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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). 

Appendix 1: Data and Methods

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