The AMA, state medical societies and independent review organizations say their members will do better in the future meeting HCFA quality standards than they did in a study released last month. But to obtain a truer measure of the quality of care delivered to Medicare patients, government researchers must look at poverty and education levels of patients and reimbursement levels in Medicare itself, providers say.
Published Oct. 4 in the Journal of the American Medical Association, the HCFA-financed study concluded physicians and other providers have plenty of room to improve in meeting quality of care benchmarks and saving patients' lives.
In a review of thousands of Medicare records from 1997 through 1999, the study found wide variations from 24 best practices in treatment and prevention of six common ailments: heart failure, heart attack, stroke, diabetes, pneumonia and breast cancer.
HCFA also found considerable variance among states and regions, with New England states generally using best practices at much higher rates than states in the South. New Hampshire, Vermont and Maine ranked highest in the study, which also included data from Washington, D.C., and Puerto Rico. Arkansas, Mississippi and Louisiana ranked above only Puerto Rico at the bottom of the survey.
The study authors concluded that the data "provides strong evidence of a substantial opportunity" to improve care to Medicare patients and that by meeting existing guidelines, providers could "save hundreds to thousands of lives a year."
It was the first such national study using these 24 guidelines, but it won't be the last. HCFA says it will continue monitoring the guidelines, preparing interim national reports every few months and state level estimates similar to the October report every three years.
AMA trustee Donald Palmisano, M.D., says physicians are confident that they can work with hospitals, patients and Medicare-contracted peer review organizations (PROs) to make improvements.
Joy Maxey, M.D., president of the Medical Association of Georgia, says HCFA needs to look deeper "to get a more accurate picture of the state of healthcare in Georgia."
"They need to consider the factors that could account for the variations from state to state, including poverty levels, education levels, Medicare coverage and reimbursement," says Maxey, an Atlanta pediatrician.
For example, Maxey says physicians in areas with poorer patients sometimes won't prescribe beta blockers to heart attack patients because they know the patients are too poor to buy them. She says other physicians have told her they have prescribed beta blockers, but patients may have forgotten and told HCFA canvassers the drug was not prescribed.
"The study is very important," Maxey says. "What we're asking is that HCFA move on and ask why these things are happening."
Next to physicians and patients, the people with the biggest stake in the study are the 37 PROs hired by HCFA to monitor patient quality within Medicare.
Medicare pays the PROs about $250 million a year, with 70% of the money going toward quality improvement work.
The PROs say their voluntary, nonpunitive educational approach to quality assurance is working.
"Casting blame and pointing fingers won't spur better performance in healthcare," says David Schulke, executive vice president of the American Health Quality Association, a Washington-based PRO trade group. "We have to get beyond that way of thinking and acknowledge that there is always room for improvement."