| Summary: | This short Atlas report updated measures of Medicare expenditures, end-of-life care, readmission rates, and the quality of ambulatory care using 2018 Medicare claims data. There are some hopeful signs in the trends; inflation adjusted Medicare expenditures per enrollee were relatively constant--one of the few cases in health care where expenditures per person have not grown--while the influence of "outlier" regions such as Miami and McAllen, Texas has diminished. Readmission rates have declined, while quality measures have risen. Despite these aggregate improvements, however, changes over time in expenditures, readmission rates, and quality of care continue to exhibit wide variation, with little change in the interquartile ranges (the ratio of spending and other measures between the 75th to the 25th percentile HRR). Furthermore, the averages mask considerable geographic variability in changes over time. In some regions, for example, rates of mammography rose, while in others they fell. Documenting these changes over time is essential for providers and policymakers to understand whether their efforts to reduce expenditures and improve quality have been successful; a more difficult question is why some regions improved so much, while others did not
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