In addition, it is thought that better metrics could help to controlcosts. Findings from the Dartmouth medical atlas project show that in high spending regions of the country, patients receive consistently more treatment. For example, Sutherland et al. (2009) found that “discretionary decisions by providers seem to account for most of the regional variation in spending,” and that outcomes were not better in high spending areas of the country. The strong implication is that costs could be reduced without sacrificing outcomes by reigning in the discretion of medical providers (Garber and Skinner,2008).