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    Medicare Patients' Care Is Generally Good, but Varies Widely


    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.

    In the past, Jencks says, HCFA has sought to improve care by hunting for "bad apples" among physicians through audits of patients' charts. The new report represents an effort to instead use population-based performance measures to gauge the quality of care across the entire Medicare system.

    "We think that a great deal of the gap between what could be done and what is happening is attributable to systems failures," Jencks tells WebMD. "We think the health care system could be engineered so that these things happen as a matter of course, rather than depending on very busy individual physicians to make them happen."

    For example, Jencks says, screening for patients' immunization status would improve if doctors' office systems were designed -- through computerization and other mechanisms -- to ensure patients were screened routinely. Now, many offices simply rely on the doctor to ask during checkups. "It is likely the immunization rates under these two scenarios are going to be profoundly different," he says.

    In an independent assessment of the study, Elliott Fisher, MD, MPH, professor of medicine at Dartmouth Medical School and a researcher involved in the Dartmouth Atlas Study Series, says the study underscores the inconsistency found in American medical practice. The Dartmouth Atlas series has found wide variation in the utilization of services in the Medicare program.

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