Medicare patients in the Tampa Bay area cost the federal government as much as 50 percent more in 2008 than they did five years before that, with much of that growth coming from higher spending on hospital and home-based care, according to a national review of Medicare spending.
The study, by economists at Dartmouth College, ranked the St. Petersburg area seventh in the country for Medicare spending in 2008. Communities in Texas and Louisiana accounted for eight of the Top 10 slots for Medicare spending, while Miami ranked No. 1.
That's not surprising, said Dartmouth economist Jon Skinner, one of the study's authors.
Miami, with an abundance of seniors and doctors, cost Medicare $15,571 per patient in 2008, keeping its spot at the most expensive Medicare market in the country. McAllen, Texas, a much smaller and poorer city, ranked No. 2.
"There are some regions that seem to exploit this perfect storm of increased demand, increased supply, and the federal treasury pays for it," Skinner said.
Medicare has become a centerpiece of the national debate over health care costs and the federal deficit. Reformers have offered everything from scrapping the current system in favor of vouchers to keeping the system intact while rooting out fraud and abuse.
Even as politicians debate the best way to slow Medicare's growth, the actual cause of that growth – Is it abuse by doctors or demand for high-ticket medical procedures? -- remains a subject of debate itself.
Beyond debates about costs and cost control lies a third mystery of Medicare: outcomes. Simply put, is all that spending actually worth it?
Any effort to improve Medicare must consider all three issues – preferably before the coming wave of retiring baby boomers swamps the entire system.
"We don't know much about outcomes," Skinner said. "Are people in Miami healthier because of all this spending? It's not clear. If you're going to change health care growth, you have to know if you're successful or not."
Medicare spending in the Tampa Bay region has climbed along with the rest of the country, led by the St. Petersburg hospital referral region, which covers most of southern Pinellas County. A referral region is the geographic area from which major hospitals draw their most problematic patients. Tampa's referral region, for example, includes hospitals in Hillsborough County and most of Pasco County.
In 2008, Medicare spent $11,341 per patient in the St. Petersburg area, up 50 percent from 2003. The Tampa referral region, by comparison, cost Medicare $10,408 per patient, up about 40 percent in the five-year period.
The Tampa Bay region's Medicare reimbursements grew faster than any other part of the state between 2003 and 2008, the Dartmouth figures show. The largest single chunk of money in both the Tampa and St. Petersburg regions went directly to hospitals.
Those costs reflect the region's abundance of specialists but also patients' demand for the best care they can get, said Janice Hagensicker, chief financial officer for Adventist Health System's Tampa region.
"You have access to medical care in this part of the country that other areas might not have," Hagensicker said. "We expect better care."
Whether all that tax money is being well spent is less clear.
On average, higher Medicare spending generally matches up with better results for patients, according to Stephen Zuckerman, a health care analyst at the market-oriented Urban Institute.
Dartmouth researchers say regions with the highest Medicare costs – a list that includes the Tampa Bay area -- tend to be places where patients see more doctors and undergo more expensive procedures.
Zuckerman disputes that.
High spending in the Tampa Bay area may simply reflect a larger number of people with major health problems instead of medical professionals gaming the system, he said.
Because health problems vary by region, comparing one region against another can be misleading, Zuckerman argues.
"We're looking at broad patterns," Zuckerman said.
To Skinner, though, comparing regions can play an important part in reforming the Medicare system by highlighting areas that may be doing things right or wrong. More work needs to go into determining what Medicare and its patients are getting for their money, he said.
"That's the question of where we should be in 10 years," Skinner said. "We should know whether places are doing better or worse."