New Findings on Specialty Hospitals and Medicare Managed Care

eAlert 42377f50-87f7-4850-929c-9faeebc9fb55

<p>Two Commonwealth Fund-supported studies exploring issues related to the quality and efficiency of care received by Medicare beneficiaries have just been published in the professional literature.<ul><li><a href="/cnlib/pub/enews_clickthrough.htm?enews_item_id=20521&return_url=http%3A%2F%2Fwww%2Ecmwf%2Eorg%2Fpublications%2Fpublications%5Fshow%2Ehtm%3Fdoc%5Fid%3D345010%26%23doc345010">Specialty Hospitals: A Problem or a Symptom?</a> (<em>Health Affairs,</em> Jan./Feb. 2006). In this article, Fund Senior Program Director Stuart Guterman discusses two congressionally mandated reports on specialty hospitals, the source of some recent controversy. Those reports find that specialty hospitals appear to provide high quality while offering popular amenities to their patients, but also tend to treat more profitable Medicare patients and fewer Medicaid and uninsured patients than community hospitals in the same markets. Guterman says that, although the potential effects of financial interests on the clinical decisions of physician-owners need to be considered, specialty hospitals are symptomatic of much broader problems with the health care financing system: low payments for most Medicaid patients and a lack of payments for uninsured patients create strong incentives for specialty hospitals and community hospitals alike to attract well-paying patients and avoid others.<br><br></li><li><a href="/cnlib/pub/enews_clickthrough.htm?enews_item_id=20522&return_url=http%3A%2F%2Fwww%2Ecmwf%2Eorg%2Fpublications%2Fpublications%5Fshow%2Ehtm%3Fdoc%5Fid%3D344933%26%23doc344933">Quality of Care in For-Profit and Not-For-Profit Health Plans Enrolling Medicare Beneficiaries</a> (<em>American Journal of Medicine,</em> Dec. 2005). Lead author Eric Schneider, M.D., M.Sc., a researcher at the Harvard School of Public Health, finds that Medicare beneficiaries enrolled in for-profit health plans received significantly lower-quality care than beneficiaries in not-for-profit plans. The study, which relied on standardized data health plans are required to report, focused on four important services: breast cancer screening, diabetic eye examination, beta-blocker medication after heart attack, and follow-up after hospitalization for mental illness. The results, say the authors, reinforce the importance of closely monitoring quality of care for enrollees in managed care plans, as well as all Medicare beneficiaries.</ul></p>