Study: Medicare Varies in Each State

C H I C A G O, Oct. 3, 2000 -- Treatment of elderly Medicare patients varies

widely by state when it comes to heart failure, stroke, breast

cancer and other life-threatening illnesses, according to a new

federal study.

Medicare patients in the Northeast and sparsely populated states were most likely to receive widely accepted treatments for such conditions. However, those in the Southeast and more populated states were least likely to get the same treatments, according to the state-by-state comparison in Wednesday’s Journal of the American Medical Association.

New Hampshire averaged the best quality of care followed by Vermont, Maine, Minnesota and Massachusetts.

The lowest-ranked states were New Jersey, Louisiana, Mississippi and Arkansas, which was second to last. Puerto Rico, the only U.S. commonwealth included in the analysis, finished 52nd in a tally counting the District of Columbia.

The study, based on tens of thousands of medical records from 1997 to 1999, was done by researchers at the Health Care Financing Administration, the Baltimore-based agency that administers Medicare to elderly Americans.

No Explanation for Disparities

The researchers offered no explanation for the disparities.

“I’m delighted if this paper stimulates people in states that are ranked a little lower to try harder,” said Dr. Stephen Jencks, an assistant surgeon general who also oversees HCFA’s quality improvement group. “But I’m very sad if it leads people who are ranked a little higher ... to say we don’t need to do anything to improve.”

The states were ranked based on a total of 22 standards of care for heart attack, heart failure, stroke, pneumonia, breast cancer and diabetes.

The standards included everything from avoiding a potentially deadly treatment — giving stroke victims the blood-pressure-suppressing drug nifedipine — to educating pneumonia patients about immunization.

New York ranked best among the most-populated states, coming in at No. 31 on the list. Florida finished 40th, California 41st, Texas 45th and Illinois 46th.

More Examination Needed

Jencks and officials at the American Hospital Association said the next step is to work with peer review organizations that contract with HCFA to make improvements.

They also plan to examine why the disparities exist—whether it has to do with such factors as “being urban versus rural, managed care versus not,” said Dr. Don Nielsen, the AHA’s senior vice president of quality.

Officials in Arkansas — the lowest-ranking state — said their state has greater challenges than some, namely more low-income elderly residents who they say often do not seek preventive care. They also noted that Arkansas ranked better than some states in certain categories.

“But we still take this as a professional challenge to move forward and improve,” said Dr. William Golden, a medical professor at the University of Arkansas who oversees the state’s peer review organization.

Golden said his organization is already working with the Arkansas Medical Society to educate doctors about proper diabetes treatment, including eye exams and hemoglobin tests, and standard treatment for heart attack patients such as giving patients aspirin and beta blocker medication within the first 24 hours.