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Medicare HMO patients may receive less treatment after heart attacks, study finds

Medicare HMO customers with heart problems are not receiving top-quality medical treatment, says a study published in the New England Journal of Medicine's Nov. 16, 2000, issue.

Based on the examination of records from 50,000 heart attack patients from seven states, the new study concludes that among patients requiring an angiogram, a post-heart-attack test that determines blood flow levels through arteries, 46 percent of fee-for-service patients received the test, compared with 37 percent of managed-care patients.

In patients admitted to hospitals without angiogram facilities, the follow-up rates were lower for both groups: 31 percent of fee-for-service patients and 15 percent of managed care patients.

"In situations where angiography is thought to be useful, it is used less often among Medicare beneficiaries enrolled in managed-care plans than among those with fee-for-service coverage."

"In situations where angiography is thought to be useful, it is used less often among Medicare beneficiaries enrolled in managed-care plans than among those with fee-for-service coverage," the study concludes.

Managed care plans will use the study's conclusions to determine whether there are gaps in patient care, says Susan Pisano, spokesperson for the American Association of Health Plans (AAHP), a national HMO trade group. However, Pisano says, the study shows that care is lacking for heart patients with both HMOs and traditional fee-for-service plans.

"We frequently are asked, don't you have an incentive to withhold this kind of care," Pisano says. "No. Withholding treatment that could help prevent a second heart attack is not only the wrong thing for the patient, but it would mean greater expenses for HMOs down the line."

The study was performed by doctors at four hospitals and the Health, Education, and Human Services Division of the U.S. General Accounting Office. The 50,000 patient records studied dated from 1994 and 1995. Prior studies have shown that managed care patients are treated with cardiac procedures less frequently than patients with fee-for-service plans. However, it was previously unknown whether the discrepancy stemmed from less frequent treatment when it was not necessary, or whether necessary treatment was withheld.

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