New Data on Geographic Variation
Overview
In January 2011, the Institute of Medicine (IOM) and Committee on Geographic Variation in Health Care Spending and Promotion of High-value Care (the Committee) sent a letter to Dr. Donald M. Berwick, the Administrator for the Centers for Medicare and Medicaid Services (CMS), requesting new datasets and analyses. The requested information will help the Committee evaluate geographic variation and growth in health care spending and the volume and intensity of health care services utilization.
In response to the IOM letter, CMS created four datasets (the Datasets) using the new Geographic Variation in Medicare Spending and Utilization (GV) database, which uses Medicare claims data to calculate utilization measures and total, standardized, and risk-adjusted spending. The GV database also incorporates a variety of quality indicators, including Hospital Compare, Prevention Quality Indicators, and Patient Safety Indicators.
Expanding upon data currently available through the Health Indicators Warehouse (http://www.healthindicators.gov), the Datasets provide demographic, cost, utilization, and quality indicators for all Hospital Referral Regions (HRRs) and States.* Tables 1 and 2 (last updated 12/8/2011) include indicators for all HRRs and all States. Reports 1 and 2 (last updated 12/8/2011) allow for comparison of a single HRR or State to the National data. Each Dataset includes a “Methods” tab, outlining the sample population and methodology, as well as a “Documentation” tab, detailing individual indicators. A methodological overview and technical supplement are also available. All documents can be downloaded using the links below. The Tables can be exported from Microsoft Excel (version 2007 or later) to other data analysis programs.
Because its scope of work requires the Committee to contemplate changes to health care payment systems “made and anticipated by” the Patient Protection and Affordable Care Act (P.L. 111-148) and the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152), the Committee must consider current and future research related to geographic variation, value, and Medicare payment policies when formulating its recommendations. The Committee encourages members of the public to incorporate the Datasets, in addition to other sources of health data, into related research activities and to submit new findings or conclusions to the Committee for consideration. All submissions must be received before June 2012.
Additionally, these Datasets may be used for the IOM’s and National Academy of Engineering’s Health Data Collegiate Challenge that is being offered as a part of the Health Data Initiative. The Go Viral to Improve Health challenge invites college and university students to transform health data into innovative and powerful products—the next “viral apps”—that improve health for communities and individuals. More information about the challenge may be found at www.iom.edu/goviral.
Documents
Table 1: HRR Level Demographic, Cost, Utilization, and Quality Data: Presents all demographic, cost, utilization, and quality indicators for all HRRs in one table.
Table 2: State Level Demographic, Cost, Utilization, and Quality Data: Presents all demographic, cost, utilization, and quality indicators for all States, Washington DC, Puerto Rico, and Virgin Islands in one table.
Report 1: Single HRR Comparison to National Data - Demographic, Cost, Utilization, and Quality: Allows for HRR specific comparisons to be made to the National data across all demographic, cost, utilization, and quality indicators. A drop down menu allows easy navigation to any of the 306 HRRs.
Report 2: Single State Comparison to National Data - Demographic, Cost, Utilization, and Quality: Allows for State specific comparisons to be made to the National data across all demographic, cost, utilization, and quality indicators. A drop down menu allows easy navigation to any of the 50 States, Washington DC, Puerto Rico, and Virgin Islands.
Methodological Overview to IOM Geographic Variation Data Request: Describes the methods used to generate the data in response to the IOM request letter. The sections include key data sources, study population, geographic variables, disease variables, standardization and risk adjustment of spending amounts, utilization measures, and quality measures.
Technical Supplement: Specifications for Standardizing Medicare Claims for IOM Request: Contain technical specifications for computing standardized Medicare payment amounts for 2008.
IOM Request Letter
*The state of Maryland has a unique waiver that exempts it from Medicare’s prospective payment systems for inpatient and outpatient care. As a result, both the standardized and standardized, risk-adjusted spending figures for Maryland are overstated. More information is provided under the “Methods” tab of each report and table.
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