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" ... Before we dismiss the regional-spending arguments though, consider the chicken and the egg aspect of the risk-adjustment process. As patients overutilize care they may pick up extra diagnoses, which bumps up their "sickness" measures, which then risk-adjusts down their total spending. Maybe patients in Miami aren't actually as sick as the data seems to suggest. Maybe they are just aggressively coded for different conditions. On the other hand for things like heart attacks and cancer, it's hard to imagine how that data could just be the result of aggressive diagnoses. This debate about what causes regional spending variations will likely continue for some time. ... "
" ... The OAA, originally enacted in 1965, is the backbone of our nation’s aging services system, but is mostly overlooked in the popular press and is largely unknown to many Americans. It includes funding for a range of home and community-based services that help seniors stay productive and independent. Both Medicare and Medicaid would be stretched even thinner if not for these cost-effective community-based services. Many older persons with multiple chronic illnesses would be forced to overutilize hospitals and other health care providers and face institutional care. ... "