What's the Matter with Miami?

Today’s Managing Health Care Costs Indicator is $5318

Medpac released a study of geographic variation within the Medicare program today.  The report reminds us that the variation in units of service is much lower than the variation in total spending. The difference in utilization between the 10th and the 90th percentile is 30%, while the difference in spending is 55%.  The report also noted that the variations in post acute services (like durable medical equipment or home health care) dwarf the variation in hospital or physician services.

So – how could the cost for home health care be $5318 per beneficiary in Miami-Dade County?  This is ten times the national average, and twice as much as two years earlier.  It’s hard to imagine this without fraud. Note the large decrease in Miami-Dade durable medical equipment during that time period.  The Medicare Inspector General notes that fraud migrates. “...As law enforcement cracks down on a particular scheme, the criminals may shift the scheme.”