Geographic Area Variations in the Medicare Health Plan Era

Keenan, Patricia S.; Cleary, Paul D.; O’Malley, A. James; Landon, Bruce E.; Zaborski, Lawrence; Zaslavsky, Alan M.

doi:10.1097/mlr.0b013e3181ca410a

Cited by 11 publications

(11 citation statements)

References 23 publications

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“…Such geographic disparities have been noted in other analyses of Medicare quality and spending. 31–33 We also found a small but significant increase in DMARD receipt in enrollees of not-for-profit health plans compared to enrollees of for-profit health plans, which has also been reported for other HEDIS measures. 34 …”

Section: Discussionsupporting

confidence: 78%

Receipt of Disease-Modifying Antirheumatic Drugs Among Patients With Rheumatoid Arthritis in Medicare Managed Care Plans

Schmajuk¹,

Trivedi²,

Solomon³

et al. 2011

JAMA

123

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Context In 2005, HEDIS introduced a quality measure to assess the receipt of disease modifying anti-rheumatic drugs (DMARDs) among patients with rheumatoid arthritis (RA). Objective To identify sociodemographic, community, and health-plan factors associated with DMARD receipt among Medicare managed care enrollees. Design, Setting, and Patients We analyzed individual-level HEDIS data for 93,143 patients ≥ 65 years old with at least 2 diagnoses of RA within a measurement year (during 2005–2008). Logistic regression models with generalized estimating equations were used to determine factors associated with DMARD receipt. We used logistic regression to adjust health plan performance for case-mix. Main Outcome Measure DMARD receipt (yes/no). Results The mean age of patients was 74 years; 75% were female, and 82% were white. Overall performance on the HEDIS RA measure was 59% in 2005, rising to 67% in 2008 (p for trend <.01). The largest difference in performance was based on age: patients ≥ 85 had a 30% (29%, 32%), p<.001) point lower rate of DMARD receipt compared to patients 65–69, even after adjusting for other factors. Males (−3%, 95% CI (−5%, −2%), p<.001), blacks (−4%, 95% CI (−6%, −2%), p<.001), patients with low personal income(−6%, 95% CI (−8%,−5%), p<.001), and those with the lowest ZIP-code-based socioeconomic status (SES) (−4%, 95% CI (−6%,−2%), p<.001) were also found to have lower percentage point rates, as were patients in the Middle (−7%, 95% CI (−13%,−2%), p<.001) and South Atlantic regions (−11%, 95% CI (−20%,−3%), p<.001, compared to the Pacific) and patients enrolled in for-profit health plans (−4%, 95% CI (−7%,−0%), p<.001). Performance varied widely by health plan, ranging from 16% to 87%. Conclusions Among Medicare managed care enrollees carrying a diagnosis of RA between 2005 and 2008, 63% received a DMARD; DMARD receipt varied based on demographic factors, SES, geographic location, and health plan.

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Section: Discussionsupporting

confidence: 78%

Receipt of Disease-Modifying Antirheumatic Drugs Among Patients With Rheumatoid Arthritis in Medicare Managed Care Plans

Schmajuk¹,

Trivedi²,

Solomon³

et al. 2011

JAMA

123

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“…To account for large geographic differences in quality of care within traditional Medicare, 10 which are strongly correlated with quality of care in Medicare Advantage plans in the same local areas, 12 we matched almost all HMO enrollees to traditional Medicare beneficiaries with equivalent demographic characteristics in the same zip codes or counties.…”

Section: Methodsmentioning

confidence: 99%

Medicare Beneficiaries More Likely To Receive Appropriate Ambulatory Services In HMOs Than In Traditional Medicare

et al. 2013

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To compare quality of care nationally between Medicare Advantage health maintenance organizations (HMOs) and traditional Medicare and determine how various types of Medicare HMOs differed in quality from traditional Medicare, we assessed performance measures of the quality of ambulatory care from the among beneficiaries matched by demographic characteristics within local areas during 2003-2009. HMO enrollees were consistently more likely than traditional Medicare beneficiaries to receive appropriate breast cancer screening, diabetes care, and cholesterol testing for cardiovascular disease. Personal physicians were rated less highly in HMOs than traditional Medicare in 2003, but more highly in 2009. Not-for-profit, larger, and older HMOs performed consistently more favorably on clinical measures and ratings of care than for-profit, smaller, and newer HMOs. The effects on ambulatory quality of care of more integrated delivery systems in Medicare HMOs may outweigh the potential incentives to restrict care under capitated payments.

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“…8,38–45 Although the possible confounding effects of patient characteristics have been a concern for a variety of measurement systems, 15 questions about the fairness of using patient reports have sometimes been raised by teaching hospitals, 23 which often have lower scores, on average, than nonteaching hospitals. 37 …”

Section: Discussionmentioning

confidence: 99%

Are Comparisons of Patient Experiences Across Hospitals Fair? A Study in Veterans Health Administration Hospitals

Cleary

Meterko²,

Wright³

et al. 2014

Medical Care

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Background Surveys are increasingly used to assess patient experiences with health care. Comparisons of hospital scores based on patient experience surveys should be adjusted for patient characteristics that might affect survey results. Such characteristics are commonly drawn from patient surveys that collect little, if any, clinical information. Consequently some hospitals, especially those treating particularly complex patients, have been concerned that standard adjustment methods do not adequately reflect the challenges of treating their patients. Objectives To compare scores for different types of hospitals after making adjustments using only survey-reported patient characteristics and using more complete clinical and hospital information. Research Design We used clinical and survey data from a national sample of 1858 veterans hospitalized for an initial acute myocardial infarction (AMI) in a Department of Veterans Affairs (VA) medical center during fiscal years 2003 and 2004. We used VA administrative data to characterize hospitals. The survey asked patients about their experiences with hospital care. The clinical data included 14 measures abstracted from medical records that are predictive of survival after an AMI. Results Comparisons of scores across hospitals adjusted only for patient-reported health status and sociodemographic characteristics were similar to those that also adjusted for patient clinical characteristics; the Spearman rank-order correlations between the 2 sets of adjusted scores were >0.97 across 9 dimensions of inpatient experience. Conclusions This study did not support concerns that measures of patient care experiences are unfair because commonly used models do not adjust adequately for potentially confounding patient clinical characteristics.

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Geographic Area Variations in the Medicare Health Plan Era

Cited by 11 publications

References 23 publications

Receipt of Disease-Modifying Antirheumatic Drugs Among Patients With Rheumatoid Arthritis in Medicare Managed Care Plans

Receipt of Disease-Modifying Antirheumatic Drugs Among Patients With Rheumatoid Arthritis in Medicare Managed Care Plans

Medicare Beneficiaries More Likely To Receive Appropriate Ambulatory Services In HMOs Than In Traditional Medicare

Are Comparisons of Patient Experiences Across Hospitals Fair? A Study in Veterans Health Administration Hospitals

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