The Latest on Geographic Variation in Medicare Spending: A Demographic Divide Persists But Variation Has Narrowed
Appendix 2: Tables
| Table 1: Counties with the Highest and Lowest Unadjusted Medicare Per Capita Spending, 2013 | |||||
| Rank in 2013 | County | State | 2013 Medicare per capita spending (unadjusted) |
2013 Medicare per capita spending (price and health-risk adjusted) |
2007-2013 Medicare per capita spending growth rate |
| United States average | $9,415 | $9,343 | 2.2% | ||
| 20 highest-spending counties (unadjusted) | |||||
| 1 | Miami-Dade | FL | $16,386 | $11,179 | -1.8% |
| 2 | Kings | NY | $14,998 | $8,235 | 1.5% |
| 3 | Bronx | NY | $14,903 | $7,948 | 2.1% |
| 4 | Baltimore City | MD | $14,370 | $9,505 | 1.6% |
| 5 | Los Angeles | CA | $13,309 | $9,021 | 3.2% |
| 6 | Queens | NY | $12,909 | $8,349 | 1.8% |
| 7 | Essex | NJ | $12,902 | $9,148 | 1.8% |
| 8 | Philadelphia | PA | $12,811 | $9,060 | 2.0% |
| 9 | Broward | FL | $12,664 | $10,357 | 1.3% |
| 10 | Wayne | MI | $12,566 | $9,761 | 1.7% |
| 11 | Hudson | NJ | $12,475 | $8,952 | 1.9% |
| 12 | Suffolk | MA | $12,274 | $8,412 | 1.9% |
| 13 | New York | NY | $12,208 | $9,184 | 1.3% |
| 14 | Harris | TX | $12,195 | $10,418 | 1.6% |
| 15 | Hidalgo | TX | $12,182 | $8,971 | -1.7% |
| 16 | Tangipahoa | LA | $12,130 | $11,066 | 1.5% |
| 17 | Baltimore | MD | $12,115 | $9,811 | 2.4% |
| 18 | Richmond | NY | $12,113 | $9,077 | 1.3% |
| 19 | Passaic | NJ | $11,976 | $9,542 | 2.5% |
| 20 | New Haven | CT | $11,952 | $8,980 | 2.8% |
| 20 lowest-spending counties (unadjusted) | |||||
| 1 | Josephine | OR | $6,058 | $7,513 | 2.1% |
| 2 | Mesa | CO | $6,263 | $7,618 | 2.4% |
| 3 | Santa Fe | NM | $6,288 | $7,871 | 2.7% |
| 4 | Tompkins | NY | $6,310 | $7,659 | 1.7% |
| 5 | Missoula | MT | $6,404 | $8,295 | 1.3% |
| 6 | Hawaii | HI | $6,433 | $6,269 | 3.0% |
| 7 | Flathead | MT | $6,434 | $8,260 | 1.7% |
| 8 | Douglas | OR | $6,550 | $7,521 | 2.8% |
| 9 | Clallam | WA | $6,655 | $8,311 | 2.4% |
| 10 | Jackson | OR | $6,692 | $7,908 | 1.8% |
| 11 | Deschutes | OR | $6,757 | $8,501 | 2.4% |
| 12 | Outagamie | WI | $6,767 | $7,913 | 2.0% |
| 13 | Island | WA | $6,800 | $8,011 | 2.4% |
| 14 | Lane | OR | $6,860 | $7,810 | 2.8% |
| 15 | Sheboygan | WI | $6,869 | $8,307 | 1.2% |
| 16 | Honolulu | HI | $6,923 | $6,672 | 3.3% |
| 17 | Dubuque | IA | $6,946 | $8,733 | 3.0% |
| 18 | Steuben | NY | $6,973 | $7,631 | 2.5% |
| 19 | Bernalillo | NM | $7,034 | $7,769 | 2.9% |
| 20 | La Crosse | WI | $7,034 | $7,727 | 3.5% |
| SOURCE: RAND Corporation/Kaiser Family Foundation analysis of Centers for Medicare & Medicaid Services Geographic Variation Public Use File (February 2015 update). | |||||
| Table 2: Average Total Spending, Beneficiary Demographics, and Provider Supply Measures for Counties with the Highest and Lowest Unadjusted Medicare Per Capita Spending, 2013 | ||||
| National average | 20 highest spending counties (unadjusted) | 20 lowest spending counties (unadjusted) | High-low difference | |
| Medicare per capita spending (unadjusted) | $9,415 | $13,149 | $6,726 | 95.5%**** |
| Medicare per capita spending (price and health-risk adjusted) | $9,343 | $9,344 | $7,640 | 22.3%**** |
| Health risk (hierarchical condition categories [HCC] score) | 1.00 | 1.19 | 0.87 | 37.3%**** |
| Medicare price index | 1.06 | 1.21 | 1.07 | 12.8%**** |
| Number of beneficiaries (traditional Medicare and Medicare Advantage, in thousands) | 50,181 | 4,645 | 735 | 532.3%**** |
| Medicare Advantage enrollment share | 31.6% | 42.8% | 42.2% | 1.4% |
| Beneficiary demographics (% of beneficiaries) | ||||
| Black | 9.8% | 19.1% | 1.0% | 1763.9%**** |
| Hispanic | 6.0% | 17.8% | 7.1% | 151.2%** |
| Eligible for Medicare and Medicaid | 21.3% | 34.9% | 16.5% | 111.8%**** |
| Poverty rate among people ages 65 and older | 9.8% | 14.7% | 7.8% | 88.5% |
| Residing in a metropolitan area | 85.3% | 100.0% | 77.1% | 29.7%** |
| Five or more chronic conditions | 34.0% | 42.5% | 23.4% | 81.6% |
| Characteristics of overall county population | ||||
| Poverty rate | 16.0% | 20.0% | 15.6% | 28.5%*** |
| Supply of health care providers (per 10,000 county residents) | ||||
| Physicians | 24.06 | 33.74 | 24.48 | 37.8%* |
| Primary care physicians as a % of all physicians | 38.5% | 37.1% | 41.3% | -10.1%** |
| Hospital beds | 25.30 | 28.30 | 22.33 | 26.7% |
| Skilled nursing facility beds | 51.49 | 44.55 | 38.03 | 17.1% |
| Home health agencies | 0.40 | 0.62 | 0.18 | 248.0%*** |
| Ambulatory surgical centers | 0.17 | 0.16 | 0.20 | -18.1% |
| Hospices | 0.12 | 0.08 | 0.13 | -38.3%* |
| NOTE: P-values are calculated by applying a t-test to the difference between the 20 highest and 20 lowest-spending counties, assuming unequal variance. *: p-value<0.10, **: p-value<0.05, ***: p-value<0.01, ****: p-value<0.001.
SOURCE: RAND Corporation/Kaiser Family Foundation analysis of Centers for Medicare & Medicaid Services Geographic Variation Public Use File (February 2015 update) for spending and most beneficiary demographics; American Community Survey 2008-2012 pooled data for poverty among people ages 65 and older; a 5 percent sample of claims from the 2013 CMS Chronic Conditions Data Warehouse (CCW) for five or more chronic conditions; Area Health Resources File for metropolitan area residents, characteristics of overall county population, and provider supply measures (various years). |
||||
| Table 3: Average Spending and Use of Specified Medicare-Covered Services for Counties with the Highest and Lowest Unadjusted Medicare Per Capita Spending, 2013 | ||||
| Measure | National average | 20 highest spending counties (unadjusted) | 20 lowest spending counties (unadjusted) | High-low difference |
| Hospital inpatient | ||||
| Spending per capita | $3,191 | $4,914 | $2,335 | 110.5%**** |
| Percent using | 17.5% | 19.2% | 13.2% | 45.8%**** |
| Price index | 1.24 | 1.57 | 1.25 | 25.8%**** |
| Standardized costs per user | $14,722 | $16,230 | $14,295 | 13.5%**** |
| Covered days per capita | 1,530 | 2,081 | 988 | 110.7%**** |
| Readmission rate | 18.0% | 21.2% | 14.8% | 44.0%**** |
| Outpatient | ||||
| Spending per capita | $1,195 | $1,184 | $1,038 | 14.1% |
| Percent using | 63.7% | 56.0% | 61.1% | -8.3% |
| Price index | 1.02 | 1.08 | 1.04 | 4.0% |
| Standardized costs per user | $1,846 | $1,939 | $1,652 | 17.3%*** |
| Visits per capita | 4,221 | 3,626 | 4,071 | -10.9% |
| Evaluation & management | ||||
| Spending per capita | $904 | $1,323 | $634 | 108.8%**** |
| Percent using | 87.8% | 86.7% | 84.7% | 2.4%** |
| Price index | 0.96 | 1.02 | 0.93 | 9.9%**** |
| Standardized costs per user | $1,078 | $1,489 | $803 | 85.4%**** |
| Visits per capita | 13,316 | 17,897 | 9,979 | 79.3%**** |
| Procedures | ||||
| Spending per capita | $605 | $785 | $467 | 67.9%**** |
| Percent using | 61.1% | 62.8% | 54.6% | 15.1%**** |
| Price index | 0.98 | 1.06 | 0.96 | 10.9%**** |
| Standardized costs per user | $1,011 | $1,170 | $896 | 30.6%**** |
| Procedures per capita | 4,612 | 6,011 | 3,629 | 65.6%**** |
| Skilled nursing facility | ||||
| Spending per capita | $774 | $1,117 | $466 | 139.8%**** |
| Percent using | 5.1% | 5.7% | 3.3% | 72.3%**** |
| Price index | 0.97 | 1.09 | 1.01 | 7.5%** |
| Standardized costs per user | $15,840 | $18,008 | $14,038 | 28.3%**** |
| Covered days per capita | 1,887 | 2,429 | 1,093 | 122.3%**** |
| Home health | ||||
| Spending per capita | $489 | $962 | $192 | 402.0%**** |
| Percent using | 9.4% | 13.8% | 4.7% | 193.4%**** |
| Price index | 0.96 | 1.09 | 1.02 | 7.4%** |
| Standardized costs per user | $5,428 | $5,942 | $3,957 | 50.2%**** |
| Visits per capita | 3,062 | 6,207 | 1,019 | 509.1%**** |
| Durable medical equipment | ||||
| Spending per capita | $199 | $182 | $155 | 17.7%** |
| Percent using | 27.6% | 27.2% | 22.7% | 19.8%*** |
| Price index | 0.94 | 0.93 | 0.96 | -3.4%**** |
| Standardized costs per user | $770 | $727 | $696 | 4.4% |
| Events per capita | 1,723 | 1,597 | 1,371 | 16.6%* |
| Hospice | ||||
| Spending per capita | $305 | $296 | $263 | 12.6% |
| Percent using | 2.7% | 2.3% | 2.5% | -5.8% |
| Price index | 0.99 | 1.11 | 1.04 | 6.8%** |
| Standardized costs per user | $11,499 | $11,448 | $9,966 | 14.9%* |
| Covered days per capita | 1,889 | 1,561 | 1,619 | -3.6% |
| NOTE: P-values are calculated by applying a t-test to the difference between the 20 highest and 20 lowest-spending counties, assuming unequal variance. *: p-value<0.10, **: p-value<0.05, ***: p-value<0.01, ****: p-value<0.001.
SOURCE: RAND Corporation/Kaiser Family Foundation analysis of Centers for Medicare & Medicaid Services Geographic Variation Public Use File (February 2015 update). |
||||
| Table 4: Counties with the Highest and Lowest Adjusted Medicare Per Capita Spending, 2013 | |||||
| Rank in 2013 | County | State | 2013 Medicare per capita spending (unadjusted) |
2013 Medicare per capita spending (price and health-risk adjusted) |
2007-2013 Medicare per capita spending growth rate |
| United States average | $9,415 | $9,343 | 2.2% | ||
| 20 highest-spending counties (adjusted) | |||||
| 1 | Smith | TX | $10,369 | $11,572 | 2.4% |
| 2 | Collin | TX | $9,932 | $11,429 | 1.1% |
| 3 | Hunt | TX | $10,999 | $11,343 | 2.2% |
| 4 | Montgomery | TX | $10,887 | $11,283 | 2.1% |
| 5 | Henderson | TX | $10,379 | $11,238 | 2.2% |
| 6 | Palm Beach | FL | $11,925 | $11,221 | 2.3% |
| 7 | Etowah | AL | $9,493 | $11,195 | 2.3% |
| 8 | Miami-Dade | FL | $16,386 | $11,179 | -1.8% |
| 9 | Denton | TX | $10,379 | $11,153 | 1.5% |
| 10 | St. Tammany | LA | $10,808 | $11,146 | 1.4% |
| 11 | Bay | FL | $10,167 | $11,080 | 2.5% |
| 12 | Tangipahoa | LA | $12,130 | $11,066 | 1.5% |
| 13 | Cleveland | OK | $9,269 | $10,945 | 2.1% |
| 14 | Rapides | LA | $9,935 | $10,938 | 1.9% |
| 15 | Parker | TX | $10,175 | $10,924 | 3.3% |
| 16 | Bossier | LA | $10,311 | $10,918 | 1.6% |
| 17 | Jefferson | OH | $10,393 | $10,907 | 3.1% |
| 18 | Orange | TX | $10,241 | $10,904 | 1.9% |
| 19 | Ouachita | LA | $10,913 | $10,891 | 1.4% |
| 20 | Johnson | TX | $11,011 | $10,880 | 3.6% |
| 20 lowest-spending counties (adjusted) | |||||
| 1 | Hawaii | HI | $6,433 | $6,269 | 3.0% |
| 2 | San Francisco | CA | $10,144 | $6,613 | 2.7% |
| 3 | Honolulu | HI | $6,923 | $6,672 | 3.3% |
| 4 | Yolo | CA | $8,060 | $7,127 | 2.9% |
| 5 | Solano | CA | $9,158 | $7,154 | 2.1% |
| 6 | Mendocino | CA | $7,894 | $7,287 | 3.4% |
| 7 | Anchorage | AK | $7,930 | $7,308 | 2.9% |
| 8 | Sacramento | CA | $9,447 | $7,369 | 4.4% |
| 9 | San Juan | NM | $8,257 | $7,377 | 2.1% |
| 10 | Santa Clara | CA | $9,797 | $7,410 | 3.1% |
| 11 | Imperial | CA | $9,799 | $7,418 | 4.1% |
| 12 | Monroe | NY | $8,030 | $7,434 | 1.6% |
| 13 | San Joaquin | CA | $9,123 | $7,499 | 3.1% |
| 14 | Linn | OR | $7,169 | $7,512 | 4.7% |
| 15 | Josephine | OR | $6,058 | $7,513 | 2.1% |
| 16 | Humboldt | CA | $7,624 | $7,519 | 3.7% |
| 17 | Douglas | OR | $6,550 | $7,521 | 2.8% |
| 18 | Multnomah | OR | $7,853 | $7,543 | 3.1% |
| 19 | Erie | NY | $7,978 | $7,572 | 2.5% |
| 20 | Mesa | CO | $6,263 | $7,618 | 2.4% |
| SOURCE: RAND Corporation/Kaiser Family Foundation analysis of Centers for Medicare & Medicaid Services Geographic Variation Public Use File (February 2015 update). | |||||
| Table 5: Average Total Spending, Beneficiary Demographics, and Provider Supply Measures for Counties with the Highest and Lowest Adjusted Medicare Per Capita Spending, 2013 | ||||
| National average | 20 highest spending counties (adjusted) | 20 lowest spending counties (adjusted) | High-low difference | |
| Medicare per capita spending (unadjusted) | $9,415 | $12,119 | $8,529 | 42.1%**** |
| Medicare per capita spending (price and health-risk adjusted) | $9,343 | $11,179 | $7,263 | 53.9%**** |
| Health risk (hierarchical condition categories [HCC] score) | 1.00 | 1.11 | 0.96 | 15.6%**** |
| Medicare price index | 1.06 | 1.02 | 1.24 | -18.3%**** |
| Number of beneficiaries (traditional Medicare and Medicare Advantage, in thousands) | 50,181 | 1,214 | 1,507 | -19.5% |
| Medicare Advantage enrollment share | 31.6% | 40.7% | 47.2% | -13.8% |
| Beneficiary demographics (% of beneficiaries) | ||||
| Black | 9.8% | 8.9% | 6.8% | 30.4% |
| Hispanic | 6.0% | 15.8% | 10.6% | 48.7% |
| Eligible for Medicare and Medicaid | 21.3% | 25.3% | 28.9% | -12.5% |
| Poverty rate among people ages 65 and older | 9.8% | 11.6% | 9.1% | 28.0% |
| Residing in a metropolitan area | 85.3% | 98.5% | 90.4% | 9.0% |
| Characteristics of overall county population | ||||
| Poverty rate | 16.0% | 16.2% | 15.6% | 3.7% |
| Supply of health care providers (per 10,000 county residents) | ||||
| Physicians | 24.06 | 22.24 | 30.25 | -26.5%** |
| Primary care physicians as a % of all physicians | 38.5% | 39.7% | 41.3% | -3.9% |
| Hospital beds | 25.30 | 27.45 | 22.89 | 19.9% |
| Skilled nursing facility beds | 51.49 | 46.39 | 35.33 | 31.3%* |
| Home health agencies | 0.40 | 1.02 | 0.15 | 587.8%**** |
| Ambulatory surgical centers | 0.17 | 0.19 | 0.13 | 41.4%** |
| Hospices | 0.12 | 0.14 | 0.06 | 119.0%* |
| NOTE: P-values are calculated by applying a t-test to the difference between the 20 highest and 20 lowest-spending counties, assuming unequal variance. *: p-value<0.10, **: p-value<0.05, ***: p-value<0.01, ****: p-value<0.001.
SOURCE: RAND Corporation/Kaiser Family Foundation analysis of Centers for Medicare & Medicaid Services Geographic Variation Public Use File (February 2015 update) for spending and most beneficiary demographics; American Community Survey 2008-2012 pooled data for poverty among people ages 65 and older; Area Health Resources File for metropolitan area residents, characteristics of overall county population, and provider supply measures (various years). |
||||
| Table 6: Counties with the Highest and Lowest Medicare Per Capita Spending Growth Rates, 2007-2013 | |||||
| Rank | County | State | 2007 Medicare per capita spending (unadjusted) |
2013 Medicare per capita spending (unadjusted) |
2007-2013 Medicare per capita spending growth rate |
| United States average | $8,272 | $9,415 | 2.2% | ||
| 20 highest spending growth counties | |||||
| 1 | Allegany | MD | $8,421 | $11,446 | 5.2% |
| 2 | Eau Claire | WI | $6,042 | $8,142 | 5.1% |
| 3 | Cass | ND | $5,883 | $7,895 | 5.0% |
| 4 | Twin Falls | ID | $5,896 | $7,878 | 4.9% |
| 5 | Jefferson | NY | $6,093 | $8,119 | 4.9% |
| 6 | Wayne | IN | $7,201 | $9,546 | 4.8% |
| 7 | Bell | TX | $6,945 | $9,204 | 4.8% |
| 8 | Bartholomew | IN | $6,614 | $8,717 | 4.7% |
| 9 | Linn | OR | $5,442 | $7,169 | 4.7% |
| 10 | Tippecanoe | IN | $6,864 | $9,003 | 4.6% |
| 11 | Clarke | GA | $6,934 | $9,090 | 4.6% |
| 12 | Centre | PA | $6,733 | $8,814 | 4.6% |
| 13 | Bonneville | ID | $6,200 | $8,105 | 4.6% |
| 14 | Tuolumne | CA | $6,749 | $8,798 | 4.5% |
| 15 | Chesterfield | VA | $6,508 | $8,461 | 4.5% |
| 16 | Sacramento | CA | $7,283 | $9,447 | 4.4% |
| 17 | Hampton City | VA | $7,020 | $9,092 | 4.4% |
| 18 | Chemung | NY | $6,370 | $8,235 | 4.4% |
| 19 | Marion | FL | $7,585 | $9,778 | 4.3% |
| 20 | Northumberland | PA | $7,335 | $9,439 | 4.3% |
| 20 lowest spending growth counties | |||||
| 1 | Miami-Dade | FL | $18,315 | $16,386 | -1.8% |
| 2 | Hidalgo | TX | $13,504 | $12,182 | -1.7% |
| 3 | Wilson | TN | $9,194 | $9,000 | -0.4% |
| 4 | Orange | NC | $7,559 | $7,482 | -0.2% |
| 5 | Walker | AL | $8,700 | $8,656 | -0.1% |
| 6 | Beaver | PA | $8,595 | $8,635 | 0.1% |
| 7 | Shelby | AL | $8,183 | $8,263 | 0.2% |
| 8 | St. Landry | LA | $10,189 | $10,346 | 0.3% |
| 9 | Johnston | NC | $9,197 | $9,350 | 0.3% |
| 10 | Surry | NC | $8,326 | $8,473 | 0.3% |
| 11 | Warren | NJ | $9,774 | $9,966 | 0.3% |
| 12 | Pulaski | AR | $7,950 | $8,120 | 0.4% |
| 13 | Williamson | TN | $7,496 | $7,660 | 0.4% |
| 14 | Fort Bend | TX | $9,942 | $10,210 | 0.4% |
| 15 | Cameron | TX | $11,354 | $11,662 | 0.4% |
| 16 | Butler | PA | $8,346 | $8,614 | 0.5% |
| 17 | Boulder | CO | $7,449 | $7,716 | 0.6% |
| 18 | Ector | TX | $9,084 | $9,411 | 0.6% |
| 19 | Washington | TN | $7,202 | $7,463 | 0.6% |
| 20 | Washington | OK | $6,819 | $7,084 | 0.6% |
| SOURCE: RAND Corporation/Kaiser Family Foundation analysis of Centers for Medicare & Medicaid Services Geographic Variation Public Use File (February 2015 update). | |||||
| Table 7: Average Spending, Beneficiary Demographics, and Provider Supply Measures for Counties with the Highest and Lowest Medicare Per Capita Spending Growth Rates, 2007 and 2013 | ||||||||||
| National average | 20 highest spending growth counties | 20 lowest spending growth counties | High-low AAGR difference | |||||||
| 2007 | 2013 | AAGR | 2007 | 2013 | AAGR | 2007 | 2013 | AAGR | ||
| Medicare per capita spending (unadjusted) | $8,272 | $9,415 | 2.2% | $6,951 | $9,089 | 4.60% | $12,124 | $11,513 | -0.9% | 5.4%*** |
| Medicare per capita spending (price and health-risk adjusted) | $8,218 | $9,343 | 2.2% | $7,377 | $8,907 | 3.20% | $9,906 | $9,927 | 0.0% | 3.2%* |
| Health risk (hierarchical condition categories [HCC] score) | 1 | 1 | 0.0% | 0.96 | 1 | 0.7% | 1.16 | 1.15 | -0.3% | 0.9%*** |
| Medicare price index | 1.04 | 1.06 | 0.2% | 1.03 | 1.09 | 0.90% | 1.02 | 1.03 | 0.0% | 0.8%* |
| Number of beneficiaries (traditional Medicare and Medicare Advantage, thousands) | 42,507 | 50,181 | 2.80% | 545 | 658 | 3.20% | 821 | 994 | 3.20% | 0.0% |
| Medicare Advantage enrollment share | 22.3% | 31.6% | 6.0% | 22.90% | 31.4% | 5.5% | 28.80% | 39.4% | 5.4% | 0.1% |
| Beneficiary demographics (% of beneficiaries) | ||||||||||
| Black | 9.4% | 9.80% | 0.8% | 8.0% | 8.6% | 1.1% | 8.7% | 8.9% | 0.4% | 0.7% |
| Hispanic | 5.5% | 6.0% | 1.3% | 3.8% | 4.4% | 2.3% | 31.8% | 32.4% | 0.3% | 2.%**** |
| Eligible for Medicare and Medicaid | 20.4% | 21.3% | 0.7% | 19.7% | 22.4% | 2.1% | 34.7% | 35.1% | 0.2% | 1.9%*** |
| Residing in a metropolitan area | 84.9% | 85.3% | 0.1% | 88.0% | 88.0% | 0.0% | 93.6% | 93.6% | 0.0% | 0.0% |
| Characteristics of overall county population | ||||||||||
| Poverty rate | 13.0% | 16.0% | 3.5% | 13.2% | 17.1% | 4.4% | 17.5% | 20.0% | 2.3% | 2.2% |
| Supply of health care providers (per 10,000 county residents) | ||||||||||
| Physicians | 23.32 | 24.06 | 0.5% | 21.01 | 21.53 | 0.4% | 27.37 | 27.36 | 0.0% | 0.4% |
| Primary care physicians as a % of all physicians | 39.6% | 38.3% | -0.6% | 39.8% | 38.6% | -0.5% | 43.2% | 42.9% | -0.1% | -0.4% |
| Hospital beds | 26.61 | 25.3 | -0.80% | 30.95 | 27.95 | -1.7% | 33.8 | 31.35 | -1.2% | -0.4% |
| SNF beds | 53.61 | 51.49 | -0.70% | 50.27 | 48 | -0.8% | 42.61 | 41.56 | -0.4% | -0.4% |
| Home health agencies | 0.31 | 0.4 | 4.10% | 0.25 | 0.25 | -0.2% | 0.84 | 1.17 | 5.6% | -5.8%**** |
| Ambulatory surgical centers | 0.16 | 0.17 | 1.10% | 0.23 | 0.21 | -1.1% | 0.16 | 0.16 | 0.0% | -1.1% |
| Hospices | 0.1 | 0.12 | 3.10% | 0.1 | 0.11 | 1.2% | 0.09 | 0.1 | 2.4% | -1.1% |
|
NOTE: AAGR is average annual growth rate. SNF is skilled nursing facility. P-values are calculated by applying a t-test to the difference between the 20 highest and 20 lowest-spending counties, assuming unequal variance. *: p-value<0.10, **: p-value<0.05, ***: p-value<0.01, ****: p-value<0.001. SOURCE: RAND Corporation/Kaiser Family Foundation analysis of Centers for Medicare & Medicaid Services Geographic Variation Public Use File (February 2015 update) for spending and most beneficiary demographics; Area Health Resources file for metropolitan area residents, characteristics of overall county population, and provider supply measures (various years). |
||||||||||
| Table 8: Average Spending and Use of Specified Medicare-Covered Services for Counties with the Highest and Lowest Medicare Per Capita Spending Growth Rates, 2007-2013 | |||||||||||
| Measure | National average | 20 highest spending growth counties | 20 lowest spending growth counties | High-low AAGR difference | |||||||
| 2007 | 2013 | AAGR | 2007 | 2013 | AAGR | 2007 | 2013 | AAGR | |||
| Hospital inpatient | |||||||||||
| Spending per capita | $3,048 | $3,191 | 0.8% | $2,601 | $3,285 | 4.00% | $3,614 | $3,527 | -0.4% | 4.4%**** | |
| Percent using | 20.5% | 17.5% | -2.6% | 18.6% | 17.3% | -1.3% | 22.0% | 18.40% | -2.9% | 1.6%**** | |
| Price index | 1.18 | 1.24 | 0.9% | 1.15 | 1.3 | 2.0% | 1.23 | 1.25 | 0.3% | 1.6%**** | |
| Standardized costs per user | $12,650 | $14,722 | 2.6% | $12,201 | $14,779 | 3.2% | $13,254 | $15,055 | 2.1% | 1.1%**** | |
| Covered days per capita | 1,901 | 1,530 | -3.6% | 1,601 | 1,443 | -1.7% | 2,329 | 1,796 | -4.2% | 2.5%**** | |
| Readmission rate | 19.2% | 18.0% | -1.1% | 17.5% | 17.7% | 0.2% | 20.3% | 19.3% | -0.8% | 1.0%*** | |
| Outpatient | |||||||||||
| Spending per capita | $767 | $1,195 | 7.70% | $710 | $1,229 | 9.60% | $680 | $1,054 | 7.6% | 2.0%* | |
| Percent using | 62.8% | 63.7% | 0.2% | 58.9% | 61.5% | 0.7% | 57.7% | 60.9% | 0.9% | -0.2% | |
| Price index | 0.97 | 1.02 | 0.80 | 0.97 | 1.02 | 0.8% | 0.95 | 0.96 | 0.2% | 0.6%*** | |
| Standardized costs per user | $1,260 | $1,846 | 6.6% | $1,235 | $1,953 | 7.9% | $1,255 | $1,811 | 6.3% | 1.6%** | |
| Visits per capita | 3,806 | 4,221 | 1.7% | 3,734 | 4,593 | 3.5% | 3,027 | 3,496 | 2.4% | 1.1% | |
| Evaluation & management | |||||||||||
| Spending per capita | $768 | $904 | 2.8% | $635 | $825 | 4.5% | $987 | $1,102 | 1.8% | 2.6%**** | |
| Percent using | 89.1% | 87.8% | -0.2% | 88.6% | 87.6% | -0.2% | 89.6% | 88.4% | -0.2% | 0.0% | |
| Price index | 0.98 | 0.96 | -0.4% | 0.95 | 0.94 | -0.2% | 0.96 | 0.95 | -0.1% | 0.0% | |
| Standardized costs per user | $883 | $1,078 | 3.4% | $754 | $999 | 4.8% | $1,140 | $1,293 | 2.1% | 2.7%**** | |
| Visits per capita | 13,093 | 13,316 | 0.3% | 11,531 | 12,506 | 1.4% | 16,714 | 16,003 | -0.7% | 2.1%**** | |
| Procedures | |||||||||||
| Spending per capita | $541 | $605 | 1.9% | $488 | $595 | 3.4% | $655 | $638 | -0.5% | 3.8%**** | |
| Percent using | 60.9% | 61.1% | 0.1% | 58.8% | 59.5% | 0.2% | 63.6% | 63.1% | -0.1% | 0.3%* | |
| Price index | 0.98 | 0.98 | 0.0% | 0.95 | 0.96 | 0.2% | 0.96 | 0.98 | 0.3% | -0.1% | |
| Standardized costs per user | $908 | $1,011 | 1.8% | $869 | $1,021 | 2.7% | $1,060 | $1,026 | -0.5% | 3.3%**** | |
| Procedures per capita | 4,271 | 4,612 | 1.3% | 3,810 | 4,208 | 1.7% | 5,144 | 4,699 | -1.5% | 3.2%**** | |
| Skilled nursing facility | |||||||||||
| Spending per capita | $641 | $774 | 3.2% | $564 | $716 | 4.1% | $629 | $728 | 2.5% | 1.6%* | |
| Percent using | 5.3% | 5.1% | -0.7% | 4.7% | 4.8% | 0.3% | 4.8% | 4.6% | -0.8% | 1.1% | |
| Price index | 0.97 | 0.97 | 0.0% | 0.98 | 1.01 | 0.5% | 0.92 | 0.92 | -0.1% | 0.7%*** | |
| Standardized costs per user | $12,581 | $15,840 | 3.9% | $12,325 | $15,038 | 3.4% | $14,174 | $17,243 | 3.3% | 0.1% | |
| Covered days per capita | 1,966 | 1,887 | -0.7% | 1,735 | 1,775 | 0.4% | 2,039 | 1,939 | -0.8% | 1.2% | |
| Home health | |||||||||||
| Spending per capita | $443 | $489 | 1.7% | $273 | $381 | 5.7% | $2,121 | $1,621 | -4.4% | 10.1%**** | |
| Percent using | 8.8% | 9.4% | 1.2% | 6.9% | 8.4% | 3.3% | 17.1% | 18.2% | 1.0% | 2.3%*** | |
| Price index | 0.96 | 0.96 | 0.0% | 0.98 | 1.01 | 0.5% | 0.94 | 0.93 | -0.3% | 0.7%*** | |
| Standardized costs per user | $5,282 | $5,428 | 0.5% | $4,008 | $4,466 | 1.80% | $10,499 | $7,814 | -4.8% | 6.6%**** | |
| Visits per capita | 3,246 | 3,062 | -1.0% | 1,746 | 2,189 | 3.8% | 26,008 | 11,289 | -13.0% | 16.8%**** | |
| Durable medical equipment | |||||||||||
| Spending per capita | $241 | $199 | -3.10% | $219 | $204 | -1.2% | $514 | $214 | -13.6% | 12.4%**** | |
| Percent using | 28.6% | 27.6% | -0.6% | 27.3% | 27.3% | 0.0% | 34.3% | 30.8% | -1.8% | 1.8%**** | |
| Price index | 0.99 | 0.94 | -1.0% | 0.99 | 0.94 | -0.9% | 0.99 | 0.92 | -1.2% | 0.3%** | |
| Standardized costs per user | $849 | $770 | -1.6% | $808 | $791 | -0.4% | $1,420 | $753 | -10.0% | 9.7%*** | |
| Events per capita | 1,950 | 1,723 | -2.0% | 1,833 | 1,731 | -1.0% | 2,998 | 1,946 | -6.9% | 6.0%**** | |
| Hospice | |||||||||||
| Spending per capita | $244 | $305 | 3.8% | $190 | $281 | 6.7% | $280 | $412 | 6.6% | 0.1% | |
| Percent using | 2.4% | 2.7% | 2.3% | 2.0% | 2.6% | 4.5% | 2.4% | 2.9% | 3.6% | 0.9% | |
| Price index | 1.01 | 0.99 | -0.3% | 1.03 | 1.03 | -0.1% | 1 | 0.97 | -0.5% | 0.4%** | |
| Standardized costs per user | $10,313 | $11,499 | 1.8% | $8,941 | $10,345 | 2.5% | $11,307 | $13,975 | 3.6% | -1.1% | |
| Covered days per capita | 1,678 | 1,889 | 2.0% | 1,352 | 1,727 | 4.2% | 1,844 | 2,424 | 4.7% | -0.5% | |
|
NOTE: AAGR is average annual growth rate. P-values are calculated by applying a t-test to the difference between the 20 highest and 20 lowest-spending counties, assuming unequal variance. *: p-value<0.10, **: p-value<0.05, ***: p-value<0.01, ****: p-value<0.001.
SOURCE: RAND Corporation/Kaiser Family Foundation analysis of Centers for Medicare & Medicaid Services Geographic Variation Public Use File (February 2015 update).
|
|||||||||||
| Table 9: Top 20 Counties with the Highest Unadjusted Medicare Per Capita Spending, 2007 and 2013 |
||||||||||
| Top 20 Counties in 2007 | Top 20 Counties in 2013 | |||||||||
| County | State | 2007 Medicare per capita spending (unadjusted) |
Rank in 2007 | Rank in 2013 | County | State | 2013 Medicare per capita spending (unadjusted) |
Rank in 2013 | Rank in 2007 | |
| Miami-Dade | FL | $18,314.65 | 1 | 1 | Miami-Dade | FL | $16,386 | 1 | 1 | |
| Kings | NY | $13,741.57 | 2 | 2 | Kings | NY | $14,998 | 2 | 2 | |
| Hidalgo | TX | $13,504.04 | 3 | 15 | Bronx | NY | $14,903 | 3 | 4 | |
| Bronx | NY | $13,130.10 | 4 | 3 | Baltimore City | MD | $14,370 | 4 | 5 | |
| Baltimore City | MD | $13,063.16 | 5 | 4 | Los Angeles | CA | $13,309 | 5 | 17 | |
| Broward | FL | $11,700.08 | 6 | 9 | Queens | NY | $12,909 | 6 | 7 | |
| Queens | NY | $11,630.65 | 7 | 6 | Essex | NJ | $12,902 | 7 | 8 | |
| Essex | NJ | $11,624.09 | 8 | 7 | Philadelphia | PA | $12,811 | 8 | 9 | |
| Philadelphia | PA | $11,380.84 | 9 | 8 | Broward | FL | $12,664 | 9 | 6 | |
| Wayne | MI | $11,377.52 | 10 | 10 | Wayne | MI | $12,566 | 10 | 10 | |
| Cameron | TX | $11,354.43 | 11 | 25 | Hudson | NJ | $12,475 | 11 | 14 | |
| New York | NY | $11,299.01 | 12 | 13 | Suffolk | MA | $12,274 | 12 | 18 | |
| Richmond | NY | $11,210.86 | 13 | 18 | New York | NY | $12,208 | 13 | 12 | |
| Hudson | NJ | $11,139.52 | 14 | 11 | Harris | TX | $12,195 | 14 | 15 | |
| Harris | TX | $11,109.23 | 15 | 14 | Hidalgo | TX | $12,182 | 15 | 3 | |
| Tangipahoa | LA | $11,066.91 | 16 | 16 | Tangipahoa | LA | $12,130 | 16 | 16 | |
| Los Angeles | CA | $11,021.51 | 17 | 5 | Baltimore | MD | $12,115 | 17 | 20 | |
| Suffolk | MA | $10,963.29 | 18 | 12 | Richmond | NY | $12,113 | 18 | 13 | |
| Nassau | NY | $10,762.73 | 19 | 23 | Passaic | NJ | $11,976 | 19 | 23 | |
| Baltimore | MD | $10,493.62 | 20 | 17 | New Haven | CT | $11,952 | 20 | 30 | |
| SOURCE: RAND Corporation/Kaiser Family Foundation analysis of Centers for Medicare & Medicaid Services Geographic Variation Public Use File (February 2015 update). | ||||||||||
| Table 10: Coefficient of Variation in County-Level Medicare Per Capita Spending, By Type of Service, 2007-2013 | |||||||||
| Type of service | 2007 | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 |
2007-2013 difference
|
2007-2013 % change |
| All services | 0.141 | 0.142 | 0.143 | 0.133 | 0.131 | 0.127 | 0.125 | -0.016 | -11.1% |
| Hospital inpatient | 0.169 | 0.174 | 0.179 | 0.174 | 0.175 | 0.171 | 0.170 | 0.001 | 0.6% |
| Outpatient | 0.184 | 0.181 | 0.179 | 0.179 | 0.182 | 0.185 | 0.185 | 0.001 | 0.3% |
| Evaluation & management | 0.212 | 0.217 | 0.217 | 0.214 | 0.213 | 0.207 | 0.207 | -0.005 | -2.4% |
| Procedures | 0.180 | 0.189 | 0.190 | 0.188 | 0.191 | 0.188 | 0.185 | 0.005 | 3.0% |
| Skilled nursing facility | 0.222 | 0.219 | 0.219 | 0.220 | 0.225 | 0.230 | 0.232 | 0.010 | 4.6% |
| Home health | 0.667 | 0.696 | 0.664 | 0.521 | 0.530 | 0.509 | 0.501 | -0.166 | -24.8% |
| Durable medical equipment | 0.245 | 0.202 | 0.177 | 0.160 | 0.152 | 0.147 | 0.159 | -0.086 | -35.0% |
| Hospice | 0.350 | 0.329 | 0.317 | 0.308 | 0.297 | 0.290 | 0.280 | -0.070 | -20.1% |
| NOTE: Coefficients of variation by type of service do not sum to coefficient of variation in total spending for all services.
SOURCE: RAND Corporation/Kaiser Family Foundation analysis of Centers for Medicare & Medicaid Services Geographic Variation Public Use File (February 2015 update). |
|||||||||