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Health Dollars & Sense

Medicare's 'Gold Standard' Being Devalued

October 09, 2000|BOB ROSENBLATT

If your 75-year-old mother enters the hospital for, say, hip surgery, the doctor who takes her medical history should check to see if she had a flu shot this year.

If Uncle Joe, a two-pack-a-day smoker at age 80, undergoes heart bypass surgery, he shouldn't leave the hospital without first receiving counseling to help him quit smoking.

Seems like common sense, but lots of physicians and their patients don't always take advantage of the obvious when it comes to either treatment or preventive care. That is one of the most compelling--and disturbing--messages from the first inside look at some basic measures of hospital treatment and preventive care provided to millions of people enrolled in Medicare.

A new study by federal researchers has some blunt criticisms. "Quality of care is and has been far more uneven than previously recognized," the researchers wrote in an article published Wednesday in the Journal of the American Medical Assn.

The report found that quality varied significantly among states and regions. And the causes are a mystery, the report acknowledged: "We do not yet understand the reasons for these differences. . . ." It is all the more puzzling because Medicare covers virtually all Americans older than 65 and the disabled of all ages. The program offers a standard package of benefits, whether a person lives in Los Angeles or Miami. Yet there is considerable variability in the treatments provided by doctors and hospitals across the country.

Studies by researchers over the years have shown major variations in practice patterns in U.S. medicine. In some regions, heart patients are more likely to undergo bypass surgeries or women are more likely to undergo Caesarean sections during childbirth. In California, patients typically have shorter hospital stays than residents of most other states.

By contrast, the treatments studied by the federal researchers are relatively basic procedures and treatments on which there is broad agreement within the medical community about their scientific validity and efficacy.

For example, if heart attack victims routinely received an aspirin after reaching the hospital and a beta blocker to prevent another heart attack, 4,000 lives would be saved each year, according to Dr. David Thomas, a family physician from Iowa and president of the American Health Quality Assn, the industry representing contractors hired by Medicare to improve quality of care.

If everyone with an irregular heartbeat was given proper medication at the hospital, another 1,500 lives would be saved, Thomas told the news conference where the Medicare report was issued. Yet, while everyone in the medical field knows this, some hospitals and doctors are better than others at actually delivering this vital care.

Public-opinion polls show that many Americans have a deep distrust of health insurers and HMOs, while generally giving their own physicians high marks. But those trusted physicians may not always be following the best scientific advice in keeping their patients healthy.

The federal Medicare program is now spending lots of money, time and energy to change behavior. It wants to go from a passive payer of bills--spending more than $250 billion a year--to an agency that puts a special emphasis on the quality of care, said Dr. Jeffrey Kang, director of the office of clinical standards and quality for the Health Care Financing Administration, which runs Medicare.

Medicare wants hospitals and doctors to do a better job of living up to the so-called gold standard, the scientifically validated measures that can help patients survive illnesses or avoid getting sick in the first place.

The report offered a unique snapshot of the care Medicare beneficiaries receive, based on a scientific sampling of patient records. The lesson for consumers is clear: Take an active role in your own health care, asking questions and making sure you get the services that are considered part of optimal care. If patients are too ill or distracted, spouses, family members or friends should actively question doctors.

The Medicare study uses 24 separate measures for treatment of heart attacks, heart failure, stroke and pneumonia, and preventive care for breast cancer, diabetes and the flu.

For example, someone admitted to a hospital with a heart attack should get an aspirin within 24 hours of arriving to help keep the arteries open. The patient also should be given a beta blocker, a medication that slows the work of the damaged heart and helps it recover. Thrombolytic therapy, which helps dissolve blood clots, should be administered as quickly as possible, the study said.

When they are discharged, the heart attack patients should get aspirins and a prescription for beta blockers.

Warning to Doctors

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