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Variation in Health Care Spending: Target Decision Making, Not Geography (2013)

Chapter: Appendix H: Public Workshop Agendas

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Suggested Citation:"Appendix H: Public Workshop Agendas." Institute of Medicine. 2013. Variation in Health Care Spending: Target Decision Making, Not Geography. Washington, DC: The National Academies Press. doi: 10.17226/18393.
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Appendix H

Public Workshop Agendas

NOVEMBER 9-10, 2010

20 F Street, NW, Conference Rooms A & B
Washington, DC 20001

DAY 1: TUESDAY, NOVEMBER 9, 2010

10:00 – 10:05 Welcome and Introductory Remarks
Joseph Newhouse, Ph.D., Committee Chair and Moderator

Policy and Legislative Context for the Study

10:05 – 10:20 Remarks from Study Sponsor, Centers for Medicare & Medicaid Services (CMS)
Jonathan Blum, Deputy Administrator, Center for Medicare, CMS, U.S. Department of Health and Human Services
 
10:20 – 10:35 Legislative Perspectives

The Honorable Allyson Schwartz, U.S. House of Representatives

 
10:35 – 11:30 Legislative Panel Discussion

Timothy Gronniger, Professional Staff, Committee on Energy and Commerce, U.S. House of Representatives

Suggested Citation:"Appendix H: Public Workshop Agendas." Institute of Medicine. 2013. Variation in Health Care Spending: Target Decision Making, Not Geography. Washington, DC: The National Academies Press. doi: 10.17226/18393.
×

Geoff Gerhardt, Professional Staff, Subcommittee on Health, Committee on Ways and Means, U.S. House of Representatives

Chris Dawe, Health Counsel, Committee on Finance, U.S. Senate

Susan Walden, Health Policy Counsel, Committee on Finance (Minority), U.S. Senate

 
11:30 – 12:30 LUNCH BREAK
 
Geographic Variation in Spending and Utilization
12:30 – 1:00 Current MedPAC Research and Experiences

Mark Miller, Ph.D., Executive Director, MedPAC

 
1:00 – 1:30 Approaches to Measuring and Interpreting Health Care Variation

Michael Chernew, Ph.D., Professor, Department of Health Care Policy, Harvard Medical School

 
1:30 – 2:00 Dartmouth Atlas Research on Variation

Jonathan Skinner, Ph.D., Joan Sloan Dickey Third Century Professor in Economics, Dartmouth Medical School

 
Remarks from The Honorable Donald M. Berwick
2:00 – 2:30 Reviewing Geographic Variation as We Improve Health Care Quality

Donald M. Berwick, M.D., M.P.P., Administrator, CMS, U.S. Department of Health and Human Services

 
2:30 Adjourn Open Session

DAY 2: WEDNESDAY, NOVEMBER 10, 2010

8:00 – 8:05 Welcome and Introductory Remarks

Joseph Newhouse, Ph.D., Chair and Moderator

 
Measuring Quality and Value
8:05 – 9:45 Panel Discussion on Measuring Quality and Value

Janet Corrigan, Ph.D., M.B.A., President and Chief Executive Officer, National Quality Forum

Suggested Citation:"Appendix H: Public Workshop Agendas." Institute of Medicine. 2013. Variation in Health Care Spending: Target Decision Making, Not Geography. Washington, DC: The National Academies Press. doi: 10.17226/18393.
×

Carolyn M. Clancy, M.D., Director, Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services

Peggy O’Kane, M.S., President, National Committee for Quality Assurance

Richard Kronick, Ph.D., Deputy Assistant Secretary, Office of Health Policy, Office of the Assistant
Secretary for Planning and Evaluation, U.S.
Department of Health and Human Services

 
9:45 Adjourn Open Session

JANUARY 17, 2011

Keck Center, Room 100
500 Fifth Street, NW
Washington, DC 20001

8:45 – 8:50 Welcome and Introductory Remarks
Joseph Newhouse, Ph.D., Committee Chair and Moderator
 
Workshop Panels
8:50 – 9:40 Panel 1: Hospitals/Health Systems

• Larry Minnix, American Association of Homes and Services for the Aging

• Scott Malaney, American Hospital Association

• Helen Darling, National Business Group on Health, and Bruce Pyenson, Milliman, Inc.

 
9:40 – 9:45 BREAK
 
9:45 – 10:45 Panel 2: Clinicians

• Larry DeGhetaldi, California Medical Association

• John Tooker, American College of Physicians

• Eileen Sullivan-Marx, University of Pennsylvania School of Nursing

• Jonathan Sunshine, American College of Radiology

 
10:45 – 10:50 BREAK
 
10:50 – 11:50 Panel 3: Value Commentators

• Denis Cortese, Arizona State University

• Herbert Pardes, New York Presbyterian Hospital

Suggested Citation:"Appendix H: Public Workshop Agendas." Institute of Medicine. 2013. Variation in Health Care Spending: Target Decision Making, Not Geography. Washington, DC: The National Academies Press. doi: 10.17226/18393.
×

• Chris Queram, Wisconsin Collaborative for Healthcare Quality

Adjourn Open Session

11:50 – 12:45 Lunch
(Committee meets in closed session; guests are encouraged to visit local restaurants for lunch)

OPEN SESSION

12:45 – 1:45 Panel 4: Consumers and Purchasers

• Elizabeth Gilbertson, Hotel Employees and Restaurant Employees International Union Welfare Fund

• Lina Walker, AARP

• Sam Nussbaum, WellPoint

 
PUBLIC TESTIFIERS
 
1:45 Speakers Begin (Committee Q&A after each speaker)

• John (Jack) Lewin
CEO, American College of Cardiology, Washington, DC

• Deborah Schumann
Physicians for a National Health Program, Bethesda, MD

• Michael Kitchell
Iowa Medical Society, Ames, IA

• Lorrie Kaplan
Executive Director, American College of Nurse-Midwives, Silver Spring, MD

• Jason Scull
Program Officer for Clinical Affairs, Infectious Disease Society of America, Arlington, VA

• James Rohack
Director, Scott & White Center for Healthcare Policy, Temple, TX

• Andrea Weddle
Executive Director, HIV Medicine Association, Arlington, VA

• William Rich
Medical Director of Health Policy, American Academy of Ophthalmology, Washington, DC

Suggested Citation:"Appendix H: Public Workshop Agendas." Institute of Medicine. 2013. Variation in Health Care Spending: Target Decision Making, Not Geography. Washington, DC: The National Academies Press. doi: 10.17226/18393.
×

• William Davenhall
Global Manager, HHS, Esri, Redlands, CA

• Anne O’Rourke
Senior Vice President of Federal Relations, California Hospital Association, Washington, DC

• Michael Richards
Executive Director Government Relations & External Affairs, Gundersen Lutheran Health System, La Crosse, WI

• Cynthia Flynn
General Director, Family Health and Birth Center, Washington, DC

• Nancy Lane
President, PDA Inc. Health Planning Management Consultants, Raleigh, NC

• Craig Samitt
President & CEO, Dean Clinic, Madison, WI

• Raymond Gibbons
Professor of Medicine, Mayo Clinic, Rochester, MN

• Karl Ulrich
President/CEO, Marshfield Clinic, Marshfield, WI

• Jeffrey Bailet
SVP and President of Aurora Medical Group, Milwaukee, WI

Adjourn Open Session
Suggested Citation:"Appendix H: Public Workshop Agendas." Institute of Medicine. 2013. Variation in Health Care Spending: Target Decision Making, Not Geography. Washington, DC: The National Academies Press. doi: 10.17226/18393.
×

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Suggested Citation:"Appendix H: Public Workshop Agendas." Institute of Medicine. 2013. Variation in Health Care Spending: Target Decision Making, Not Geography. Washington, DC: The National Academies Press. doi: 10.17226/18393.
×
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Suggested Citation:"Appendix H: Public Workshop Agendas." Institute of Medicine. 2013. Variation in Health Care Spending: Target Decision Making, Not Geography. Washington, DC: The National Academies Press. doi: 10.17226/18393.
×
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Suggested Citation:"Appendix H: Public Workshop Agendas." Institute of Medicine. 2013. Variation in Health Care Spending: Target Decision Making, Not Geography. Washington, DC: The National Academies Press. doi: 10.17226/18393.
×
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Suggested Citation:"Appendix H: Public Workshop Agendas." Institute of Medicine. 2013. Variation in Health Care Spending: Target Decision Making, Not Geography. Washington, DC: The National Academies Press. doi: 10.17226/18393.
×
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Suggested Citation:"Appendix H: Public Workshop Agendas." Institute of Medicine. 2013. Variation in Health Care Spending: Target Decision Making, Not Geography. Washington, DC: The National Academies Press. doi: 10.17226/18393.
×
Page 169
Suggested Citation:"Appendix H: Public Workshop Agendas." Institute of Medicine. 2013. Variation in Health Care Spending: Target Decision Making, Not Geography. Washington, DC: The National Academies Press. doi: 10.17226/18393.
×
Page 170
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Health care in the United States is more expensive than in other developed countries, costing $2.7 trillion in 2011, or 17.9 percent of the national gross domestic product. Increasing costs strain budgets at all levels of government and threaten the solvency of Medicare, the nation's largest health insurer. At the same time, despite advances in biomedical science, medicine, and public health, health care quality remains inconsistent. In fact, underuse, misuse, and overuse of various services often put patients in danger.

Many efforts to improve this situation are focused on Medicare, which mainly pays practitioners on a fee-for-service basis and hospitals on a diagnoses-related group basis, which is a fee for a group of services related to a particular diagnosis. Research has long shown that Medicare spending varies greatly in different regions of the country even when expenditures are adjusted for variation in the costs of doing business, meaning that certain regions have much higher volume and/or intensity of services than others. Further, regions that deliver more services do not appear to achieve better health outcomes than those that deliver less.

Variation in Health Care Spending investigates geographic variation in health care spending and quality for Medicare beneficiaries as well as other populations, and analyzes Medicare payment policies that could encourage high-value care. This report concludes that regional differences in Medicare and commercial health care spending and use are real and persist over time. Furthermore, there is much variation within geographic areas, no matter how broadly or narrowly these areas are defined. The report recommends against adoption of a geographically based value index for Medicare payments, because the majority of health care decisions are made at the provider or health care organization level, not by geographic units. Rather, to promote high value services from all providers, Medicare and Medicaid Services should continue to test payment reforms that offer incentives to providers to share clinical data, coordinate patient care, and assume some financial risk for the care of their patients.

Medicare covers more than 47 million Americans, including 39 million people age 65 and older and 8 million people with disabilities. Medicare payment reform has the potential to improve health, promote efficiency in the U.S. health care system, and reorient competition in the health care market around the value of services rather than the volume of services provided. The recommendations of Variation in Health Care Spending are designed to help Medicare and Medicaid Services encourage providers to efficiently manage the full range of care for their patients, thereby increasing the value of health care in the United States.

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