Dartmouth Revises Medicare Spending Variation Report

Dartmouth Atlas researchers have taken to heart last year's heated criticism that they hadn't adjusted for variations in regional cost of living differences when they published statistical maps showing wide regional variations in Medicare per capita spending. This week, statisticians with the group released a new set of tables that do just that.

Most of the 306 geographic hospital referral regions moved a few points up or down, but most noteworthy were downward shifts in spending for New York City and San Francisco, Dartmouth statistician Jonathan Skinner said in a telephone interview.

"We published these measures for years where we didn't adjust for the fact that Medicare pays more in San Francisco, Chicago and New York than in other places," Skinner said. "And over time, people said, 'Oh, our city costs (Medicare) a lot more because everything costs more in our city.'

"So we decided to redo the whole thing where we did it both ways – price adjusted and unadjusted, and with a larger Medicare sample size, 20% (of Medicare fee for service beneficiaries) instead of 5%," he said. "We felt it was important for researchers and policymakers to have this data available in case they want to know how much cheaper is San Francisco really."

The Dartmouth Atlas had been a relatively obscure set of maps showing the amounts providers in various regions of the country submitted in healthcare claims for Medicare beneficiaries. But during the health reform debate, the maps came alive, showing how providers in some regions of the country were providing patients with a lot more expensive care, but with apparent negligible benefit to their survival.

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