August 19, 2003
Contact: Corinna
Kaarlela, News Director
Source: Eve Harris, (415) 885-7277
E-mail: eharris@pubaff.ucsf.edu
Web: www.ucsf.edu
FOR IMMEDIATE RELEASE
CALIFORNIA HMOs TREAT HEART ATTACK PATIENTS AS WELL AS TRADITIONAL MEDICAL
PLANS
HMO-enrolled Medicare patients who
suffered a heart attack in California fared no
worse -- perhaps even a little better -- than those who were covered by fee-for-service,
according to a new UCSF study.
"The important finding was not
the difference between HMOs and fee-for-service plans,"
said author Harold Luft, PhD. "Rather, some HMOs were significantly better
than others, as well as fee-for-service." Luft is director of the UCSF Institute
for Health Policy Studies.
The factor that appeared to make a
difference was how patient referrals were handled.
Some HMOs and most fee-for-service providers performed a coronary artery
bypass graft (CABG) in the facility to which the patient was initially taken.
But research on surgical outcomes has continually shown that
high-volume surgical
practices perform better, and this also applies to CABG procedures, according
to Luft. The UCSF research found that HMOs in the study whose patients
were treated only in higher-volume medical practices had more favorable
outcomes.
Titled "Variations in Patterns
of Care and Outcomes after Acute Myocardial
Infarction," the study is
published in the August issue of Health Services
Research. "The
best-performing HMOs were consistently referring their patients to high volume
centers," Luft said. "Future investigations should look at specific practice
guidelines, quality review and other features and not simply pit fee-for-service
against HMO."
In this study, Luft assessed
risk-adjusted results for HMOs and
fee-for-service plans
using hospital discharge and death certificate data. Luft linked that data
set with Medicare enrollment files for those patients 65 and older discharged
from California hospitals between 1994 and 1996.
Heart disease is the leading cause
of death in the United States, killing more
than 500,000 people each year.
Cardiovascular disease cost the nation
more than $200 billion in health
care expenditures and lost productivity in 1992, according
to Luft.
CABG surgery is an open-heart
operation in which an artery or a piece of vein taken
from the leg is attached to the blood vessel to detour blood around the blockage.
CABG is the most common major heart surgery in the Western world.
Although a study of HMOs in
Massachusetts yielded quite different findings,
Luft "was not surprised"
because there are substantial differences in the ways HMOs
operate.
Because this study was performed
with unidentified data, Luft could not say
which HMOs performed best, although
he would like to continue the study with identified
data.
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