Echoing the findings of the Commonwealth Fund survey (See story above), the Journal of the American Medical Association last week published two reports indicating that Medicare recipients don't get as high-quality care as other patients do.
One noted that the level at which Medicare beneficiaries receive six recommended preventive-medicine services is well below national goals. The second indicated that hypertension control among elderly patients is suboptimal.
According to the first report's author, Hoangmai Pham, a senior health researcher at the Center for Studying Health System Change, the biggest news is how often doctors who are in solo or two-physician practices and who are more dependent on Medicaid revenue fail to deliver routine preventive care.
Pham found that board-certified physicians in practices with three or more doctors with access to healthcare information technology were more likely to offer eye exams for diabetic patients, hemoglobin testing for monitoring glucose levels, mammograms, colon cancer screening, and flu and pneumonia vaccinations. She collected data from the Community Tracking Study Physician Survey on 3,660 physicians caring for 24,581 Medicare beneficiaries in 2001.
According to the report, there is an expectation that 100% of the appropriate Medicare beneficiaries will receive an eye exam, hemoglobin monitoring, mammogram and flu vaccination. The overall observed rates, however, ranged from 46.5% to 55.9%.
And patients visiting a practice where Medicaid accounted for 5% or less of total revenue received more preventive care than those going to doctors where Medicaid accounted for 16% or more of practice revenue.
Pham said that solo physicians serving a low-income patient population may also face financial barriers that limit their ability to hire support staff or invest in IT. "You don't want to give physicians a pass, but you must also recognize that they are not working in a vacuum," she said.
Pham did not measure hypertension control, the focus in the second JAMA report. It indicates that people ages 80 and older are particularly at risk. Donald Lloyd-Jones, an assistant professor of medicine at Northwestern University's Feinberg School of Medicine in Chicago, analyzed data on 5,296 people enrolled in the National Heart, Lung and Blood Institute's Framingham Heart Study.
Lloyd-Jones found that the rates of controlling hypertension for patients under 60, ages 60 to 79, and 80 and older were, respectively, 38%, 36% and 38% for men and 38%, 28% and 23% in women. "Control rates among older women are abysmal," he said, adding that concerns about mixing multiple prescriptions and prescription costs in general could be leading doctors to avoid treating hypertension aggressively in older patients.