A Decade of Modest Convergence in Geographic Variation in Per Capita Medicare Fee-for-Service Expenditures: Taxation Without Representation Is Not Sustainable; Is It Time for Taxpayer and Consumer Engagement?

Wasteful healthcare spending persists1 but is concentrated and amenable to change: Hospital Referral Regions (HRRs) with higher per capita expenditures provide more low-value care,2 and more wasteful Accountable Care Organizations reduce low-value care use after entering value-based payment plans.3 We hypothesized that increasing adoption of value-based payment models—introduced by the Centers for Medicare and Medicaid Services (CMS) in 2010 and designed to reduce waste—might reduce geographic variation in per capita healthcare spending and slow per capita expenditure growth in higher spending areas. To explore this hypothesis, we examined recent CMS data.