Appendix G

Selected Results of the Committee’s Commissioned Empirical Analyses

MEDICARE SERVICE CATEGORY UTILIZATION (MONTHLY COST RESIDUAL) BY HRR

To determine the extent to which variation in particular health care services contributes to total variation in Medicare expenditure, the Committee disaggregated price-standardized, risk-adjusted Medicare spending into seven types of services. Table G-1 sorts 306 hospital referral regions (HRRs) by their total monthly adjusted differences from the national mean of spending (also known as residual cost). This table serves as a supplement to Figure 2-5a–h (Medicare Service Category Utilization by Hospital Referral Region), in Chapter 2.1

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1Information on other services categories are available on the Acumen Medicare spreadsheets, which can be accessed through the Institute of Medicine website (http://www.iom.edu/geovariationmaterials).



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Appendix G Selected Results of the Committee’s Commissioned Empirical Analyses MEDICARE SERVICE CATEGORY UTILIZATION (MONTHLY COST RESIDUAL) BY HRR To determine the extent to which variation in particular health care services contributes to total variation in Medicare expenditure, the Com- mittee disaggregated price-standardized, risk-adjusted Medicare spending into seven types of services. Table G-1 sorts 306 hospital referral regions (HRRs) by their total monthly adjusted differences from the national mean of spending (also known as residual cost). This table serves as a supplement to Figure 2-5a–h (Medicare Service Category Utilization by Hospital Refer- ral Region), in Chapter 2.1 1  Information on other services categories are available on the Acumen Medicare spread- sheets, which can be accessed through the Institute of Medicine website (http://www.iom.edu/ geovariationmaterials). 151

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152 VARIATION IN HEALTH CARE SPENDING TABLE G-1 Medicare Service Category Utilization (Monthly Cost Residual) by Hospital Referral Region (HRR) Total Monthly Acute Care Post-Acute Care Adjusted Monthly Adjusted Monthly Adjusted Differences from Differences from Differences from the National the National the National Mean of Spending Mean of Spending Mean of Spending HRR Name Across HRRs Across HRRs Across HRRs Rochester, NY -$174 -$43 -$79 Stockton, CA -$172 -$41 -$64 Sacramento, CA -$171 -$52 -$69 Buffalo, NY -$166 -$46 -$57 Bronx, NY -$166 -$38 -$89 Santa Cruz, CA -$158 -$39 -$64 Santa Rosa, CA -$157 -$61 -$67 Medford, OR -$156 -$48 -$69 San Francisco, CA -$153 -$34 -$65 Salem, OR -$150 -$47 -$58 Albuquerque, NM -$149 -$52 -$31 Modesto, CA -$141 -$25 -$80 La Crosse, WI -$138 -$36 -$68 Bakersfield, CA -$136 -$26 -$86 Yakima, WA -$135 -$39 -$70 Eugene, OR -$134 -$34 -$59 Santa Barbara, CA -$134 -$59 -$71 Alameda County, CA -$133 -$24 -$57 Syracuse, NY -$131 -$41 -$73 Portland, ME -$130 -$40 -$36 Fresno, CA -$130 -$34 -$83 Burlington, VT -$127 -$38 -$58 San Jose, CA -$126 -$36 -$58 Portland, OR -$126 -$36 -$57 Binghamton, NY -$121 -$45 -$71 Elmira, NY -$117 -$13 -$71 Danville, PA -$115 -$49 -$25

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APPENDIX G 153 TABLE G-1 Continued Total Monthly Acute Care Post-Acute Care Adjusted Monthly Adjusted Monthly Adjusted Differences from Differences from Differences from the National the National the National Mean of Spending Mean of Spending Mean of Spending HRR Name Across HRRs Across HRRs Across HRRs Minot, ND -$114 -$21 -$42 Albany, GA -$112 -$54 -$62 Olympia, WA -$110 -$33 -$43 Iowa City, IA -$108 -$14 -$52 Honolulu, HI -$108 -$28 -$48 Chico, CA -$104 -$17 -$57 El Paso, TX -$104 -$48 -$7 Redding, CA -$104 -$38 -$45 Dubuque, IA -$103 -$30 -$41 San Bernardino, CA -$102 -$23 -$26 Springfield, MA -$102 -$40 -$12 Pueblo, CO -$101 -$38 -$34 Marshfield, WI -$101 -$10 -$61 San Mateo County, CA -$100 -$28 -$48 Charleston, WV -$100 -$23 -$50 Appleton, WI -$99 -$34 -$49 Albany, NY -$97 -$21 -$57 Roanoke, VA -$96 -$24 -$25 Sayre, PA -$96 -$11 -$58 Madison, WI -$95 -$22 -$37 Bangor, ME -$93 -$20 -$55 Neenah, WI -$93 -$34 -$52 Rochester, MN -$93 -$4 -$51 Napa, CA -$92 -$15 -$80 Providence, RI -$92 -$30 -$16 Rapid City, SD -$91 -$22 -$44 Charlottesville, VA -$91 -$20 -$36 continued

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154 VARIATION IN HEALTH CARE SPENDING TABLE G-1 Continued Total Monthly Acute Care Post-Acute Care Adjusted Monthly Adjusted Monthly Adjusted Differences from Differences from Differences from the National the National the National Mean of Spending Mean of Spending Mean of Spending HRR Name Across HRRs Across HRRs Across HRRs Everett, WA -$90 -$38 -$47 Bend, OR -$88 -$36 -$42 Winchester, VA -$87 -$18 -$42 Tacoma, WA -$86 -$28 -$36 Grand Junction, CO -$84 -$33 -$24 Muskegon, MI -$83 -$54 -$20 San Luis Obispo, CA -$82 -$42 -$51 Seattle, WA -$80 -$27 -$38 Fargo, ND/Moorhead, -$80 -$10 -$35 MN Contra Costa County, CA -$79 -$11 -$50 Greensboro, NC -$79 -$33 -$35 Morgantown, WV -$76 -$11 -$42 Cedar Rapids, IA -$75 -$14 -$40 Spokane, WA -$73 -$38 -$40 Des Moines, IA -$73 -$5 -$56 Bismarck, ND -$72 -$5 -$60 Erie, PA -$72 -$25 -$26 Anchorage, AK -$72 $6 -$62 Lancaster, PA -$71 -$11 -$22 Columbus, GA -$67 -$36 -$15 Lebanon, NH -$65 -$37 -$22 St. Cloud, MN -$63 -$1 -$45 Green Bay, WI -$63 -$15 -$37 San Diego, CA -$63 -$33 -$28 Grand Rapids, MI -$62 -$21 -$24 Minneapolis, MN -$61 $4 -$43 Salinas, CA -$61 $16 -$57

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APPENDIX G 155 TABLE G-1 Continued Total Monthly Acute Care Post-Acute Care Adjusted Monthly Adjusted Monthly Adjusted Differences from Differences from Differences from the National the National the National Mean of Spending Mean of Spending Mean of Spending HRR Name Across HRRs Across HRRs Across HRRs Mason City, IA -$59 $8 -$67 Wausau, WI -$59 -$1 -$44 Harrisburg, PA -$58 -$18 -$21 Springfield, MO -$58 -$25 -$21 Kingsport, TN -$57 -$9 -$9 Duluth, MN -$57 -$2 -$35 Augusta, GA -$56 -$25 -$33 Missoula, MT -$56 -$18 -$36 Durham, NC -$56 -$16 -$37 Altoona, PA -$55 -$31 $5 Spartanburg, SC -$54 -$25 -$12 St. Paul, MN -$53 $13 -$47 Hartford, CT -$52 -$24 -$10 Johnstown, PA -$51 -$3 -$6 Norfolk, VA -$51 -$13 -$36 Manhattan, NY -$51 -$10 -$86 Sioux City, IA -$50 $0 -$52 Lynchburg, VA -$50 $0 -$5 Springdale, AR -$48 -$6 $7 Marquette, MI -$45 -$10 -$39 Manchester, NH -$44 -$27 $3 Colorado Springs, CO -$43 -$22 -$8 Newport News, VA -$42 -$22 -$37 Worcester, MA -$42 -$18 $16 Billings, MT -$41 $0 -$45 Reading, PA -$40 -$8 -$6 Arlington, VA -$39 -$12 -$20 continued

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156 VARIATION IN HEALTH CARE SPENDING TABLE G-1 Continued Total Monthly Acute Care Post-Acute Care Adjusted Monthly Adjusted Monthly Adjusted Differences from Differences from Differences from the National the National the National Mean of Spending Mean of Spending Mean of Spending HRR Name Across HRRs Across HRRs Across HRRs York, PA -$39 -$16 -$17 Tucson, AZ -$39 -$9 -$20 Tallahassee, FL -$37 -$26 -$10 Ogden, UT -$37 -$61 $25 Boise, ID -$35 -$41 $7 Davenport, IA -$35 $8 -$30 South Bend, IN -$33 -$22 -$7 Sioux Falls, SD -$33 $15 -$43 Kalamazoo, MI -$32 $2 -$16 Reno, NV -$32 -$12 -$21 Allentown, PA -$32 $13 -$14 Phoenix, AZ -$31 $4 -$21 Traverse City, MI -$31 $3 -$40 Huntington, WV -$31 $4 -$31 Urbana, IL -$30 $11 -$38 Fort Wayne, IN -$29 -$20 -$6 New Haven, CT -$29 -$10 -$10 Asheville, NC -$29 -$31 -$11 Richmond, VA -$28 $17 -$22 Scranton, PA -$27 -$15 $14 Macon, GA -$27 $3 -$40 Salt Lake City, UT -$27 -$50 $13 Atlanta, GA -$27 -$20 -$15 Petoskey, MI -$26 -$1 -$29 Waterloo, IA -$26 $2 -$53 Winston-Salem, NC -$26 -$12 -$22 Ventura, CA -$24 -$7 -$45

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APPENDIX G 157 TABLE G-1 Continued Total Monthly Acute Care Post-Acute Care Adjusted Monthly Adjusted Monthly Adjusted Differences from Differences from Differences from the National the National the National Mean of Spending Mean of Spending Mean of Spending HRR Name Across HRRs Across HRRs Across HRRs Bloomington, IL -$24 $0 -$35 Great Falls, MT -$23 $15 -$36 Columbia, MO -$23 $22 -$34 Greenville, SC -$23 -$20 -$6 Springfield, IL -$22 $15 -$37 Canton, OH -$22 -$10 -$2 White Plains, NY -$17 $16 -$44 Denver, CO -$16 -$20 -$10 Boston, MA -$15 -$9 $31 East Long Island, NY -$15 $12 -$54 Milwaukee, WI -$15 $11 -$20 Bridgeport, CT -$14 $1 -$31 Jonesboro, AR -$14 $6 -$10 Palm Springs/ -$14 -$12 -$43 Rancho Mira, CA Paterson, NJ -$14 -$2 -$30 Lansing, MI -$13 $3 -$19 Flint, MI -$13 $26 -$20 Temple, TX -$13 -$25 $27 Hickory, NC -$12 -$22 -$8 Raleigh, NC -$12 $1 -$25 Peoria, IL -$11 $20 -$15 Greenville, NC -$11 $10 -$43 Charlotte, NC -$11 -$15 -$18 Johnson City, TN -$10 $12 $3 Casper, WY -$9 $20 -$24 Florence, SC -$9 $23 -$39 St. Joseph, MI -$9 -$6 -$10 continued

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158 VARIATION IN HEALTH CARE SPENDING TABLE G-1 Continued Total Monthly Acute Care Post-Acute Care Adjusted Monthly Adjusted Monthly Adjusted Differences from Differences from Differences from the National the National the National Mean of Spending Mean of Spending Mean of Spending HRR Name Across HRRs Across HRRs Across HRRs Fort Smith, AR -$8 -$27 $72 Greeley, CO -$8 $0 -$9 Knoxville, TN -$8 -$18 $1 Fort Collins, CO -$7 -$1 -$8 Grand Forks, ND -$5 $21 -$29 Newark, NJ -$5 $14 -$39 Joplin, MO -$4 $25 -$2 Wilkes-Barre, PA -$4 -$28 $51 Rockford, IL -$3 $27 -$18 Washington, DC -$2 $45 -$48 Wilmington, DE -$1 $21 -$12 Dothan, AL -$1 $5 $18 Chattanooga, TN $0 -$11 $18 Muncie, IN $0 -$21 $9 Rome, GA $1 -$1 $8 Little Rock, AR $2 $12 -$2 Sun City, AZ $3 $10 -$26 Akron, OH $3 $13 $7 Morristown, NJ $4 $5 -$16 Lafayette, IN $4 -$8 $0 St. Louis, MO $6 $26 -$13 Youngstown, OH $7 $29 -$1 Philadelphia, PA $8 $22 -$17 Lawton, OK $8 $3 $37 New Brunswick, NJ $9 $21 -$22 Topeka, KS $10 $1 -$3 Montgomery, AL $10 -$12 $21

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APPENDIX G 159 TABLE G-1 Continued Total Monthly Acute Care Post-Acute Care Adjusted Monthly Adjusted Monthly Adjusted Differences from Differences from Differences from the National the National the National Mean of Spending Mean of Spending Mean of Spending HRR Name Across HRRs Across HRRs Across HRRs Ridgewood, NJ $10 $13 -$22 Cape Girardeau, MO $10 $3 -$21 Cleveland, OH $11 $14 $20 Idaho Falls, ID $11 -$24 $6 Jackson, TN $12 -$5 $42 Lexington, KY $12 $7 $4 Boulder, CO $12 -$2 $0 Cincinnati, OH $13 $4 $6 Paducah, KY $13 $34 -$5 Memphis, TN $14 $10 $15 Indianapolis, IN $15 -$8 $13 Aurora, IL $15 $26 $11 Toledo, OH $15 $21 $6 Pittsburgh, PA $15 $26 $20 Nashville, TN $15 $2 $21 Columbia, SC $16 -$4 -$10 Owensboro, KY $16 $24 -$24 Oxford, MS $16 $12 $20 Omaha, NE $17 $25 -$17 Ann Arbor, MI $17 $11 $12 Provo, UT $17 -$45 $44 Huntsville, AL $19 $8 -$1 Los Angeles, CA $20 $3 -$12 Columbus, OH $20 $18 $3 Camden, NJ $20 $20 -$17 Dayton, OH $21 $16 $10 Birmingham, AL $22 $12 $23 continued

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160 VARIATION IN HEALTH CARE SPENDING TABLE G-1 Continued Total Monthly Acute Care Post-Acute Care Adjusted Monthly Adjusted Monthly Adjusted Differences from Differences from Differences from the National the National the National Mean of Spending Mean of Spending Mean of Spending HRR Name Across HRRs Across HRRs Across HRRs Waco, TX $22 -$6 $37 Saginaw, MI $25 $32 -$4 Savannah, GA $25 -$6 -$23 Gainesville, FL $25 $9 $14 Hackensack, NJ $26 $13 -$21 Lincoln, NE $27 $11 -$21 Louisville, KY $27 $19 $13 Charleston, SC $29 -$3 -$4 Covington, KY $30 $48 -$1 Kansas City, MO $30 $16 $9 Tuscaloosa, AL $33 $41 $26 Evansville, IN $34 $8 $23 Mesa, AZ $34 $15 -$6 Salisbury, MD $36 $61 -$28 Ocala, FL $36 -$6 $12 Takoma Park, MD $37 $60 -$42 Pensacola, FL $37 $9 $17 Wichita, KS $39 $18 -$9 Tupelo, MS $40 -$6 $29 Melrose Park, IL $40 $49 $31 Kettering, OH $42 $5 $30 Wilmington, NC $42 -$12 -$19 Ormond Beach, FL $43 -$18 $31 Orange County, CA $44 -$5 $4 Odessa, TX $47 -$16 $80 San Antonio, TX $47 -$20 $63 Dearborn, MI $50 $42 $26

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APPENDIX G 161 TABLE G-1 Continued Total Monthly Acute Care Post-Acute Care Adjusted Monthly Adjusted Monthly Adjusted Differences from Differences from Differences from the National the National the National Mean of Spending Mean of Spending Mean of Spending HRR Name Across HRRs Across HRRs Across HRRs New Orleans, LA $52 -$20 $85 Hinsdale, IL $55 $42 $29 Hudson, FL $57 -$5 $42 Lakeland, FL $57 $9 $46 Chicago, IL $59 $51 $63 Mobile, AL $61 $31 $34 Terre Haute, IN $64 $11 -$3 Tampa, FL $65 $13 $44 Detroit, MI $66 $38 $25 Gary, IN $66 $50 $26 San Angelo, TX $67 $16 $55 Abilene, TX $68 $23 $45 Evanston, IL $69 $24 $29 Elyria, OH $69 $51 $28 Orlando, FL $73 $13 $28 Sarasota, FL $74 -$36 $11 Texarkana, AR $75 $1 $94 Pontiac, MI $75 $32 $16 Houma, LA $76 -$5 $54 Blue Island, IL $79 $78 $37 Corpus Christi, TX $85 -$36 $115 Royal Oak, MI $90 $37 $22 Elgin, IL $90 $72 $33 Las Vegas, NV $91 $27 $54 Joliet, IL $92 $85 $15 Fort Myers, FL $93 $1 $10 Lubbock, TX $93 $23 $73 continued

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162 VARIATION IN HEALTH CARE SPENDING TABLE G-1 Continued Total Monthly Acute Care Post-Acute Care Adjusted Monthly Adjusted Monthly Adjusted Differences from Differences from Differences from the National the National the National Mean of Spending Mean of Spending Mean of Spending HRR Name Across HRRs Across HRRs Across HRRs Bradenton, FL $96 -$10 $32 Tulsa, OK $97 $17 $87 Gulfport, MS $97 $52 $52 Baltimore, MD $98 $135 -$53 Jacksonville, FL $98 $24 $28 Austin, TX $100 -$1 $57 Amarillo, TX $100 $7 $69 Munster, IN $104 $78 $50 Oklahoma City, OK $108 $22 $82 Hattiesburg, MS $108 $17 $60 Longview, TX $109 $3 $101 Panama City, FL $109 $26 $39 Bryan, TX $111 $33 $60 Jackson, MS $115 $5 $110 Wichita Falls, TX $115 -$8 $114 Fort Worth, TX $116 -$7 $113 St. Petersburg, FL $120 $13 $72 Meridian, MS $120 -$4 $125 Clearwater, FL $120 -$13 $81 Harlingen, TX $123 -$34 $157 Beaumont, TX $123 -$5 $102 Slidell, LA $129 $30 $81 Lake Charles, LA $132 $17 $107 Tyler, TX $133 -$2 $90 Victoria, TX $152 $38 $79 Dallas, TX $159 -$3 $140 Metairie, LA $163 $11 $111

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APPENDIX G 163 TABLE G-1 Continued Total Monthly Acute Care Post-Acute Care Adjusted Monthly Adjusted Monthly Adjusted Differences from Differences from Differences from the National the National the National Mean of Spending Mean of Spending Mean of Spending HRR Name Across HRRs Across HRRs Across HRRs Fort Lauderdale, FL $172 -$2 $52 Baton Rouge, LA $172 -$12 $140 Shreveport, LA $174 $20 $145 Lafayette, LA $177 $5 $143 Alexandria, LA $180 $41 $134 Houston, TX $189 $23 $120 Monroe, LA $229 $8 $179 McAllen, TX $266 -$23 $255 Miami, FL $435 -$10 $350

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164 Quintile 5: ($569 to $1,311) Quintile 4: ($515 to $569) Quintile 3: ($483 to $515) Quintile 2: ($450 to $483) Quintile 1: ($327 to $450) No Data FIGURE G-1 Input-price-adjusted/total health care spending by hospital referral region (HRR). NOTE: PHE’s analysis of total health care spending accounts for the commercially insured, Medicare, Medicaid, and the uninsured. HRR regions are divided into five spending quintiles. The figure above illustrates the variation in total health care spending in the United States. Refer to the original subcontractor report for details on methodology, and associated discussion. SOURCE: PHE, 2013.