A new study published this month in JAMA found lingering disparities in regional rates of major cardiovascular procedures, a problem that Medicare’s Advantage program was meant to help curb.
Researchers compared Medicare’s fee-for-service program to Medicare Advantage program, in which physicians receive a "capitated" payment rather than being paid for each procedure performed. Rates of angiography and percutaneous coronary intervention were lower patients in the Medicare Advantage program, an expected outcome, but researchers also found wide variation in regional procedure rates.
"Compared with Medicare FFS patients, Medicare Advantage patients had lower age-, sex-, race-, and income-adjusted procedure rates for angiography and PCI but similar rates for CABG surgery," according to a press release. "When examining procedure rates across HRRs, there was wide geographic variation among Medicare Advantage patients and Medicare FFS patients."
Medicare Advantage is one of the largest of Medicare’s managed care programs, offering incentives to healthcare providers who limit their spending, according to Kaiser Health News. Unsurprisingly, procedure rates were lower among patient groups in the Medicare Advantage program, but researchers had expected less variation within the program itself.
"The finding that Medicare Advantage patients have lower rates of angiography and PCI underscores the need for additional research," study authors wrote. "One explanation for the differences in rates seen in this report could be that Medicare Advantage beneficiaries are healthier and require fewer cardiovascular procedures than Medicare FFS beneficiaries."
Other variables include "more efficient utilization of procedures among Medicare Advantage patients (i.e., overutilization in Medicare FFS), or harmfully restrictive management of utilization among Medicare Advantage patients."
The geographic disparities are an additional conundrum, which cost-control incentives were designed to help stem.
"Geographic variation in health services in the Medicare FFS population has fueled the perception of an inefficient, ineffective U.S. health care system," the authors wrote. "Until the causes of geographic variation are understood, shedding light on the sources of variability remains an important research and quality improvement endeavor."