RTI instituted an internal triple check process for all data output. In some cases, they have rerun analyses to make sure the analysis was done correctly. Replication of the computer runs was not possible due to the number of iterations and refinements requested by committee members after the preliminary analyses started. The time and expense would have been prohibitive.

When the report is released to the public, all of the RTI data simulations in the form of Excel tables (Appendix A-2) will be released on the study website (http://www.iom.edu/GeoAdjustPaymentSimulations) in a downloadable format so they are available to anyone who chooses to review the data in detail.

In sum, the payment simulations were highly technical and complex, and multiple crosschecks were followed by RTI in preparing and executing programming code and reviewing output. To the extent feasible, qualified committee members provided direction and oversight for the simulations, but they were reluctant to review detailed documentation themselves and chose an independent contractor to perform that function on their behalf.


Prepared by Tim Dali, IHS Global Insight

Since its establishment in 1970, the IOM has played a prominent role in helping to inform and shape the national debate on health care policy and delivery. IOM’s current commission from the Department of Health and Human Services is to conduct analysis of data sources and methods available to calculate the geographic adjustments used by the Centers for Medicare & Medicaid Services (CMS) for fee-for-service Medicare payments to hospitals and providers.

IOM’s Phase I report provided recommendations for improving the accuracy of the geographic adjustment factors. IOM’s Phase II report investigates the extent to which recommendations in the Phase I report, if implemented, would affect access to health care services. With Medicare spending approaching $525 billion in 2010, ensuring the accuracy of the geographic adjustments has substantial implications for hospitals and providers of medical services and the people they serve.

With such prominence in shaping policy, and given the importance of Medicare reimbursement in care delivery, comes a responsibility to provide the highest quality of work possible given data and resource constraints. IOM engaged RTI International in this 2-year study to conduct analyses and simulations related to the accuracy of the data and methods used to develop CMS’s geographic adjustments. IOM engaged IHS Global Insight to provide an independent quality assurance review of the work completed by RTI and presented in the second year report titled Geographic Adjustment in Medicare Payment: Phase II: Implications for Access, Quality, and Efficiency.

The goal of the independent analysis reported in this appendix is to review documentation provided by RTI detailing the data and methods used to develop their payment simulations and results, to verify the integrity of the underlying data, and to assess the transparency and completeness of work presented. This independent review is in addition to review activities conducted by members of IOM’s Committee on Geographic Adjustment Factors in Medicare Payment, a group of prominent subject matter experts who have volunteered their time to participate in this study.

The committee determined early in its deliberations that replication of the payment simulations would not be practical, given the limited resources available. However, the committee did

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