Overuse Index reported by state

We examined overuse among Medicare beneficiaries at the state level by generating the Overuse Index, for each U.S. state and the District of Columbia. We previously created an Overuse Index that uses billing codes for diverse clinical services that act as indicators to reflect the latent tendency of a region to overuse health care resources relative to other regions. We newly operationalized our approach to first measure overuse among Medicare beneficiaries within hospitals and their associated outpatient clinics, before we apply the model to generate the Overuse Index at the levels of interest (health systems, regions, or states.) We accessed 100% of the inpatient and outpatient claims, and the Master Beneficiary Summary files of Medicare beneficiaries from July 2015 through December 2018 through the Center for Medicare and Medicaid Services’ (CMS) Virtual Research Data Center (VRDC). Seventeen indicator procedures contributed to the Overuse Index. This set included five new indicators compared to our earlier work. We ran a model across the 17 indicators with fixed effects for states, indictors, and year-quarter; hospital-level random effects, and hospital-level patient characteristics. The fixed effects for the states are the Overuse Index for that state, and represent the tendency for state-wide overuse of healthcare relative to the average state. This was then normalized so the average is 0 with a S.D. of 1.