A new report from the Institute of Medicine may finally put to rest the idea that policymakers should adopt a geographically based value index to set Medicare reimbursements, a proposal favored by providers and members of Congress in regions that have high-quality, low-cost care. But that doesn't mean the debate on geographic variation in healthcare spending and utilization is over.
Academics and policy analysts have examined the concept of geographic variation for four decades, since Dr. John Wennberg—who founded the Dartmouth Atlas of Health Care that studies the patterns of medical resources and utilization—published a paper in 1973 reporting significant variations in the use of healthcare services across regions. Four years ago, members of Congress asked HHS Secretary Kathleen Sebelius to commission two IOM studies on geographic payments under Medicare. The second study, Variation in Health Care Spending: Target Decision Making, Not Geography, was released last week.
After analyzing Medicare and commercial payer data, a committee of 19 experts at the IOM concluded in the 178-page report that geographic variation in healthcare spending is real, but recommended that Congress not adopt a geographic value index because decisions about care are made at the physician and organizational levels, not the regional level.