New Study Finds Wide Disparities in Medicare's Quality of Care
By James Arvantes
• Washington
6/11/2008
The quality of care provided to Medicare patients varies widely based on geographic location and the race and ethnicity of beneficiaries, according to a recently released report commissioned by the Robert Wood Johnson Foundation and conducted by the Dartmouth Atlas Project.
Health care quality in the United States is dangerously uneven, says Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation, during a recent press conference in Washington.
"Disparities in Health and Health Care Among Medicare Beneficiaries" (20-page PDF, About PDFs) is based on fee-for-service Medicare enrollment and claims data for patients 65 and older. Researchers found wide care disparities in the areas of diabetes testing, breast cancer screening, and rates of leg amputations resulting from diabetes and peripheral vascular disease complications.
"The new research we are releasing confirms how dangerously uneven health care quality in America really is," said Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation, during a June 6 press conference here. "The data we commissioned from the Dartmouth Atlas Project show that people's race and where they live are linked to significant differences in whether they get the basic care we know works."
For example, the report indicates that one in three women insured by Medicare did not receive a mammogram during the two-year period from 2004 through 2005. In fact, according to the study, there was a 17-point gap between the percentage of women who received mammograms in Maine, which had the highest rate, and Mississippi, which had the lowest rate. In addition, black patients were less likely to receive mammograms than white patients. The largest gaps in mammography screening rates between white and black patients -- 12 percent -- occurred in Illinois and California.
In the area of diabetes care, one in six patients with diabetes is not getting blood tests essential to care, and there is a 20-point difference in testing rates between Vermont -- with the highest testing rate -- and Alaska -- with the lowest testing rate -- said Lavizzo-Mourey.
In addition, black patients with diabetes were less likely to receive hemoglobin A1c testing than white patients, but the differences in testing rates varied by state. The greatest gaps occurred in Colorado, where the rate for white patients was 84 percent compared with a rate of 66 percent for black patients, and in Illinois, where the rate for white patients was 84 percent compared with a rate for black patients of 70 percent.
The study found, however, that when it comes to mammograms and diabetes testing, "disparities across states and regions are substantially greater than the differences by race. … Furthermore, there are some regions where blacks receive equal or better care than whites but where care for all patients is less than ideal."
Black patients are losing legs at a rate nearly four times that of white patients, said Lavizzo-Mourey, referring to the "health care nightmare of losing a leg to amputation."
Leg amputation rates, however, "varied substantially for both blacks and whites across states," based on a period from 2003 to 2005, the study said. The amputation rate for black patients, for example, was 6 per 1,000 in Louisiana, Mississippi and South Carolina, but less than 2 per 1,000 in Colorado and Nevada, according to the study.
"Although the rates for whites were much lower, the disparities across states were similar: The amputation rates for whites in Mississippi and Louisiana were around 1.3 per 1,000, but were about half that in Colorado and Nevada," said the study.
The study acknowledged the benefits of using primary care physicians to manage chronic conditions and coordinate high-quality health care. "For conditions such as diabetes and hypertension, primary care physicians have been shown to provide care that is similar to (sub)specialty care in quality and lower in cost," the report said. "Adequate access to primary care can improve care coordination and reduce the frequency of avoidable hospitalizations."
The report also said "studies have found that regions with a greater proportion of care provided by primary care physicians have both lower costs and higher quality." In nearly every state, 90 percent of Medicare beneficiaries were seen by a primary care physician at least once in a two-year period.
"There was, however, substantial variation in the proportion of beneficiaries whose pre-dominant ambulatory physician was a primary care doctor, ranging from 85 percent in Nebraska, Maine and South Dakota to less than 70 percent in Connecticut and New Jersey," the study found. "Although the differences between blacks and whites were smaller than the variation across regions, blacks were slightly more likely to have a primary care physician as their predominant provider than were whites."
"The new research we are releasing confirms how dangerously uneven health care quality in America really is," said Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation, during a June 6 press conference here. "The data we commissioned from the Dartmouth Atlas Project show that people's race and where they live are linked to significant differences in whether they get the basic care we know works."
For example, the report indicates that one in three women insured by Medicare did not receive a mammogram during the two-year period from 2004 through 2005. In fact, according to the study, there was a 17-point gap between the percentage of women who received mammograms in Maine, which had the highest rate, and Mississippi, which had the lowest rate. In addition, black patients were less likely to receive mammograms than white patients. The largest gaps in mammography screening rates between white and black patients -- 12 percent -- occurred in Illinois and California.
In the area of diabetes care, one in six patients with diabetes is not getting blood tests essential to care, and there is a 20-point difference in testing rates between Vermont -- with the highest testing rate -- and Alaska -- with the lowest testing rate -- said Lavizzo-Mourey.
In addition, black patients with diabetes were less likely to receive hemoglobin A1c testing than white patients, but the differences in testing rates varied by state. The greatest gaps occurred in Colorado, where the rate for white patients was 84 percent compared with a rate of 66 percent for black patients, and in Illinois, where the rate for white patients was 84 percent compared with a rate for black patients of 70 percent.
The study found, however, that when it comes to mammograms and diabetes testing, "disparities across states and regions are substantially greater than the differences by race. … Furthermore, there are some regions where blacks receive equal or better care than whites but where care for all patients is less than ideal."
Black patients are losing legs at a rate nearly four times that of white patients, said Lavizzo-Mourey, referring to the "health care nightmare of losing a leg to amputation."
Leg amputation rates, however, "varied substantially for both blacks and whites across states," based on a period from 2003 to 2005, the study said. The amputation rate for black patients, for example, was 6 per 1,000 in Louisiana, Mississippi and South Carolina, but less than 2 per 1,000 in Colorado and Nevada, according to the study.
"Although the rates for whites were much lower, the disparities across states were similar: The amputation rates for whites in Mississippi and Louisiana were around 1.3 per 1,000, but were about half that in Colorado and Nevada," said the study.
The study acknowledged the benefits of using primary care physicians to manage chronic conditions and coordinate high-quality health care. "For conditions such as diabetes and hypertension, primary care physicians have been shown to provide care that is similar to (sub)specialty care in quality and lower in cost," the report said. "Adequate access to primary care can improve care coordination and reduce the frequency of avoidable hospitalizations."
The report also said "studies have found that regions with a greater proportion of care provided by primary care physicians have both lower costs and higher quality." In nearly every state, 90 percent of Medicare beneficiaries were seen by a primary care physician at least once in a two-year period.
"There was, however, substantial variation in the proportion of beneficiaries whose pre-dominant ambulatory physician was a primary care doctor, ranging from 85 percent in Nebraska, Maine and South Dakota to less than 70 percent in Connecticut and New Jersey," the study found. "Although the differences between blacks and whites were smaller than the variation across regions, blacks were slightly more likely to have a primary care physician as their predominant provider than were whites."
