Center for Studying Health System Change

Many Elderly Medicare Patients Don't Receive Recommended Preventive Care

JAMA Study: Physicians Training and Practice Setting Linked to Variation in Quality of Preventive Care

News Release
July 26, 2005

FURTHER INFORMATION, CONTACT:
Alwyn Cassil (202) 264-3484 or acassil@hschange.org

WASHINGTON, DC—Many elderly Medicare patients fail to get routine preventive care, but patients cared for by board-certified physicians in larger practices treating fewer poor patients are more likely to receive cancer screenings and other preventive care, according to a study by researchers at the Center for Studying Health System Change (HSC) and Memorial Sloan-Kettering Cancer Center (MSKCC) in the July 27 Journal of the American Medical Association.

Researchers analyzed six recommended preventive services covered by Medicare: routine blood tests and eye examinations for diabetics; colon and breast cancer screening; and influenza and pneumococcal vaccinations. Generally, less than half of eligible Medicare beneficiaries received the recommended care in 2001. For example, 48 percent and 56 percent of diabetic beneficiaries received eye examinations and hemoglobin A1c blood tests, respectively, while 47 percent of women aged 65 to 75 received mammograms and 47 percent of all beneficiaries received flu shots.

"Across the board, the delivery of routine preventive care to elderly Medicare patients fell far short of optimal levels, indicating there is a tremendous opportunity to improve care for these patients," said Hoangmai H. Pham, M.D., M.P.H., the study’s lead author and senior health researcher at HSC, a nonpartisan policy research organization funded principally by The Robert Wood Johnson Foundation.

The new JAMA study, "Delivery of Preventive Services to Older Adults by Primary Care Physicians," for the first time documents wide variation in the quality of care associated with physician and practice setting characteristics in a nationally representative group of physicians.

In particular, Medicare patients are more likely to receive preventive care if they are treated by physicians practicing in a group of three or more, rather than physicians in solo practice; in practices less dependent on revenue from Medicaid patients; and practices with information technology to generate preventive care reminders or access treatment guidelines. The study also found that patients are more likely to receive recommended preventive care if their physicians are board certified or a graduate of a U.S. or Canadian medical school rather than a medical school in another country.

"This study shows that physicians don’t work in a vacuum—practice setting counts in their ability to provide high-quality care," Pham said. "The strongest factors we identified as influencing care delivery—larger practice size, less Medicaid revenue and more clinical information technology—all point to greater resources as a key factor."

The study is based on information from HSC’s nationally representative Community Tracking Study Physician Survey, which collects information from 12,000 practicing physicians, and Medicare claims information on beneficiaries these physicians treated, from a representative sample of 5 percent of Medicare beneficiaries. Data on physicians and patients were linked with the use of the physicians’ unique provider identification number, and a total of 3,660 primary care physicians and 24,581 elderly Medicare patients were included in the study.

The Centers for Medicare and Medicaid Services (CMS) has developed a number of initiatives aimed at improving the delivery of preventive services to Medicare beneficiaries

"For example, paying physicians for performance is one way Medicare is trying to improve quality of care for beneficiaries—by rewarding physicians and practices that consistently deliver high quality care," said Peter B. Bach, M.D., M.A.P.P., coauthor of the study and a researcher in the Department of Epidemiology and Biostatistics at MSKCC in New York City. Bach is currently on leave from Sloan-Kettering to serve as a senior adviser at CMS.

"Understanding why quality of care varies among physicians can help ensure that pay-for-performance programs are designed in ways that allow physicians to be assessed within the constraints of their practice environments," Bach said.

The study was coauthored by Deborah Schrag, M.D., M.P.H., of MSKCC, and J. Lee Hargraves, Ph.D., a consulting HSC researcher and associate professor at the University of Massachusetts Medical School, and was supported by grants from the American Cancer Society, the National Cancer Institute and The Robert Wood Johnson Foundation.

The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by The Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.