focused on reining in Medicare spending as it attempts to pass comprehensive health system reform.
MedPAC presented data demonstrating the differences between regional variation in Medicare spending and regional variation in the use of Medicare-covered services. Variation in spending reflects program payment rates, service volume and service intensity, among other factors. Regional variation in the use of services reflects only differences in the volume and intensity of services that beneficiaries with comparable health status receive, MedPAC said.
The report was developed in response to lawmakers who said they wanted to understand how better to compare differences in the use of Medicare services.
MedPAC discovered that service use in Florida's Miami-Dade County area was nearly 40% higher than the national average, and more than 10% higher than in any other large metropolitan area. Beneficiaries in non-urban counties in Hawaii had the lowest use of services.
The use of health services per Medicare beneficiary was 98% of the national average in the New York City metropolitan area, and equal to the national average in the Boston area. By comparison, usage was higher in Oklahoma City (120%), Houston (122%) and New Orleans (125%). Per capita use of services was significantly lower in Danville, Va. (83%), Grand Junction, Colo. (81%), Yuma, Ariz. (82%), Sacramento and San Jose, Calif. (both 82%), and La Crosse, Wis. (77%).
Regions that have the highest levels of service use are not always the regions where usage rates are growing the fastest, MedPAC concluded. Service use varies at all geographic levels, including within states and among physicians within metropolitan statistical areas, the commission said.
