Medicare Compliance & Reimbursement

Quality of care tethered to physician training, experience.

Few elderly Medicaid patients receive routine preventive health care, and the likelihood of receiving poor preventive care is linked to the level of a physician's training and the size of the medical practice.
 
These are just some of the key findings contained in a study published by researchers at the Center for Studying Health System Change and Memorial Sloan-Kettering Cancer Center in the July 27 Journal of the American Medical Association.

Investigators analyzed six recommended preventive services covered by Medicaid: routine blood tests, eye examinations for diabetics, colon screening, breast cancer screening, influenza and pneumococcal vaccinations.

Generally, less than half of eligible Medicaid beneficiaries included in the study received the recommended care. A total of 3,660 primary care physicians and 24,581 elderly Medicaid patients comprised the database.

The service with the highest percent of Medicaid beneficiaries receiving preventive care was routine blood work, where the proportion was only 55.9 percent. Just 47.9 percent of diabetic beneficiaries were given eye examinations, 46.7 percent of elderly women received mammograms and 46.5 percent of beneficiaries 65 and over received influenza vaccinations.

In addition to characterizing the level of preventive care the elderly beneficiaries were receiving, the primary purpose of the study was to identify characteristics of physicians and their practices that are associated with the quality of preventive care their patients receive.

Medicaid 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, according to the study, "Delivery of Preventive Services to Older Adults by Primary Care Physicians." A higher standard of care is also associated with the amount of Medicaid patients the practice treats.

Beneficiaries receiving care in practices deriving less than 6 percent of their revenue from Medicaid were more likely than those with more than 15 percent of revenue derived from Medicaid to receive diabetic eye examinations (48.9 percent vs. 43 percent). A similar relationship was also observed for all five of the other services analyzed: hemoglobin monitoring, mammograms, colon cancer screening, and influenza and pneumococcal vaccinations.

Physicians whose offices had information technology to generate preventive care reminders or access treatment guidelines also offered better preventive care. The sex of the physician was not generally associated with delivery of services, except that female beneficiaries with female providers were more likely to receive a mammogram than beneficiaries with male physicians.