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Suggested Citation:"Appendix B: Statement of Task." Institute of Medicine. 2013. Interim Report of the Committee on Geographic Variation in Health Care Spending and Promotion of High-Value Care: Preliminary Committee Observations. Washington, DC: The National Academies Press. doi: 10.17226/18308.
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Appendix B

Statement of Task

An ad hoc committee will conduct a study on geographic variation in intensity, cost, and growth of health care services and in per capita health care spending among the Medicare, Medicaid, privately insured, and uninsured U.S. populations as proposed in Section 1159 of the Affordable Health Care for America Act (H.R. 3962) in 2009, and commissioned by the Secretary of the Department of Health and Human Services in 2010.

The committee will commission relevant new analyses and will evaluate and review factors such as

•   variation in areas of different sizes;

•   input prices, health status, practice patterns, access to medical services, supply of medical services, socioeconomic factors (including race, ethnicity, gender, age, income and educational status), and provider and payment organizations;

•   patient access to care, insurance status, distribution of health care resources, health care outcomes, and quality;

•   physician discretion consistent with or different from best evidence;

•   patient preferences and compliance;

•   empirical evidence for variation;

•   insurance status prior to Medicare enrollment, dual eligibility, fee-for-service, Parts C and D Medicare; and

•   other factors deemed appropriate.

The effects of relevant sections of the Affordable Care and Budget Reconciliation Acts of 2010 on variation in Medicare Parts A, B, and C spending will be taken into account and recommendations made for changes in Medicare Parts A, B, and C payments for items and services that include impacts on physicians and hospitals, beneficiary access to care, and Medicare spending (but excluding graduate medical education, Disproportionate Share Hospital, and health IT add-ons).

The committee will further address whether Medicare payment systems should be modified to provide incentives for high-value, high-quality, evidence-based, patient-centered care through adoption of a value index (based on measures of quality and cost) that would adjust payments on a geographic area basis.

To meet a firm congressional deadline, a brief interim report will be issued in March 2013. The report will include the committee’s preliminary observations, based primarily on the results of the subcontracted analyses, but will not contain any recommendations.

Suggested Citation:"Appendix B: Statement of Task." Institute of Medicine. 2013. Interim Report of the Committee on Geographic Variation in Health Care Spending and Promotion of High-Value Care: Preliminary Committee Observations. Washington, DC: The National Academies Press. doi: 10.17226/18308.
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Interim Report of the Committee on Geographic Variation in Health Care Spending and Promotion of High-Value Health Care: Preliminary Committee Observations is designed to provide the committee's preliminary observations for the 113th Congress as it considers further Medicare reform. This report contains only key preliminary observations related primarily to the committee's commissioned analyses of Medicare Parts A (Hospital Insurance program), B (Supplementary Medical Insurance program) and D (outpatient prescription drug benefit), complemented by other empirical investigations. It does not contain any observations related to the committee's commissioned analyses of the commercial insurer population, Medicare Advantage, or Medicaid, which will be presented in the committee's final report after completion of quality-control activities.

This interim report excludes conclusions or recommendations related to the committee's consideration of the geographic value index or other payment reforms designed to promote highvalue care. Additional analyses are forthcoming, which will influence the committee's deliberations. These analyses include an exploration of how Medicare Part C (Medicare Advantage) and commercial spending, utilization, and quality vary compared with, and possibly are influenced by, Medicare Parts A and B spending, utilization, and quality. The committee also is assessing potential biases that may be inherent to Medicare and commercial claims-based measures of health status. Based on this new evidence and continued review of the literature, the committee will confirm the accuracy of the observations presented in this interim report and develop final conclusions and recommendations, which will be published in the committee's final report.

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