Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy, Second Edition PDF
Preview Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy, Second Edition
Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy, Second Edition Geographic Adjustment in Medicare Payment Phase I: Improving Accuracy Second Edition Committee on Geographic Adjustment Factors in Medicare Payment Board on Health Care Services Margaret Edmunds and Frank A. Sloan, Editors PREPUBLICATION COPY: SECOND EDITION Copyright © National Academy of Sciences. All rights reserved. Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy, Second Edition THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. 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 responsible 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 and Medicaid Services. Any opinions, 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. International Standard Book Number 0-309-XXXXX-X (Book) International Standard Book Number 0-309- XXXXX -X (PDF) Library of Congress Control Number: 00 XXXXXX Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2011 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). 2011. Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy. Washington, DC: The National Academies Press. PREPUBLICATION COPY: SECOND EDITION Copyright © National Academy of Sciences. All rights reserved. Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy, Second Edition PREPUBLICATION COPY: SECOND EDITION Copyright © National Academy of Sciences. All rights reserved. Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy, Second Edition 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 administration 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 superior 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 initiative, 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 Sciences 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 is chair and vice chair, respectively, of the National Research Council. www.national-academies.org PREPUBLICATION COPY: SECOND EDITION Copyright © National Academy of Sciences. All rights reserved. Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy, Second Edition 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 M. ROY WILSON (Vice Chair), Chair, Board of Trustees, Charles R. Drew University of Medicine and Science, and Chancellor Emeritus, University of Colorado Denver JON B. CHRISTIANSON, Professor and James A. Hamilton Chair in Health Policy and Management, University of Minnesota Sc hool of Public Health STUART GUTERMAN, Vice President, Payment and System Reform, The Commonwealth Fund JUDITH K. HELLERSTEIN, Professor, Economics, University of Maryland (resigned from committee service June 2011) 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 MERIDEAN MAAS, Professor Emerita and Co-Director of the John A. Hartford Center of Geriatric Nurse Excellence, University of Iowa (resigned from committee service January 2011) MARILYN MOON, Senior Vice President and Director, Health, American Institutes of Research CATHRYN NATION, Associate Vice President, Division of Health Sciences and Services, University of California Office of the President JOANNE M. POHL, Professor Emerita, Division of Health Promotion and Risk Reduction, University of Michigan School of Nursing (appointed to committee service June 2011) THOMAS RICKETTS III, Managing Director, Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill JANE E. SISK, Director, Division of Health Care Statistics, Centers for Disease Control and Prevention, National Center for Health Statistics BRUCE STEINWALD, Independent Consultant DAVID VLAHOV, Dean and Professor, School of Nursing, University of California, San Francisco BARBARA O. WYNN, Senior Policy Analyst, RAND Corporation ALAN M. ZASLAVSKY, Professor, Health Care Policy (Statistics), Harvard Medical School STEPHEN ZUCKERMAN, Senior Fellow, Health Policy Center, The Urban Institute RTI International Consultants KATHLEEN DALTON, RTI Project Director, Senior Health Policy Analyst GREGORY C. POPE, Program Director, Health Care Financing and Payment Program WALTER ADAMACHE, Research Economist ELIZABETH SEELEY, Health Economist DEBORAH HEALY, Research Economist BRIEANNE LYDA-MACDONALD, Public Health Analyst JUSTINE L.E. ALLPRESS, Research Geospatial Programmer/Analyst NATHAN WEST, Health Services Analyst ALTON WRIGHT, Public Health Analyst Study Staff MARGARET EDMUNDS, Study Director KATHLEEN HADDAD, Senior Program Officer PREPUBLICATION COPY: UNCORRECTED PROOFS v Copyright © National Academy of Sciences. All rights reserved. Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy, Second Edition SERINA S. RECKLING, Research Associate SARA SPIZZIRRI, Research Assistant JOI WASHINGTON, Research Assistant (August 2011) ASHLEY McWILLIAMS, Senior Program Assistant (August 2010 to August 2011) JOHN BAILAR III, Scholar-in-Residence ROGER C. HERDMAN, Board Director PREPUBLICATION COPY: SECOND EDITION vi Copyright © National Academy of Sciences. All rights reserved. Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy, Second Edition REVIEWERS This report has been reviewed in draft form by individuals chosen for their diverse perspectives 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: ANDREW BAZEMORE, The Robert Graham Center ROBERT BERENSON, The Urban Institute DAVID CUTLER, Harvard University JONATHAN GRUBER, Massachusetts Institute of Technology KAREN HELLER, Greater New York Hospital Association TERRENCE KAY, Centers for Medicare and Medicaid Services KEITH J. MUELLER, University of Iowa JOSEPH NEWHOUSE, Harvard University DOUGLAS REDING, Marshfield Clinic GEORGE STAMAS, Bureau of Labor Statistics DAVID TORCHIANA, Massachusetts General Physicians Organization JAN TOWERS, American Academy of Nurse Practitioners LANCE A. WALLER, Emory University, Rollins School of Public Health Although the reviewers listed above have provided many constructive comments and suggestions, 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 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 accordance 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. PREPUBLICATION COPY: SECOND EDITION vii Copyright © National Academy of Sciences. All rights reserved. Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy, Second Edition PREPUBLICATION COPY: SECOND EDITION viii Copyright © National Academy of Sciences. All rights reserved. Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy, Second Edition 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 report. The following individuals shared their expertise through invited presentations at the two public sessions: James Bentley, Consultant; Dan Black, Professor and Dean of the Harris School of Public Policy, University of Chicago; The Honorable Bruce Braley, U.S. House of Representatives, Iowa; Larry DeGhetaldi, Palo Alto Medical Foundation and Chair of Medicare Committee, California Medical Association; Roland Goertz, President, American Academy of Family Physicians; Karen Heller, Executive Vice President, Greater New York Hospital Association; Michael Kitchell, President of Board of Directors, McFarland Clinic and President, Iowa Medical Society; Mark Miller, Executive Director of MedPAC; Rob Otten, Vice President of Health Policy, American Medical Association; James Potter, Senior VP of Advocacy and Government Relations, American Academy of Physician Assistants; Douglas Reding, Vice President, Marshfield Clinic; Jennie Rhinehart, Administrator and CEO, Community Hospital, Tallassee, Alabama; Elena Rios, President, National Hispanic Medical Association; The Honorable Allyson Schwartz, Pennsylvania; Sherry Smith, Director of Physician Payment Policy at the American Medical Association; Byron Sogie-Thomas, Health Policy Director, National Medical Association; James Spletzer, Senior Research Economist, Bureau of Labor Statistics; Alice Tolbert-Coombs, President, Massachusetts Medical Society; and Jan Towers, Health Policy Director, American Academy of Nurse Practitioners. Additional presentations were made by Dale Baker, Baker Consulting; Tim Bartholow, Wisconsin Medical Society; Edward Bentley, Santa Barbara Gastroenterology Associates; Craig Boyer, North Country Health Services, Bemidji, Minnesota; and Jerome Connolly, American Academy of Family Physicians; Dario DeGhetaldi, Corey, Luzaich, Pliska, DeGhetaldi & Nastari LLP. Written testimony from the following individuals and organizations is gratefully acknowledged: The Honorable Charles Grassley, United States Senate, Iowa; Atul Grover, Chief Advocacy Officer, Association of American Medical Colleges; Joanna Kim, Senior Associate Director, Policy, American Hospital Association; Ellen Kugler, National Association of Urban Hospitals; Brent Miller, Director of Federal Government Relations, Marshfield Clinic; Anne O’Rourke, California Hospital Association; Eneida Roldan, President and CEO, Jackson Health System, Miami; Steve Speil, Senior Vice President, Health and Finance Policy, Federation of American Hospitals; and David Winslow, Vice President, Maine Hospital Association. A commissioned paper by Dobson DaVanzo LLC on the technical approach to the study was also provided. Several others provided valuable information and technical assistance. Phil Doyle, Laurie Salmon, and George Stamos of the Bureau of Labor Statistics met with committee members and staff and provided statistical consultations and data for the committee’s consideration. Alex Calgano of the Massachusetts Medical Society; Linda Fishman and Don May of the American Hospital Association; Atul Grover of the American Association of Medical Colleges; Elizabeth McNeil of the California Medical Association; Brent Miller of Marshfield Clinic; and Robert Phillips, Director of the Robert Graham Center: Policy Studies in Family Medicine and Primary Care were instrumental in identifying speakers for the public sessions and in providing materials for the committee’s consideration. Several Congressional staff members also provided valuable background information for the study. They include Susan Walden of the Senate Committee on Finance; Jennifer Friedman, Geoff Gerhardt, and Tim Gronniger of the House Committee on Ways and Means, Subcommittee on Health; Stephen Cha and Anne Morris, House Committee on Energy and Commerce; Christa Shively, Office of Congressman Earl Blumenauer; Mike Goodman, Office of Congressman Bruce Braley; Megan Eidman, PREPUBLICATION COPY: SECOND EDITION ix Copyright © National Academy of Sciences. All rights reserved.
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