Variations in the delivery of medical care in central New York

This paper presents an application of the Wennberg small area analysis methodology to the experience of a metropolitan county in upstate New York. It illustrates how these techniques can be used cooperatively by physicians and business to address purchaser concerns such as the impact of ambulatory surgery, the potential need for preadmission review and second opinion programs, and the contribution of high cost procedures to overall utilization and cost. The study found that use rates for most diagnoses and procedures were substantially below statewide norms, representing an annual savings of more than +30 million. It also found ambulatory surgery was effectively used as an alternative to hospitalization, and that high use rate areas involved high cost procedures targeted by second opinion and preadmission review programs.