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Medicare Patients' Care Is Generally Good, but Varies Widely

WebMD Health News

Oct. 3, 2000 -- The quality of medical care received by Medicare beneficiaries nationwide is generally good, but varies greatly from patient to patient and could be improved significantly, according to a new study published in the Journal of the American Medical Association.

The study found that nationally, an average of 69% of the patients in the Medicare fee-for-service program got the recommended care, as determined by 24 specific measures related to the prevention or treatment of six medical conditions (heart attack, breast cancer, diabetes, heart failure, pneumonia, and stroke).

But it also found that the quality of care varies considerably from state to state and region to region, as well as among different health care services. For instance, 95% of all the Medicare beneficiaries with acute stroke nationwide were appropriately treated on at least one measure of care -- they were not given a medication that can be dangerous in stroke patients -- but only 11% of those with pneumonia were appropriately screened to see if they had received the pneumococcal vaccine.

There also was wide variation in the quality of care within states. For instance, Ohio ranked as high as seventh among the states in administering aspirin to heart-attack patients upon their admission to a hospital, but it ranked 47th in the percentage of patients receiving a pneumococcal vaccination.

"There is a significant national opportunity to improve care, although it is important to note that the care that is being delivered is pretty good," Stephen F. Jencks, MD, MPH, director of the quality improvement group at the Health Care Financing Administration (HCFA), and lead author of the study, tells WebMD.

John Eisenberg, MD, director of the federal Agency for Healthcare Research and Quality, hailed the report. "This is the first time a national study has looked at evidence-based measures and provided us with an opportunity to [measure] our performance for services that ought to be provided to Medicare beneficiaries," Eisenberg tells WebMD.

The report shows that while many beneficiaries are being well-served, others are not, he says. "If anything resonates throughout our health care system, it is that some Americans are being left out," he says.

The report indicates that less populous states and those in the Northeast tended to score better on the various measures than more populous states and those in the Southeast.

The 10 states with the highest average scores across all measures were, in order, New Hampshire, Vermont, Maine, Minnesota, Massachusetts, Connecticut, North Dakota, Iowa, Colorado, and Oregon.

The areas with the lowest average scores, in order, were Puerto Rico, Arkansas, Mississippi, Louisiana, New Jersey, Georgia, Illinois, Texas, Alabama, and West Virginia.

In an interview with WebMD, Jencks says that the development of performance measures for a range of medical services is at least as important as the researchers' actual results. The measures, derived from widely accepted practice guidelines, will be used by the HCFA to help improve care through the agency's national network of Peer-Review Organizations. The mission of each state or territorial Peer Review Organization is to ensure the quality, effectiveness, and efficiency of services for Medicare beneficiaries.

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