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 stateswere most likely to receive widely accepted treatments for suchconditions. However, those in the Southeast and more populatedstates were least likely to get the same treatments, according tothe state-by-state comparison in Wednesday’s Journal of theAmerican Medical Association.
New Hampshire averaged the best quality of care followed byVermont, Maine, Minnesota and Massachusetts.
The lowest-ranked states were New Jersey, Louisiana, Mississippiand Arkansas, which was second to last. Puerto Rico, the only U.S.commonwealth included in the analysis, finished 52nd in a tallycounting the District of Columbia.
The study, based on tens of thousands of medical records from1997 to 1999, was done by researchers at the Health Care FinancingAdministration, the Baltimore-based agency that administersMedicare 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 thatare ranked a little lower to try harder,” said Dr. Stephen Jencks,an assistant surgeon general who also oversees HCFA’s qualityimprovement group. “But I’m very sad if it leads people who areranked a little higher ... to say we don’t need to do anything toimprove.”
The states were ranked based on a total of 22 standards of carefor heart attack, heart failure, stroke, pneumonia, breast cancerand diabetes.
The standards included everything from avoiding a potentiallydeadly treatment — giving stroke victims theblood-pressure-suppressing drug nifedipine — to educating pneumoniapatients 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 andIllinois 46th.
More Examination Needed
Jencks and officials at the American Hospital Association saidthe next step is to work with peer review organizations thatcontract with HCFA to make improvements.
They also plan to examine why the disparities exist—whether ithas to do with such factors as “being urban versus rural, managedcare versus not,” said Dr. Don Nielsen, the AHA’s senior vicepresident of quality.
Officials in Arkansas — the lowest-ranking state — said theirstate has greater challenges than some, namely more low-incomeelderly residents who they say often do not seek preventive care.They also noted that Arkansas ranked better than some states incertain categories.
“But we still take this as a professional challenge to moveforward and improve,” said Dr. William Golden, a medical professorat the University of Arkansas who oversees the state’s peer revieworganization.
Golden said his organization is already working with theArkansas Medical Society to educate doctors about proper diabetestreatment, including eye exams and hemoglobin tests, and standardtreatment for heart attack patients such as giving patients aspirinand beta blocker medication within the first 24 hours.