How to Make a Map of Health Care Costs

The data used are from the Centers for Medicare and Medicaid Services’ (CMS) Chronic Conditions Data Warehouse.

We limited the analyses to only Medicare Fee-for-service beneficiaries with both Medicare Part A and Part B coverage and who were aged 65 years or older. We excluded beneficiaries enrolled in Medicare Advantage or in Medicare Part A only or Part B only. Maps are based on beneficiary-years, or the number of years that people were covered by Medicare Fee-for-service health insurance coverage.

Beginning with estimates from 2016, beneficiaries with diagnosed heart disease were identified using the following CMS Chronic Condition Data Warehouse codes: atrial fibrillation (AFIB_END), acute myocardial infarction (AMI_END), congestive heart failure (CHF_END), and ischemic heart disease (IHD_END). Beneficiaries were considered to have any of those conditions if the indicator was coded as either (1) = Beneficiary met claims criteria but did not have sufficient FFS coverage OR (3) = Beneficiary met claims criteria and had sufficient FFS coverage.

Data for counties with small populations are not displayed. County-level health care costs were suppressed when counties had <20 beneficiaries.

All cost data have been directly age-standardized using the 2000 US Standard Population. An age- standardized rate is a weighted average of age specific rates calculated on the basis of the proportion of people in the corresponding age groups of a standard population. Age adjustment allows for comparison of rates between counties with different age distributions.

To make Medicare payments across geographic areas comparable, payments have been standardized to remove geographic differences in payment rates for individual services, such as those that account for local wages or input prices.

Costs of care per capita and Incremental costs of care per capita for Medicare beneficiaries with diagnosed Heart Disease are provided. Costs per capita are the average costs incurred by a Medicare beneficiary with diagnosed heart disease in a given county. Incremental costs are the costs incurred among beneficiaries with diagnosed heart disease above and beyond the costs incurred among beneficiaries without diagnosed heart disease.

Costs include Medicare, beneficiary, and third-party payments and are presented for the following service categories: inpatient, outpatient, post-acute care, and total costs (total costs include inpatient, outpatient, post-acute care (e.g. skilled nursing facility care and home health), hospice, physician, testing, and imaging costs).

Incremental costs are calculated by taking the difference between mean annual costs per capita for beneficiaries with and without diagnosed heart disease for each county. They are the costs incurred among beneficiaries with diagnosed heart disease above and beyond the costs incurred among beneficiaries without heart disease. This can also be thought of as the “excess” cost attributed to having the condition. In 2015, Medicare beneficiaries with heart disease had, on average, over $10,000 more in healthcare costs compared to those without heart disease.

See the publication below for a more detailed description of incremental costs:

Wakim R, Ritchey M, Hockenberry J, Casper M. Geographic Variations in Incremental Costs of Heart Disease Among Medicare Beneficiaries, by Type of Service, 2012. Preventing Chronic Disease. 2016;13:E180. doi:10.5888/pcd13.160209. https://www.cdc.gov/pcd/issues/2016/16_0209.htm