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Medicare Releases Trove of Claims Data Showing Regional Variations

By John Reichard, CQ HealthBeat Editor

June 2, 2014 -- Medicare officials have released volumes of 2012 claims data featuring interactive "dashboards" permitting analysts to compare how per capita spending varies down to the county level and pinpointing the sharply varying burden of chronic diseases in the Medicare population across different parts of the United States.

The geographic variation dashboard shows that per capita Medicare spending in Florida's Miami-Dade County totaled $14,905 in 2012. But at the southern tip of the state, in Monroe County, which includes the Florida Keys, it stood at $7,678. Statewide, per capita Medicare costs averaged $10,728.

Thousands of miles away, in the northwestern United States, per capita Medicare spending in Oregon totaled $6,402 in 2012. In the geographic center of the state, Crook County, per capita spending a averaged $5,715.

The data also breaks down spending at the county level by categories such as inpatient, post-acute care, hospice, physician/outpatient department/tests/imaging, durable medical equipment, part B drugs and outpatient dialysis facility spending.

In Miami Dade, post-acute care spending averaged $5,432 or 142 percent more than the state average of $2,206. In Monroe County, post-acute care spending per capita totaled $1,162, or 47 percent below the state average.

In Oregon, Medicare per capita spending in 2012 totaled just $6,402 in 2012. Post-acute care spending per capita in Crook County added up to $491.

The figures are "standardized," meaning they adjust for geographic differences in how much Medicare pays for a particular service.

The sharp variations illustrate differences in the health status of Medicare beneficiaries in different states and in different counties within states. They also offer leads for additional studies examining how differences in treatment approaches contribute to spending variations.

The chronic disease dashboard shows that Alaska and Wyoming bore the lightest burden of chronic disease, while Florida and New Jersey had the heaviest.

Among beneficiaries with six or more chronic conditions, prevalence rates were lowest in Alaska and Wyoming at 7 percent, while in Florida and New Jersey 18 percent of Medicare beneficiaries had six or more chronic conditions.

In that population, the rate of readmissions to the hospital was lowest in Utah at 19 percent and highest in Washington, D.C., at 31 percent. The number of emergency department visits per beneficiary was lowest in New York and Florida, at 1.6 on average in the group with multiple chronic conditions, and highest in Washington, DC at 2.7. And Medicare spending per beneficiary with six or more chronic conditions was lowest in Hawaii at $24,086 and highest in Maryland, Washington, D.C. and Louisiana at over $37,000.

The Department of Health and Human Services also said the data can be used to examine the burden of different types of chronic diseases at the county level.

"These public data resources provide a better understanding of Medicare utilization, the burden of chronic conditions among beneficiaries and the implications for our health care system and how this varies by where beneficiaries are located," said Bryan Spivak, HHS chief technology officer in a news release.

The data and research tools were unveiled last week to a Washington, D.C. audience of some 2,000 entrepreneurs, investors, researchers and others at the annual HHS "Datapalooza." The department hopes to spur software development in the private sector to improve the efficiency and quality of care.

The "big data" trend has already featured the release of Medicare physician billing figures that helped identify the highest billing doctors in Medicare and the sometimes questionable use by physicians of high priced drugs and relatively unorthodox procedures.

The cornucopia of claims analysis also included the first annual update of Medicare hospital charges comparing the average amounts billed for various types of hospital services.

The data cover the 100 most common types of Medicare inpatient stays at over 3,000 hospitals in all 50 states. Now that two years of data are available, researchers were able to show that average charges for back problems rose 9 percent from $23,000 in 2011 to $25,000 in 2012 but the total number of discharges from the hospital for the condition dropped by nearly 7,000.

A "research cohort estimate tool" permits estimates of the number of Medicare enrollees with certain health conditions, HHS said. Before the data conference ends, the HHS health IT coordinator will announce the winners of two "data challenges," including software to identify which doctor in a particular zip code does the most cardiovascular procedures, for example.

Separately, a new "openFDA" initiative was unveiled recently to ease access to big new data sets. Developers may develop software making it easier for consumers to track recalls of drugs and foods.

OpenFDA starts with a pilot program that includes "millions of reports of drug adverse events and medication errors submitted to the FDA from 2004 to 2013," HHS said. An expansion at some point the future will include product labeling as well as recalls.

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