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

Chapter: Appendix I: Committee Biographies

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Suggested Citation:"Appendix I: Committee Biographies." 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 I

Committee Biographies

Joseph P. Newhouse, Ph.D. (Chair), is the John D. MacArthur Professor of Health Policy and Management at Harvard University, Director of the Division of Health Policy Research and Education, chair of the Committee on Higher Degrees in Health Policy, and Director of the Interfaculty Initiative in Health Policy. He is a member of the faculties of the John F. Kennedy School of Government, the Harvard Medical School, the Harvard School of Public Health, and the Faculty of Arts and Sciences, as well as a faculty research associate of the National Bureau of Economic Research. He received B.A. and Ph.D. degrees in economics from Harvard University.

In 1981 Dr. Newhouse became the founding editor of the Journal of Health Economics, which he edited for 30 years. He is a current member of the editorial board of the New England Journal of Medicine. He has served as the vice-chair of the Medicare Payment Advisory Commission, chaired the Prospective Payment Assessment Commission, and served as a Commissioner of the Physician Payment Review Commission. From 2007 to 2012 he served on the CBO Board of Health Advisers and from 2010 to 2012 he co-chaired the Medicare Trustees Technical Advisory Panel. He has received numerous prizes and awards for his research. He is a director of Aetna, Abt Associates, and the National Committee for Quality Assurance (NCQA).

Alan M. Garber, M.D., Ph.D. (Vice-Chair), is Provost of Harvard University and the Mallinckrodt Professor of Health Care Policy at Harvard Medical School, a professor of economics in the Faculty of Arts and Sciences, professor of public policy in the Harvard Kennedy School of Government, and professor in the Department of Health Policy and Management in the

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

Harvard School of Public Health. Before becoming the provost at Harvard, Dr. Garber was the Henry J. Kaiser Jr. Professor and a professor of medicine, as well as a professor of economics, health research and policy, and economics in the Graduate School of Business (by courtesy) at Stanford University. From 1997 to 2011, he was Director of the Center for Primary Care and Outcomes Research in the Stanford University School of Medicine and Director of the Center for Health Policy at Stanford, and from 1986 to 2011 he served as a staff physician at the Department of Veterans Affairs Palo Alto Health Care System. Dr. Garber is an elected member of American College of Physicians, the Association of American Physicians, and the Institute of Medicine of the National Academy of Sciences, and an elected fellow of the Royal College of Physicians. He currently serves as associate editor for the Journal of Health Economics. He is a member of the Board on Science, Technology, and Economic Policy of the National Academies and formerly served as a member of the Panel of Health Advisers for the Congressional Budget Office (CBO). Dr. Garber graduated summa cum laude from Harvard College with an A.B. in economics in 1976. He earned an A.M. in economics in 1977 and a Ph.D. in economics in 1982, both from Harvard University. In 1983, he received his M.D. from Stanford University School of Medicine.

Peter Bach, M.D., is the Director of the Center for Health Policy and Outcomes at the Memorial Sloan-Kettering Cancer Center. His main research interests cover health care policy, particularly as relates to Medicare, racial disparities in cancer care quality, and lung cancer epidemiology. His research examining quality of care for Medicare beneficiaries has demonstrated that blacks do not receive as high quality care as whites when diagnosed with lung cancer, and that the aptitude and resources of primary care physicians who treat blacks are inferior, when compared to primary care physicians who primarily treat whites. In 2007 he was the senior author on a study demonstrating that care in Medicare is highly fragmented, with the average beneficiary seeing multiple primary care physicians and specialists. His work in lung cancer epidemiology has focused on the development and utilization of lung cancer prediction models that can be used to determine what lung cancer events populations of elderly smokers will experience over a period of time. His health care policy analysis includes investigations into Medicare’s approaches to cancer payment, as well as developing models of alternative reimbursement, payment systems, and coverage policies. He is funded by grants from the National Institute of Aging, a contract from the NCI, and philanthropic sources. He formerly served a senior adviser to the Administrator of the Centers for Medicare & Medicaid Services (CMS). He serves on several national committees, including the Institute of Medicine’s National Cancer Policy Forum and the Committee on Performance

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

Measurement of the NCQA. He chairs the Technical Expert Panel that is developing measures of cancer care quality for CMS. Along with publishing in the medical literature, Dr. Bach’s opinion pieces have appeared in numerous lay news outlets, including the New York Times, the Wall Street Journal, Forbes Online, and National Public Radio.

Joseph Baker, J.D., has been president of the Medicare Rights Center since June 2009. Mr. Baker is a member of the Institute of Medicine’s Board on Health Care Services and Committee on Geographic Variation in Health Care Spending and Promotion of High-Value Care. He also serves on the CMS Advisory Panel on Outreach and Education. He is an adjunct professor at the New York University School of Law, where he teaches a class on implementation of the Affordable Care Act.

Previously, he was the deputy secretary for health and human services in New York State under Governor David A. Paterson, where he was instrumental in developing Medicaid reforms and a proposal to extend health coverage to younger New Yorkers. Mr. Baker served as assistant deputy secretary for health and human services under Governor Eliot Spitzer, after having directed the Health Care Bureau under Spitzer when he was attorney general of New York. Mr. Baker was executive vice president of Medicare Rights from 1994 to 2001, and prior to that was associate director of legal services for Gay Men’s Health Crisis. He is a graduate of the University of Virginia School of Law.

Amber E. Barnato, M.D., M.P.H., M.S., is a tenured associate professor of medicine, clinical and translational science, and health policy and management. She is a board-certified public health and preventive medicine physician and health services researcher whose NIH-funded research focuses on elucidating the determinants of hospital and provider variation in intensive care unit (ICU) and life-sustaining treatment use among elders. She is vice-president elect of the Society for Medical Decision Making and a fellow of the American College of Preventive Medicine, and a former visiting scholar at the CBO. She received her B.A. in physiology from the University of California (UC), Berkeley, her M.D. from Harvard Medical School, her M.P.H. in health policy and management from UC Berkeley, and her M.S. in health services research from Stanford University.

Robert Bell, Ph.D., has been a member of the Statistics Research Department at AT&T Labs-Research since 1998. He previously worked at RAND doing public policy analysis. His current research interests include machine learning methods, analysis of data from complex samples, and record linkage methods. He was a member of the team that won the Netflix Prize competition. He has served on the Fellows Committee of the American

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

Statistical Association, the board of the National Institute of Statistical Sciences, the Committee on National Statistics, the advisory committee of the Division of Behavioral and Social Sciences and Education, and several previous National Research Council (NRC) advisory committees studying statistical issues, from conduct of the decennial census to airline safety.

Karen Davis, Ph.D., is currently the Eugene and Mildred Lipitz Professor in the Department of Health Policy and Management and director of the Roger C. Lipitz Center for Integrated Health Care at the Bloomberg School of Public Health at Johns Hopkins University. The center strives to discover and disseminate practical, cost-effective approaches to providing comprehensive, coordinated, and compassionate health care to chronically ill people and their families. Dr. Davis has served as president of The Commonwealth Fund, chairman of the Department of Health Policy and Management at The Johns Hopkins Bloomberg School of Public Health, and deputy assistant secretary for health policy in the Department of Health and Human Services (HHS). In addition, she was a senior fellow at the Brookings Institution in Washington, DC, a visiting lecturer at Harvard University and an assistant professor of economics at Rice University. She received her Ph.D. in economics from Rice University

A. Mark Fendrick, M.D., is a professor of internal medicine in the School of Medicine and a professor of health management in the School of Public Health at the University of Michigan. Dr. Fendrick currently directs the Center for Value-Based Insurance Design at the University of Michigan [www.vbidcenter.org], the leading advocate for development, implementation, and evaluation of innovative health benefit plans. Dr. Fendrick’s research focuses on the clinical and economic assessment of medical interventions with special attention to how technological innovation influences clinical practice, benefit design, and health care systems. Dr. Fendrick remains clinically active in the practice of general internal medicine. He is the co–editor in chief of the American Journal of Managed Care and is an editorial board member for three additional peer-reviewed publications. He serves on the Medicare Coverage Advisory Committee.

Paul B. Ginsburg, Ph.D., is president of the Center for Studying Health System Change (HSC). Founded in 1995 with support from the Robert Wood Johnson Foundation, HSC conducts research to inform policymakers and other audiences about changes in organization, financing and delivery of care and their effects on people. HSC is widely known for the objectivity and technical quality of its research and its success in communicating it to policy makers, industry and the media as well as to the research community. It enjoys particular respect for its knowledge of developments in communi-

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

ties and health care markets. A sister organization to Mathematica Policy Research, Inc., HSC is funded by the National Institute for Health Care Reform (NIHCR) and various foundations and government agencies. Dr. Ginsburg also serves as research director of NIHCR. See www.hschange.org and www.nihcr.org for additional information.

Prior to his founding HSC, Dr. Ginsburg served as the founding executive director of the Physician Payment Review Commission (now the Medicare Payment Advisory Commission). Widely regarded as highly influential, the Commission developed the Medicare physician payment reform proposal that was enacted by the Congress in 1989. Dr. Ginsburg was a senior economist at RAND and served as deputy assistant director at the CBO. Before that, he served on the faculties of Duke and Michigan State Universities. He earned his doctorate in economics from Harvard University.

Dr. Ginsburg is a noted speaker and consultant on the changes taking place in the health care system and the future outlook. In addition to presentations on the overall direction of change, his recent topics have included cost trends and drivers, consumer-driven health care, provider payment, future of employer-based health insurance, and competition in health care. As a consultant to the Bipartisan Policy Center, he has contributed to reports on reducing federal spending on health care and policies to contain health care costs. He has been named to Modern Healthcare’s “100 Most Influential Persons in Health Care” eight times. He received the first annual HSR Impact Award from AcademyHealth. He is a founding member of the National Academy of Social Insurance and a Public Trustee of the American Academy of Ophthalmology, served two elected terms on the Board of AcademyHealth, and serves on the Health Affairs editorial board.

Douglas A. Hastings, J.D., currently serves as chair of the Board of Directors of Epstein Becker & Green, P.C., and is based in the Washington, DC, office. He is a member of the firm’s Health Care and Life Sciences practice and is a strategic advisor with the firm’s consulting affiliate EBG Advisors. Mr. Hastings provides a wide range of health care organizations with strategic and transactional guidance in responding to the challenges and opportunities of the rapidly changing U.S. health care system. He is a graduate of Duke University and the University of Virginia Law School.

Mr. Hastings served on the Board on Health Care Services of the Institute of Medicine (IOM) from 2003 to 2011. He is a member of the National Advisory Board of Accountable Care News and a member of the Advisory Board of the BNA’s Health Law Reporter. He is a past president and fellow of the American Health Lawyers Association and was named one of the nation’s “Most Influential Lawyers” by the National Law Journal in 2011. In 2010, he was presented with the David J. Greenburg Service Award from the American Health Lawyers Association, was named by Best Lawyers as

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

the “Washington, DC Health Care Lawyer of the Year,” and received the BNA Insights Award for his article, “The Timeline for Accountable Care.” He is listed in Chambers USA Leading Lawyers for Business in Band 1 for health care transactions nationally.

Brent C. James, M.D., M.Stat., is known internationally for his work in clinical quality improvement, patient safety, and the infrastructure that underlies successful improvement efforts, such as culture change, data systems, payment methods, and management roles. He is a member of the Institute of Medicine (and participated in many of that organization’s seminal works on quality and patient safety). He is a fellow of the American College of Physician Executives and holds faculty appointments at the University of Utah School of Medicine, Harvard School of Public Health, and the University of Sydney, Australia, School of Public Health. He is chief quality officer, and executive director, at the Institute for Health Care Delivery Research at Intermountain Healthcare, based in Salt Lake City, Utah. Through the Intermountain Advanced Training Program in Clinical Practice Improvement (ATP), he has trained almost 5,500 senior physician, nursing, and administrative executives, drawn from around the world, in clinical management methods, with proven improvement results.

He has been honored with a series of awards for quality in health care delivery, and for 8 of the 9 years it has been in existence, he has been named among Modern Physician’s “50 Most Influential Physician Executives in Healthcare.” He has been named among the “100 Most Powerful People in Healthcare” (Modern Healthcare) for 5 years, and Modern Healthcare’s “25 Top Clinical Informaticists” for the 2 years it has been in existence. Before coming to Intermountain, he was an assistant professor in the Department of Biostatistics at the Harvard School of Public Health, providing statistical support for the Eastern Cooperative Oncology Group (ECOG), and staffed the American College of Surgeons’ Commission on Cancer. He holds bachelor of science degrees in computer science (electrical engineering) and medical biology; an M.D. (with residency training in general surgery and oncology); and a master of statistics degree. He serves on several nonprofit boards of trustees dedicated to clinical improvement.

Kimberly S. Johnson, M.D., M.H.S., is an assistant professor of medicine in the Division of Geriatrics and Center for Palliative Care and a fellow in the Center for the Study of Aging and Human Development at Duke University Medical Center. She received her undergraduate education at Dillard University in New Orleans, Louisiana, and her M.D. from Johns Hopkins University School of Medicine. She completed her residency training in internal medicine, fellowship in geriatrics, and clinical research training at

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

Duke University Medical Center. Dr. Johnson is board-certified in internal medicine, geriatrics, and hospice and palliative medicine.

Dr. Johnson’s research focuses on understanding racial disparities in end-of-life care. She has published widely and is nationally recognized for her work investigating how cultural beliefs and preferences and organizational practices and policies may influence the use of hospice care by older African Americans. Dr. Johnson has received the American Academy of Hospice and Palliative Medicine Junior Investigator Award and American Geriatrics Society Outstanding Excellence in Geriatric Research Award for her work. Her research is supported by a Beeson Career Development Award in Aging Research and an R01 from the National Institute on Aging.

Emmett B. Keeler, Ph.D., is a professor at the Pardee RAND Graduate School, an adjunct professor at the University of California, Los Angeles, School of Public Health, and senior mathematician at RAND. In the RAND Health Insurance Experiment, he investigated the theoretical and empirical effects of alternative health insurance plans on episodes of treatment and on health outcomes. The resulting micro-simulation model has been used to study spending and insurance choice. He has led studies to evaluate a new model for helping people with chronic diseases manage their health better and to improve the management of childbirth. He taught at Harvard and the University of Chicago while on leave from RAND. He is the author or co-author of many journal articles, and four books. His research interests are in cost-effectiveness analysis, insurance design, health economics, and health services research. He was the 2003 Distinguished Investigator of AcademyHealth and is a member of the IOM. He received his B.A. from Oberlin College and Ph.D. in mathematics from Harvard University.

Thomas H. Lee, M.D., is an internist and cardiologist and is network president for Partners Healthcare System, the integrated delivery system founded by Brigham and Women’s Hospital and Massachusetts General Hospital, and chief executive officer for Partners Community HealthCare. He is a graduate of Harvard College, Cornell University Medical College, and Harvard School of Public Health. He is a professor of medicine at Harvard Medical School and professor of health policy and management at the Harvard School of Public Health. His research interests include risk stratification and optimal management strategies for common cardiovascular problems, and improvement of quality of care, with a particular focus on critical pathways, guideline development and implementation, and managed care.

Dr. Lee is a member of the Board of Directors of Geisinger Health System, the Special Medical Advisory Group of the Department of Veterans Affairs, and the Panel of Health Advisors of the CBO. With James J.

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

Mongan, M.D., he is the author of Chaos and Organization in Health Care (MIT Press, 2009). He is an associate editor of the New England Journal of Medicine.

Mark B. McClellan, M.D., Ph.D., is director of the Engelberg Center for Health Care Reform and Leonard D. Schaeffer Chair in Health Policy Studies at the Brookings Institution. Dr. McClellan’s work at the Engelberg Center focuses on promoting high-quality, innovative, and affordable health care. A doctor and economist by training, he also has a highly distinguished record in public service and in academic research. Dr. McClellan is a former administrator of the CMS and former commissioner of the U.S. Food and Drug Administration (FDA), where he developed and implemented major reforms in health policy. These include the Medicare prescription drug benefit FDA’s Critical Path Initiative, and public-private initiatives to develop better information on the quality and cost of care. Dr. McClellan chairs the Reagan-Udall Foundation, is co-chair of the Quality Alliance Steering Committee, sits on the National Quality Forum’s Board of Directors, is a member of the IOM, and is a research associate at the National Bureau of Economic Research. He previously served as a member of the President’s Council of Economic Advisers and senior director for health care policy at the White House and was an associate professor of economics and medicine at Stanford University.

Sally C. Morton, Ph.D., is Professor and Chair of the Department of Biostatistics in the Graduate School of Public Health, and directs the Comparative Effectiveness Research Core at the University of Pittsburgh. She holds secondary appointments in the Clinical and Translational Science Institute, and the Department of Statistics. Previously, she was vice president for statistics and epidemiology at RTI International. She spent the first part of her career at the RAND Corporation, where she was head of the Statistics Group, and held the RAND Endowed Chair in Statistics. Her research interests include the use of statistics in evidence-based medicine, particularly meta-analysis. She serves as an evidence synthesis expert for the Agency for Healthcare Research and Quality Evidence-Based Practice Center (EPC) program, and was co-director of the Southern California EPC. She has been a member of several IOM committees on comparative effectiveness research, and systematic reviews. Dr. Morton is a member of the National Academy of Sciences Committee on National Statistics, Chair of the Statistics Section of the American Association for the Advancement of Science (AAAS), and a statistical expert for the Patient-Centered Outcomes Research Institute (PCORI) Methodology Committee. She was the 2009 president of the American Statistical Association (ASA), is a Fellow of the ASA and of the

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

AAAS, and is an elected member of the Society for Research Synthesis Methodology. She received a Ph.D. in statistics from Stanford University.

Robert D. Reischauer, Ph.D., is a Distinguished Institute Fellow and president emeritus of the Urban Institute, a nonprofit, nonpartisan policy research and education organization that he was the president of from 2000 to 2012. Between 1989 and 1995, he served as the director of the CBO. He also served as CBO’s deputy director, assistant director for Health, Retirement and Long-Term Analysis and executive assistant to the director between 1975 and 1981. Reischauer has been a senior fellow (1986-1989 and 1995-2000) and research associate (1970-1975) in the Economic Studies Program of the Brookings Institution and the senior vice president of the Urban Institute (1981-1986).

Reischauer, who holds an A.B. from Harvard and a master’s in international affairs and a Ph.D. in economics from Columbia University, is one of two public trustees of the Social Security and Medicare Trust Funds. He is a founding member of the Academy of Social Insurance and a member of the American Academy of Arts and Science, the IOM, the National Academy of Public Administration, and CBO’s Panel of Health Advisers. He was a member of the Medicare Payment Advisory Commission (MedPAC) from 2000 to 2009, serving as its vice chair from 2001 to 2008. He chaired the National Academy of Social Insurance’s project, “Restructuring Medicare for the Long Term,” from 1995 to 2004. Reischauer, who serves on the boards of several nonprofit organizations, is the senior fellow of the Harvard Corporation.

Alan Weil, J.D., has been the executive director of the National Academy for State Health Policy (NASHP) since September 2004. An independent, nonpartisan, nonprofit research and policy organization, NASHP is dedicated to excellence in state health policy and practice. Prior to joining NASHP, Mr. Weil served as director of the Urban Institute’s Assessing the New Federalism project, one of the largest privately funded social policy research projects ever undertaken in the United States. He previously held a cabinet position as executive director of the Colorado Department of Health Care Policy and Financing, was health policy advisor to Colorado Governor Roy Romer, and was assistant general counsel in the Massachusetts Department of Medical Security.

Mr. Weil is a frequent speaker on national and state health policy, Medicaid, federalism, and implementation of the Affordable Care Act. He is the co-editor of two books, publishes regularly in peer-reviewed journals, has testified before Congress more than half a dozen times, and is called on by major media outlets for his knowledge and analysis.

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

He is on the editorial board of the journal Health Affairs, and is a member of IOM’s Board on Health Care Services, The Commonwealth Fund’s Commission on a High Performance Health System, and the Kaiser Commission on Medicaid and the Uninsured. He is a member of the Board of Trustees of the Consumer Health Foundation in Washington, DC, and of the Board of Directors of the National Public Health and Hospitals Institute. He is a graduate of UC Berkeley, the John F. Kennedy School of Government at Harvard University, and Harvard Law School.

Gail R. Wilensky, Ph.D., is an economist and senior fellow at Project HOPE, an international health foundation. She directed the Medicare and Medicaid programs and served in the White House as a senior adviser on health and welfare issues to President George H. W. Bush. She was also the first chair of the Medicare Payment Advisory Commission. Her expertise is on strategies to reform health care, with particular emphasis on Medicare, comparative effectiveness research, and military health care.

Dr. Wilensky currently serves as a trustee of the Combined Benefits Fund of the United Mine Workers of America and the National Opinion Research Center, is on the Board of Regents of the Uniformed Services University of the Health Sciences (USUHS), the Visiting Committee of the Harvard Medical School, and the Board of Directors of the Geisinger Health System Foundation. She is an elected member of the IOM and has served two terms on its governing council. She is a former chair of the board of directors of Academy Health, a former trustee of the American Heart Association and a current or former director of numerous other nonprofit organizations. She is also a director of Brainscope, Quest Diagnostics, and United HealthGroup. Dr. Wilensky testifies frequently before congressional committees, serves as an adviser to members of Congress and other elected officials, and speaks nationally and internationally. She received a bachelor’s degree in psychology and a Ph.D. in economics at the University of Michigan and has received several honorary degrees.

Suggested Citation:"Appendix I: Committee Biographies." 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 I: Committee Biographies." 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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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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