PROGRESS HAS BEEN MADE, BUT MORE WORK NEEDS TO BE DONE
Medical care for Medicare beneficiaries improved significantly since 1998, according to a study from the Centers for Medicare & Medicaid Services (CMS) that is published today in the Journal of the American Medical Association. Nevertheless, the study reports that more than a quarter of Medicare beneficiaries still do not receive services that could protect them from disease or prolong life.
The study is the first since a baseline of health care quality was established by a CMS survey published in 2000. It compares current quality of care conditions with those measured in the 1998-1999 study and shows improvement across the board.
The original study of 22 health care measures related to primary prevention, secondary prevention, and/or treatment of six medical conditions, found that the typical beneficiary had a 69 percent chance of receiving care that was appropriate on the typical measure; in 2000-2001 that chance had risen to 73 percent. (If all patients received appropriate care, the rate would be 100 percent.)
"This report shows we're making important progress on quality health care delivery," said HHS Secretary Tommy G. Thompson. "Medicare beneficiaries deserve high quality care -- and more. They deserve a stronger Medicare program with high quality, meaningful choice and effective coverage. They deserve prescription drug coverage, and preventive services that are often already available to those under 65. This administration has taken unprecedented steps to improve quality of care, and our efforts are working. We will continue those efforts as we move ahead to modernize and strengthen Medicare."
HHS and CMS launched the National Nursing Home Quality Initiative in November, 2002 to make quality of care information about the nation’s nursing homes available and in 2003 will report similar information for in home health agencies. HHS has also joined with hospitals, consumers, the National Quality Forum and others to begin to develop the public reporting of quality measures for hospitals. That project includes a three-state pilot project and a standardized patient experience survey instrument.
"Progress is taking place and we are accelerating that progress through the publication of this article and the launch of these public reporting initiatives," Tom Scully, CMS Administrator.
The study provides data for individual states as well as for the entire United States and shows that in 2000-2001 beneficiaries in some states were consistently more likely than those in other States to receive these vital services. The pattern of differences among states changed little over the 2 years. The article does not, however, report information on individual hospitals or doctors, which is not currently available.
The gap between care delivered and the care that could be delivered is generally much greater than the differences among states. "It’s important to look at these findings as pointing to areas for further improvement for all states, because even the best-performing States have large opportunities to improve," said Stephen F. Jencks, M.D., Assistant Surgeon General and the senior author of the study. "The problem is not bad physicians, bad nurses, or bad hospitals; it is a broken health care system that allows too many patients to fall through the cracks."
In an accompanying editorial, Dr. David Hsia describes the study as "valid, robust, understandable, and correct." He emphasizes the importance of improving health care systems rather than blaming individuals.
The study includes quality indicators for inpatient care, such as whether a patient with pneumonia received prompt treatment, and office-based care, such as whether diabetic patients got appropriate care. In particular, nine of the ten measures recently endorsed by hospital associations for voluntary public reporting are included.
The data for the study was collected by the Medicare Quality Improvement Organizations Program, whose mission is to improve care for Medicare beneficiaries. The Program abstracted more than a quarter million hospital records, analyzed bills, and surveyed beneficiaries in order to measure performance of the health care system.
Some specific results:
For inpatient care,
- The percentage of patients receiving beta-blockers at hospital discharge, which reduce complications and death in patients who have had a heart attack, rose from 72% of appropriate patients to 79%,
- The percentage of patients receiving an effective combination of antibiotics for pneumonia rose from 79 percent to 85%
- The percentage of patients with high blood pressure and acute stroke whoreceived medication to decrease blood pressure (an inappropriate treatment) dropped from 3% to 1%.
- No more patients with pneumonia had their blood cultured for bacteria before they received antibiotics in 2000-2001 (82 percent) than in 1998-1999.
- And, though screening of pneumonia patients for influenza and pneumococcal vaccination improved substantially, only a quarter of patients were being screened in 2000-2001.
For outpatient care:
- The percentage of diabetic patients screened for cholesterol problems rose from 56% to 74%
- The percentage of patients immunized against pneumococcus (a bacterium that causes both pneumonia and devastating bloodstream infections) rose from 55% to 65%
- The percentage of diabetics who received appropriate eye exams to help prevent blindness increased from 68 to 70 percent.
The study is the first to track a large number of quality indicators over time at national and State levels. It foreshadows the National Quality Report, a more general report on quality of healthcare in the United States that the Department of Health and Human Services will publish in September of this year.
HHS, CMS, the QIOs, the American Medical Association, the American Hospital Association and others will continue to use this data to find ways to improve the quality of care provided to Medicare beneficiaries, as well as identifying additional opportunities to publicly report quality information.