Call them bundled payments, medical homes, capitation or accountable care, new versions of managed care (think HMOs in the 1990s) are health care鈥檚 . Researchers publishing in the latest JAMA tested that idea by counting procedures in one of the biggest managed care programs of all: Medicare Advantage plans for seniors. One finding they expected. The other they didn鈥檛.
Medicare Advantage offers incentives to insurers and caregivers to limit costs. In classic, 鈥渇ee for service鈥� Medicare, the more procedures providers perform, the more money they collect. So the scholars had assumed utilization would be lower among Medicare Advantage patients. They got similar results for diagnostic heart scans. Angiography procedures were 36 percent lower among Medicare Advantage patients, adjusted for age, sex and the other usual variables.
What they didn鈥檛 expect were enormous differences in utilization rates among Medicare Advantage patients from one city to another. They figured cost-control incentives would smooth out the in how often procedures are administered under traditional Medicare. They didn鈥檛. In some regions Medicare Advantage patients in non-emergency situations had coronary arteries propped open by balloons or scaffolds at five times the rate of others. In some places patients were four times as likely to get a diagnostic heart scan as in others.
鈥淭here is this policy in this country to push to more capitated reimbursement,鈥� or paying fixed amounts per member, as Medicare Advantage does, Matlock said in an interview. 鈥淎t least in our study, that hasn鈥檛 done anything to address this wide variation in health care. There is something going on beyond incentives that causes a patient to be five times more likely to get a procedure in one place than in another part of the country.鈥�
One possible factor: A boom in some regions in cardiac catheterization labs that deliver the procedures, .听狈耻尘别谤辞耻蝉 studies show that the mere existence of medical facilities drives up utilization whether it鈥檚 needed or not.
Matlock and colleagues didn鈥檛 test to see if heart patients鈥� health results differed between Medicare Advantage and traditional Medicare or between regions. That鈥檚 part of the next study, he said.