CMS's concern is partly driven by the variation in Medicare spending per beneficiary, which ranges from $3,341 in Minneapolis to $8,881 in Miami, a difference in lifetime cost of about $50,000, Dr. Desch said. Only 27% of that difference is attributable to differences in demographics, price, and health status. "Do you get more effective care in high-spending than in low-spending areas? The answer is no," Dr. Desch said.

Project Goals

A major goal of the project is to increase the use of underused effective care, such as radiotherapy in stage II or III rectal cancer (utilization of which varied from 52% to 92% in five metropolitan regions). Another goal is to decrease the use of ineffective care, such as chemotherapy given less than 14 days before a cancer patient's death.

The final result is expected to be a national data set that will permit analysis of outcomes relative to many aspects of the patient's treatment. "It's a structure for pay-for-performance," Dr. Desch said. "The 2006 demo pays doctors for collecting data, promotes awareness and adherence to guidelines, and potentially creates a new tool for national quality improvement."