Quality of Care Varies Widely In Fee-for-Service Medicare

In what may be the largest known attempt to gauge quality of care in fee-for-service medicine, a Health Care Financing Administration study has found dramatic variance in treatment of Medicare enrollees for six medical conditions. About 85 percent of the 39 million Medicare beneficiaries are in the fee-for-service program.

For purposes of its study, HCFA defined quality of care as adherence to 24 accepted medical guidelines. Examining three years' worth of records for patients with breast cancer, diabetes, pneumonia, stroke, heart failure, and acute myocardial infarction, HCFA found that patients in New England and Minnesota were most likely to receive care based on standard protocols.

Evidence-based guidelines were least likely to be followed in the Southeast and in some of the country's most populous states — including Florida (40th place), California (41st), Texas (45th), and Illinois (46th).

The guidelines included process measures — such as giving heart failure patients ACE inhibitors before discharge and giving retinal examinations to diabetic patients every two years — and treatment protocols, such as avoiding nifedipine administration to stroke patients.

Median compliance for all measures was 69 percent.

Results were published in the Journal of the American Medical Association.