Managing care? Medicare managed care and patient use of cardiologists.

Publisher: Blackwell Country of Publication: United States NLM ID: 0053006 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1475-6773 (Electronic) Linking ISSN: 00179124 NLM ISO Abbreviation: Health Serv Res Subsets: MEDLINE

Publication: Malden, MA : Blackwell
Original Publication: Chicago, Hospital Research and Educational Trust.

Cardiology/*standards ; Managed Care Programs/*organization & administration ; Medicare/*organization & administration ; Physicians/*standards ; Physicians/*statistics & numerical data; Aged ; Angioplasty, Balloon, Coronary ; Clinical Competence ; Florida ; Humans ; Length of Stay ; Logistic Models ; Medical Audit ; Models, Econometric ; Models, Statistical ; Outcome Assessment, Health Care ; Reimbursement Mechanisms ; Retrospective Studies ; Stents ; United States

Objective: To examine the impact of Medicare managed care (MMC) versus Medicare fee for service (MFFS) on stent patients' use of physicians with lower resource use and better outcomes.
Data Sources/study Setting: Retrospective secondary data from 2003 through 2006 for 67,476 patients without acute myocardial infarction, staying 2 or more days in hospital, and treated by 486 physicians in Florida performing 10 or more cases per quarter.
Study Design: Analysis was at the patient level. Multivariate logistic models estimated the probability of an MMC patient using a physician with a particular risk-adjusted profile rank with respect to hospital peers.
Principal Findings: No differences were found in usage of physicians with shorter admissions. Compared with MFFS, MMC patients were significantly less likely to use physicians whose average mortality was the lowest/lowest quartiles/below median among facility peers, and more likely to use a physician ranked below median on live discharges directly home (not needing home health care, skilled nursing care, or a subacute hospital convalescence). Similar results were found with emergency admissions, and where physicians both attended and treated.
Conclusions: Florida percutaneous coronary interventions patients insured by MMC used physicians with worse outcome profiles than those of MFFS patients. Results were not consistent with hospital care differences, physician-patient, or payor-physician selection, but they were consistent with selection of unobservably sicker members into MMC and concentration of MMC among physicians.

Circulation. 2007 May 1;115(17):2248-50. (PMID: 17470706)
Med Care Res Rev. 2006 Dec;63(6 Suppl):112S-140S. (PMID: 17099132)
Rand J Econ. 1995 Summer;26(2):227-95. (PMID: 10160534)
Health Serv Res. 2007 Apr;42(2):682-705. (PMID: 17362213)
J Health Econ. 2002 Mar;21(2):337-53. (PMID: 11939245)
Health Aff (Millwood). 2009 May-Jun;28(3):897-906. (PMID: 19414903)
Jt Comm J Qual Improv. 1997 Feb;23(2):117-27. (PMID: 9061441)
Med Care Res Rev. 1999 Sep;56(3):340-62; discussion 363-72. (PMID: 10510608)
Health Serv Res. 2002 Jun;37(3):631-45. (PMID: 12132598)
J Am Coll Cardiol. 1998 Aug;32(2):387-92. (PMID: 9708465)
Health Serv Res. 2000 Mar;34(7):1499-518. (PMID: 10737450)
Am J Manag Care. 2003 Aug;9(8):553-61. (PMID: 12921233)
Health Aff (Millwood). 2004 Nov-Dec;23(6):107-13. (PMID: 15584103)
J Aging Health. 2006 Aug;18(4):507-33. (PMID: 16835387)
Health Serv Res. 2002 Aug;37(4):963-84. (PMID: 12236393)
Med Care. 2004 Jan;42(1):38-47. (PMID: 14713738)
Health Serv Res. 2004 Feb;39(1):131-52. (PMID: 14965081)
J Health Care Finance. 2008 Summer;34(4):42-51. (PMID: 21110480)
Health Serv Res. 2004 Apr;39(2):345-61. (PMID: 15032958)
N Engl J Med. 1978 Jun 1;298(22):1229-38. (PMID: 418336)
Health Aff (Millwood). 2008 Mar-Apr;27(2):528-37. (PMID: 18332511)
Health Serv Outcomes Res Methodol. 2003;4(3):135-149. (PMID: 19606272)
Med Care Res Rev. 2002 Dec;59(4):455-81. (PMID: 12508705)
Rand J Econ. 2000 Fall;31(3):526-48. (PMID: 11503704)
Health Aff (Millwood). 2009 May-Jun;28(3):864-73. (PMID: 19414899)
J Am Coll Cardiol. 1998 Jul;32(1):275-82. (PMID: 9669281)
Am Heart J. 2006 Jul;152(1):110-7. (PMID: 16824839)
Health Serv Res. 2003 Aug;38(4):1065-79. (PMID: 12968817)
J Health Polit Policy Law. 2004 Dec;29(6):1187-226. (PMID: 15688581)
Circulation. 2005 Mar 15;111(10):1257-63. (PMID: 15769766)
JAMA. 2000 Apr 19;283(15):1976-82. (PMID: 10789665)
J Am Coll Cardiol. 2001 Nov 1;38(5):1416-23. (PMID: 11691517)
Health Aff (Millwood). 2002 Jul-Aug;21(4):63-86. (PMID: 12117154)
Pediatrics. 2000 Jun;105(6):1271-8. (PMID: 10835068)
JAMA. 1998 Nov 18;280(19):1690-1. (PMID: 9832001)
J Health Polit Policy Law. 2002 Jun;27(3):495-512. (PMID: 12092678)

Date Created: 20100107 Date Completed: 20100616 Latest Revision: 20211020

20221213

PMC2838149

10.1111/j.1475-6773.2009.01070.x

20050932