Jack Wennberg, M.D., and the Dartmouth Health Atlas team have been trying to send a message to the profession for 25 years: Measured variations in costs by geography and facility are not due to patient risk factors, differences in quality of care or socioeconomic community status. He’s starting to have a major impact.

Congress is getting a geography lesson this week from its own CBO agency. Congressional Quarterly reports that the Congressional Budget Office (CBO) is now seriously looking at this data, in anticipation of doing something about it. CBO says reducing variations not related to quality or risk adjustment justifies payment systems in Medicare based in part on “efficiency” — not to be confused with “effectiveness.”

It’s hard to argue that some genuine effort is not needed in these regards. But, we should take it on.

Wennberg doesn’t feel his measured variations are deliberate or greed-oriented. Some increased costs, for example, occur in response to malpractice-induced defensive medicine. He does believe however that a lot of this is due to supply side factors — “if we build it, we use it (more often),” at least as it pertains to hospital bed and technology use. He also shows data suggesting that per capita numbers of specialists are directly related to proportionate increases in specialty services and costs.

There’s no associated measured improvement in quality or health status that comes along with that surplus of specialists. This will definitely be part of the upcoming system reform and payment reform discussions.