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Managing care? Medicare managed care and patient use of cardiologists.
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- المؤلفون: Huesch MD;Huesch MD
- المصدر:
Health services research [Health Serv Res] 2010 Apr; Vol. 45 (2), pp. 329-54. Date of Electronic Publication: 2009 Dec 30.
- نوع النشر :
Comparative Study; Journal Article
- اللغة:
English
- معلومة اضافية
- المصدر:
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
- بيانات النشر:
Publication: Malden, MA : Blackwell
Original Publication: Chicago, Hospital Research and Educational Trust.
- الموضوع:
- نبذة مختصرة :
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.
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- الموضوع:
Date Created: 20100107 Date Completed: 20100616 Latest Revision: 20211020
- الموضوع:
20221213
- الرقم المعرف:
PMC2838149
- الرقم المعرف:
10.1111/j.1475-6773.2009.01070.x
- الرقم المعرف:
20050932
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