Medicare Advantage quality of care differs by sex and race

Women enrolled in Medicare Advantage are more likely than men to be prescribed a bronchodilator for lung disease. But women with a history of falls are also more likely to be prescribed a potentially harmful medication.

In fact, for some health conditions, the quality of the care provided to a Medicare Advantage beneficiary varies whether the patient is a man or a woman, or whether that patient is black, white or Hispanic.

Two new reports from the CMS published on Thursday found significant disparities in clinical care experiences between Medicare Advantage enrollees of different genders and races.

The CMS looked at patients' reported healthcare experiences and clinical care data for 24 conditions gathered through medical records and insurance claims for hospitalizations, medical office visits, and procedures.

The first report showed that male and female patients reported similar care experiences. But clinical data showed women received better treatment for certain conditions, such as chronic lung disease and rheumatoid arthritis.

For example, 78.7% of women diagnosed with rheumatic arthritis were dispensed at least one prescription for an antirheumatic drug. Just 75.6% of men were dispensed a prescription for the drug.

About 80.4% of women who experienced an exacerbation of their chronic obstructive pulmonary disease, a disease that makes it hard to breathe, were given a bronchodilator — which opens the lungs' airways to make it easier for patients to breathe — within 30 days. Just 76.8% of men with the same condition were given a bronchodilator.

"Showing the data this way helps us to understand the intersection between a person's race, ethnicity, and gender and their health care," said Dr. Cara James, Director of the CMS Office of Minority Health.

Women also were more likely than men to receive follow-up care after being hospitalized for a mental health disorder. According to the report, 57.2% of women who were hospitalized for mental health disorder visited with a mental health practitioner within 30 days of discharge. About 50% of men did.

But there were situations where men received better care than women.

Women with dementia were more likely than men with dementia to be dispensed a potentially harmful medication that should be avoided among elderly adults with the disease. About 52.2% of the time, women were dispensed a harmful medication, while men were given a harmful medication just 43.9% of the time.

Men with a history of falls were dispensed a prescription for a potentially harmful medication 39% of the time, while women were dispensed the potentially harmful medication 50.3% of the time.

The second report focused on disparities in care by race or ethnic group. Generally, white women and men reported better care experiences than black, Hispanic and Asian/Pacific Islander men and women.

Clinical data showed that Hispanic (76.1%) and Asian (75.6%) women were more likely than white women (65.4%) to have been appropriately screened for colorectal cancer. Black women were the least likely to be screened at 62.3%.

Similar trends occurred with men. Hispanic and Asian men were equally likely to be screened for colorectal cancer (73.6%). White men were screened 63.8% of the time, while black men were screened 57.1% of the time.

Asian (87.8%) and Hispanic (77.2%) women with diabetes were more likely to have their blood sugar levels under control than white (74%) and black (70.2%) women. The same was true for men: Asian (86.4%) and Hispanic (75.5%) men were more likely than white (73.5%) and black (68%) men to have blood sugar under control, according to the report.

Among patients age 65 and older with a history of falling, 69.4% of Asian women, 60.6% of black women, 46.7% of Hispanic women and 48.5% of white women were not dispensed a prescription for a potentially harmful medication. The CMS report stated that potentially harmful medication should be avoided among elderly adults with a history of falls.

And 73.9% of Asian men, 70.1% of black men, 56.9% of Hispanic men and 60.2% of white men were not dispensed a prescription for a potentially harmful medication

Women and men of all races and ethnic groups studied experienced similar rates of blood sugar testing, kidney disease monitoring, continuous beta-blocker treatment, testing to confirm COPD, prescriptions for managing rheumatoid arthritis, and monitoring long-term medication use.