Research published in the Journal of the American Medical Association finds itself at the intersection of two controversies–geographic variation in utilization and spending and the relative value of Medicare Advantage plans versus traditional Medicare. (JAMA Article) The researchers looked at common cardiovascular procedures to ascertain the relative rates of use both in various locales and between the fee-for-service and Medicare Advantage programs. Angiography, bypass surgery and stenting were the procedures and hospital referral regions were the geographic unit. In general, Medicare Advantage beneficiaries had substantially lower rates per thousand person-years for angiography–16.5 vs. 25.9 for fee-for-service; PCI–6.8 vs.9.8; but more similar rates for bypass surgery–3.1 vs. 3.5. Interestingly urgent angiography and stenting rates were very similar; indicating that the reductions in use for MA patients was due to more cautious elective use of the procedures. However, Medicare Advantage showed equally great geographic variation in the rates of use of the procedures as did fee-for-service. The range of variation is three to four-fold for each procedure, which is simply astounding. The reasons for the variation are unclear, but other research is zeroing in on both population health differences and regional practice pattern preferences by providers. To the extent that population health characteristics are the driver, the variation is acceptable; to the extent that it merely reflects provider practice preferences, there is a clear opportunity to encourage the providers with high procedure rates to reexamine the appropriateness of their utilization.
✅ Subscribe via Email
About this Blog
The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry. Mr. Roche is available to assist health care companies through consulting arrangements through Roche Consulting, LLC and may be reached at [email protected].
Healthy Skeptic Podcast
This is an outstanding report on total global drug spending and trends, with projections out to 2025. It helps you understand this important area of health care, which does much...
June 1, 2021
MedPAC 2019 Report to Congress
June 18, 2019
It may be investors that need the redesign. They just keep pouring money into this digital health crap despite all the losses. Redesign Health claims that it makes money by...
September 16, 2022
In truth, this seems like more money down a rathole. Google’s parent and other investors are putting a billion dollars into Google’s health arm, Verily. Apparently want to compete with...
September 12, 2022
It is like investors have learned nothing from the past two years. Even supposedly smart investors like Morgan Health, which is making a $20 million contribution to LetsGetChecked, which supposedly...
September 12, 2022
Access ACO Care Management Chronic Disease Comparative Effectiveness Consumer Directed Health Consumers Devices Disease Management Drugs EHRs Elder Care End-of-Life Care FDA Financings Genomics Government Health Care Costs Health Care Quality Health Care Reform Health Insurance Health Insurance Exchange HIT HomeCare Hospital Hospital Readmissions Legislation M&A Malpractice Meaningful Use Medicaid Medical Care Medicare Medicare Advantage Mobile Pay For Performance Pharmaceutical Physicians Providers Regulation Repealing Reform Telehealth Telemedicine Wellness and Prevention Workplace