JAMA examines Medicare quality

The results of the first systematic program monitoring the quality of medical care provided to Medicare beneficiaries have been published in the Journal of the American Medical Association (vol. 284, no. 13). The national study evaluated data collected from 1997 through 1999 on all Medicare fee-for-service beneficiaries or a representative sample of individuals with a specific condition. Results varied across all states and measures. Less-populated states and states in the Northeast consistently ranked high in relative performance, while states with higher concentrations and those in the Southeast consistently ranked low.

"The differences in average performance among states and regions are modest compared with the overall need for improvement," wrote the authors. "Nevertheless, the data suggest real underlying geographic differences in the way care is delivered to the Medicare FFS population. They also suggest that variations among states on individual measures are part of a larger pattern and not simply local variations."

Added the authors, "We do not yet understand the reasons for these differences or whether aspects of the systems in high-performing states can be easily replicated in low-performing states."

The authors concluded that the results should reinforce the need for cooperation among the Health Care Financing Administration, beneficiaries, health plans, providers and practitioners to achieve improvements. PR