Medicare FFS Enrollees Receive More Angiograms Than HMOs
Medicare HMO enrollees who need coronary angiograms receive them less often than those with fee-for-service coverage, while utilization rates for the procedure are low for both groups, a study in the New England Journal of Medicine reports. Among patients for whom angiography is "beneficial, useful and effective," those in the fee-for-service group underwent angiography at higher rates than those in the HMO group, at 46% vs. 37%, respectively. The respective levels of underuse were therefore 54% and 63%. The rate of angiogram use among patients who would not benefit from the procedure was low in both groups, at about 13%.
The researchers also found that angiography was performed less often for patients admitted to hospitals lacking angiography facilities than for those admitted to angiography-equipped hospitals, at a rate of 31% in the fee-for-service group and 15% in the HMO group for facilities without angiogram equipment, amounting to "striking" levels of underuse, at 69% and 85%, respectively. Although the authors conclude that angiography was "used less often [for] managed care enrollees than [for] fee-for-service beneficiaries," they note that due to the high levels of underuse across all groups, "there is room for improving the care of elderly patients with [myocardial infarctions], regardless of the type of Medicare coverage, and especially those initially admitted to hospitals without angiography facilities" (Guadagnoli et al, New England Journal of Medicine, 11/16).