Geographic Adjustment in Medicare Payment: Phase II: Implications for Access, Quality, and Efficiency PDF
Preview Geographic Adjustment in Medicare Payment: Phase II: Implications for Access, Quality, and Efficiency
Geographic Adjustment in Medicare Payment: Phase II: Implications for Access, Quality, and Efficiency Committee on Geographic Adjustment Factors in Medicare Payment Board on Health Care Services Margaret Edmunds, Frank A. Sloan, and A. Bruce Steinwald, Editors Copyright © National Academy of Sciences. All rights reserved. Geographic Adjustment in Medicare Payment: Phase II: Implications for Access, Quality, and Efficiency THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee respon- sible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by Contract No. HHS P23320042509XI, Task Order No. HHS P23337012T between the National Academy of Sciences and the Centers for Medicare & Medicaid Services. Any opin- ions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. Library of Congress Cataloging-in-Publication Data Institute of Medicine (U.S.). Committee on Geographic Adjustment Factors in Medicare Payment. Geographic adjustment in Medicare payment. Phase II, Implications for access, quality, and efficiency / Committee on Geographic Adjustment Factors in Medicare Payment, Board on Health Care Services ; Margaret Edmunds and Frank A. Sloan, and A. Bruce Steinwald, editors. p. ; cm. Implications for access, quality, and efficiency Includes bibliographical references and index. ISBN 978-0-309-25798-5 (pbk.) — ISBN 978-0-309-25799-2 (pdf) I. Edmunds, Margaret. II. Sloan, Frank A. III. Steinwald, Bruce. IV. Title. V. Title: Implications for access, quality, and efficiency. [DNLM: 1. Medicare Part A—economics. 2. Medicare Part B—economics. 3. Fee-for-Service Plans—organization & administration—United States. 4. Professional Practice Location—economics—United States. WT 31] 368.4’20140973—dc23 2012040470 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2012 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2012. Geographic adjustment in Medicare payment: Phase II: Implications for access, quality, and efficiency. Washington, DC: The National Academies Press. Copyright © National Academy of Sciences. All rights reserved. Geographic Adjustment in Medicare Payment: Phase II: Implications for Access, Quality, and Efficiency “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe Advising the Nation. Improving Health. Copyright © National Academy of Sciences. All rights reserved. Geographic Adjustment in Medicare Payment: Phase II: Implications for Access, Quality, and Efficiency The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administra- tion and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the supe- rior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initia- tive, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sci- ences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org Copyright © National Academy of Sciences. All rights reserved. Geographic Adjustment in Medicare Payment: Phase II: Implications for Access, Quality, and Efficiency COMMITTEE ON GEOGRAPHIC ADJUSTMENT FACTORS IN MEDICARE PAYMENT FRANK A. SLOAN (Chair), J. Alexander McMahon Professor of Health Policy and Management, Professor of Economics, Center for Health Policy, Duke University, Durham, NC M. ROY WILSON (Vice-Chair), Chancellor Emeritus, University of Colorado Denver JON B. CHRISTIANSON, Professor and James A. Hamilton Chair in Health Policy and Management, University of Minnesota School of Public Health, Minneapolis STUART GUTERMAN, Vice President, Payment and System Reform, The Commonwealth Fund, Washington, DC CARLOS R. JAÉN, Chair of Family and Community Medicine and Dr. John M. Smith, Jr. Endowed Professor, University of Texas Health Science Center at San Antonio JACK KALBFLEISCH, Professor of Biostatistics and Statistics and Director, Kidney Epidemiology and Cost Center, University of Michigan School of Public Health, Ann Arbor MARILYN MOON, Senior Vice President and Director, Health, American Institutes of Research, Washington, DC CATHRYN NATION, Associate Vice President, Division of Health Sciences and Services, University of California Office of the President, Oakland JOANNE M. POHL, Professor Emerita, Division of Health Promotion and Risk Reduction, University of Michigan School of Nursing, Ann Arbor THOMAS C. RICKETTS III, Managing Director, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill JANE E. SISK, Institute of Medicine Scholar-in-Residence, and Former Director, Division of Health Care Statistics, Centers for Disease Control and Prevention, National Center for Health Statistics, Washington, DC A. BRUCE STEINWALD, Independent Consultant, Washington, DC DAVID VLAHOV, Dean and Professor, School of Nursing, University of California, San Francisco BARBARA O. WYNN, Senior Policy Analyst, RAND Corporation, Arlington, VA ALAN M. ZASLAVSKY, Professor, Health Care Policy (Statistics), Harvard Medical School, Boston, MA STEPHEN ZUCKERMAN, Senior Fellow, Health Policy Center, The Urban Institute, Washington, DC RTI International Consultants WALTER ADAMACHE, Research Economist JUSTINE L.E. ALLPRESS, Research Geospatial Programmer/Analyst KATHLEEN DALTON, RTI Project Director, Senior Health Policy Analyst GREGORY C. POPE, Program Director, Health Care Financing and Payment Program ELIZABETH SEELEY, Health Economist NATHAN WEST, Health Services Analyst ALTON WRIGHT, Public Health Analyst v Copyright © National Academy of Sciences. All rights reserved. Geographic Adjustment in Medicare Payment: Phase II: Implications for Access, Quality, and Efficiency IHS Global Insight Consultants TIM DALL, IHS Project Director, Managing Director PAUL GALLO, Project Staff MIKE STORM, Project Staff Study Staff MARGARET EDMUNDS, Study Director KATHLEEN HADDAD, Senior Program Officer (August 2010 to November 2011) JENSEN JOSE, Research Associate (December 2011 to March 2012) SERINA S. RECKLING, Research Associate (September 2010 to November 2011) SARA SPIZZIRRI, Research Assistant (August 2010 to March 2012) JOI D. WASHINGTON, Research Assistant (August 2011 to January 2012) ASHLEY McWILLIAMS, Senior Program Assistant (August 2010 to August 2011) ROGER C. HERDMAN, Director, Board on Health Care Services vi Copyright © National Academy of Sciences. All rights reserved. Geographic Adjustment in Medicare Payment: Phase II: Implications for Access, Quality, and Efficiency Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspec- tives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Robert Berenson, The Urban Institute Karen Heller, Greater New York Hospital Association Keith J. Mueller, University of Iowa Joseph Newhouse, Harvard University Robert Phillips, Robert Graham Center for Policy Studies in Family Medicine and Primary Care Douglas Reding, Marshfield Clinic William Scanlon, Independent Consultant Susan M. Skillman, University of Washington George Stamas, Bureau of Labor Statistics David Torchiana, Massachusetts General Physicians Organization Lance A. Waller, Emory University, Rollins School of Public Health Although the reviewers listed above have provided many constructive comments and sug- gestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by vii Copyright © National Academy of Sciences. All rights reserved. Geographic Adjustment in Medicare Payment: Phase II: Implications for Access, Quality, and Efficiency viii REVIEWERS Harold Sox, American College of Physicians, and Charles E. Phelps, Rochester University. Appointed by the National Research Council and Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accor- dance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution. Copyright © National Academy of Sciences. All rights reserved. Geographic Adjustment in Medicare Payment: Phase II: Implications for Access, Quality, and Efficiency Acknowledgments The Committee on Geographic Adjustment Factors in Medicare Payment and the Institute of Medicine (IOM) study staff would like to thank the many individuals and organizations who generously contributed their time, knowledge, and expertise to this Phase II report. The following individuals shared their expertise through invited presentations at the public session in September 2011: Cindy Bagwell, Vice President for Talent Acquisition, Geisinger Health System, Danville, PA; Blair Childs, Senior Vice President, Premier, Inc.; James Dickson, CEO, Copper Queen Community Hospital, Bisbee, Arizona; Kathy Duckett, Director of Clinical Programs, Partners Home Care, Boston, MA; Jennifer Grebenschikoff, President, The Physician Executive Leadership Center, Tampa, FL; Mark Miller, Executive Director, MedPAC, Washington, DC; Rachel Morgan, National Conference of State Legislatures, Washington, DC; and Anne Rosewarne, President, Michigan Health Council, Okemos, MI. Several others provided valuable information and technical assistance. Phil Doyle, Laurie Salmon, and George Stamas of the Bureau of Labor Statistics met with committee members and staff and provided statistical consultations and data for the committee’s consideration. Others were instrumental in identifying speakers for the public session and in providing materials and information for the committee’s consideration: Alex Calgano of the Massachusetts Medical Society; Linda Fishman, Don May, and Joanna Kim of the American Hospital Association; Atul Grover of the American Association of Medical Colleges; Elizabeth McNeil of the California Medi- cal Association; Brent Miller of Marshfield Clinic; Mark Miller, Jeffrey Stensland, Kevin Hayes, Cristina Boccutti, and Arielle Mir of MedPAC; Robert Phillips, Director of the Robert Graham Center: Policy Studies in Family Medicine and Primary Care; Edward Salsberg of the Health Resources and Services Administration; and Jan Towers, Health Policy Director of the American Academy of Nurse Practitioners. Several congressional staff members also provided valuable background information for the study. They include professional staff members Nick Bath of the Senate Health, Energy, Labor and Pensions Committee; Celina Cunningham, Office of Congressman Jay Inslee; Jennifer Friedman and Geoff Gerhardt of the House Committee on Ways and Means, Subcommittee on ix Copyright © National Academy of Sciences. All rights reserved.
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