Medicare data in the Health Indicators Warehouse: Comparing utilization and quality across geographic regions

Background: Geographic variation in Medicare utilization and quality has been documented in studies and reports in recent years. To support further analysis of this important issue, the Centers for Medicare and Medicaid Services (CMS) developed a data set containing Medicare demographic, utilization, and quality measures for the Health Indicators Warehouse (HIW). Objectives/Purpose: This presentation will focus on regional comparisons of Medicare demographic, utilization, and quality indicators. The presentation will spotlight the ability of HIW users to compare Medicare indicators across regions or between a region and the national average, using comparative tables, reports, and maps. Methods: Using 100 percent enrollment and claims data for beneficiaries enrolled in Medicare fee-for-service, CMS calculated various demographic, utilization, and quality indicators at the national, state, and Hospital Referral Region (HRR) level. Results: The CMS indicators section of the HIW contains over 150 indicators covering all aspects of the Medicare program. The indicators are organized in the HIW into comparative reports, which can be used to compare the status of one geographic jurisdiction relative to another, similar to a dashboard. For example, although the national Medicare all cause readmission rate is 18.6 percent, Utah has a rate of 13.1 percent and New Jersey has a rate of over 21 percent. Readmission rates at the HRR level range from less than 13 percent in parts of Oregon to nearly 25 percent in Chicago. Discussion/Conclusions: The CMS indicators in the HIW are structured to allow users to easily evaluate geographic variation. Understanding differences in Medicare utilization and quality across regions is the first step in determining appropriate patterns of care delivery and ultimately improving care delivery.