MEDICARE: California Ranks Low in Quality of Care
A new HCFA study finds that California ranks in the bottom 10% of states for providing quality care to Medicare beneficiaries, the Los Angeles Times reports. The report, the first of its kind, ranked California 41st among the 50 states, Washington, D.C., and Puerto Rico in providing care to traditional Medicare beneficiaries. The study examined California's 2.4 million seniors with fee-for-service coverage, but did not include the 1.6 million beneficiaries in Medicare HMOs, "although researchers said they have no reason to believe quality is significantly different under managed care" (Marquis/Rosenblatt, Los Angeles Times, 10/4). The study, which appears in today's Journal of the American Medical Association, ranked each state based on 24 "standards of care for heart attack, heart failure, stroke, pneumonia, breast cancer and diabetes." Titled "Quality of Medical Care Delivered to Medicare Beneficiaries," the report was based on tens of thousands of medical records from 1997 to 1999 (AP/Baltimore Sun, 10/4). California fell below the median in 16 of the categories, including the distribution of beta blockers to heart attack victims and anticlotting medication to patients who have suffered strokes (Los Angeles Times, 10/4). For example, 75% of California stroke patients received "appropriate care" compared to the national average of 83% (Clark, San Diego Union-Tribune, 10/4). Still, Dr. Stephen Jencks, head of HCFA's quality improvement group and lead author of the study, said that "variation among the states was relatively modest" compared to the need for improvement "across the board."
The report drew a host of reactions from state health care professionals. Jo Ellen Ross, president of CMRI, a federally funded organization working to improve the quality of care for California Medicare beneficiaries, called the state's performance "unacceptable," adding, "These indicators are very straightforward, noncontroversial and scientifically accepted. We would have expected to see higher rates than we did. ... We hope (the study) will serve as a catalyst for physicians and hospitals to focus on improving care." Officials at the California Medical Association blamed the state's performance on "chronic underfunding" and the "spillover" effects of managed care, which have "squeezed medical groups, overtaxed emergency rooms and threatened the solvency of hospitals statewide." CMA President Dr. Marie Kuffner said, "Medicare patients don't go to a separate doctor's office. They're mixed up with the whole population. Their care is going to reflect ... the general environment" (Los Angeles Times, 10/4). Theodore Mazer, chair of the CMA's medical services committee, added, "[The report] shows the way physicians and hospitals have altered the practice of medicine to accommodate the needs of managed care. We need to ask if there's a staffing problem in hospitals due to reimbursement levels or some such thing that's resulting in poor practice" (San Diego Union-Tribune, 10/4). However, Bobby Pena, spokesperson for the California Association of Health Plans, said that it is "illogical" to blame HMOs for problems with care in traditional fee-for-service Medicare (Los Angeles Times, 10/4). Assessing the report, a Sacramento Bee editorial calls it a "milestone in measuring health care quality, [but] far from what savvy shoppers of medical services ultimately need." It adds, "But at least the quest to assess the quality of care has finally begun" (Sacramento Bee, 10/4). To view the entire report, go to http://jama.ama- assn.org/issues/current/rfull/joc01200.html.