Today, MedPAC released a report on regional variation in both spending and service use under Medicare, updating a previous analysis from 2011. There is little evidence that higher service use results in higher quality. Moreover, it is likely that health care service use and spending could be substantially reduced without harming quality if service-use patterns of high-use areas were brought into line with those of lower-use areas.
The Commission has consistently stated that rural beneficiaries’ access to emergency services needs to be preserved. Since January 2013, there have been 41 hospital closures in rural counties and rural parts of urban communities. While some closures reflect excess capacity in areas, in other cases, the closed hospital has been the sole emergency room in the area. It is both the concern over maintaining access to care and concerns over inefficiencies in the current delivery system that motivated the Commission’s October session on preserving rural access to emergency services.