Yunjie Song|Jonathan Skinner|Julie Bynum|Jason M. Sutherland|John E. Wennberg|Elliott S. Fisher
Regional Variations in Diagnostic Practices
Dartmouth Institute for Health Policy and Clinical Practice|Dartmouth College|National Bureau of Economic Research|Dartmouth Institute for Health Policy and Clinical Practice|Dartmouth Psychiatric Research Center|Dartmouth Institute for Health Policy and Clinical Practice|Dartmouth Institute for Health Policy and Clinical Practice|Dartmouth Institute for Health Policy and Clinical Practice|White River Junction VA Medical Center|Dartmouth Institute for Health Policy and Clinical Practice
current methods risk adjustment rely diagnoses recorded clinical administrative records differences among providers diagnostic practices could lead biaswe used medicare claims data 1999 2006 measure trends diagnostic practices medicare beneficiaries regions grouped five quintiles according intensity hospital physician services beneficiaries region received compared trends respect diagnoses laboratory testing imaging assignment hierarchical condition categories hccs among beneficiaries moved regions higher lower intensity practicebeneficiaries within quintile moved study period regions higher lower intensity practice similar numbers diagnoses similar hcc risk scores derived hcc coding algorithms move number diagnoses hcc measures increased cohort aged increased greater extent among beneficiaries moved regions higher intensity practice among moved regions lower intensity practice example among beneficiaries lived initially regions lowest quintile greater increase average number diagnoses among moved regions higher quintile among moved regions within lowest quintile increase 1008 95 confidence interval ci 896 1121 vs increase 617 95 ci 558 674 moving higher quintile intensity associated additional 59 increase 95 ci 52 67 hcc scores results similar respect laboratory testing imagingsubstantial differences diagnostic practices unlikely related patient characteristics observed across us regions use clinical claimsbased diagnoses risk adjustment may introduce important biases comparativeeffectiveness studies public reporting payment reforms