HMOs drop the ball in heart attack patients

A study published in the November 16, 2000 issue of the New England Journal of Medicine showed that Medicare patients enrolled in HMOs and other managed care plans fail to receive appropriate therapy after a heart attack more often than patients in traditional, fee-for-service Medicare plans.

The study examined the care received by 50,000 Medicare patients in seven states after those patients had suffered myocardial infarctions (heart attacks).  Of the patient who met the generally accepted guidelines for needing heart catheterization, only 37% who were enrolled in HMOs or managed care plans actually received the catheterization tests.  In contrast, 46% of those in traditional fee-for-service plans received the needed tests.

The results were even worse for patients admitted to hospitals in which cardiac catheterization was not available (that is, to hospitals in which transfer to another facility would have been necessary for appropriate therapy).  For these patients, only 15% in managed care plans and 31% in fee-for-service plans received catheterizations.

The lead investigator said that the results suggest that financial incentives might be limiting the access to needed care for Medicare patients enrolled in HMOs.

DrRich comments:

These results are even more disturbing in light of data presented at the Annual Scientific Sessions of the American Heart Association this week, showing that patients who are tested early-on with cardiac catheterization following a heart attack have a significantly better prognosis than patients not receiving the procedure.

And while the results published in the New England Journal do indeed indict the care received by Medicare patients enrolled in managed care plans, they also indict the care received by Medicare patients in traditional plans.  Even for these patients, less than half received cardiac catheterizations when they were indicated.

So, while being enrolled in a managed care plan does seem to compound the problem, the problem is bad enough even without managed care.

Nobody should be surprised by this finding.  Doctors are being strongly incented on all fronts to withhold expensive medical procedures, whether it's the financial incentives build in to managed care plans, or the anti-fraud incentives build into any medical care overseen by the feds.  This is merely another example of what results when the health care system spends most of its energy preventing doctors from acting in their patient's best interests.

11/17/2000

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