In Medicare's upside-down reimbursement system, hospitals and doctors who order unnecessary tests, provide poor care or even injure patients often receive higher payments than those who provide efficient, high-quality medicine.

Second of three parts The creators of Medicare faced a problem. They were about to hand out millions -- eventually billions -- of dollars each year in tax money for hospitals to care for the nation's elderly. But how to make sure those hospitals were qualified? The joint commission, which is...

Each year, Medicare pays nearly $300 million to Quality Improvement Organizations to measure quality, work with hospitals and doctors to improve care, and investigate patient complaints.At the same time, the number of sanctions QIOs recommend against doctors each year has dwindled from hundreds to a few.

A detailed look at Medicare spending versus medical care quality and how surgical rates vary from state to state.