Guideline-Recommended CAD Care Better with Medicare Advantage than Fee For Service

Patients with Medicare Advantage are more likely to receive guideline-recommended care for coronary artery disease than patients with Medicare Fee for Service. But whether that translates into better outcomes remains unclear, according to a study published in the February 20 online issue of JAMA Cardiology.

The study is the first nationwide comparison of quality of care for coronary artery disease among Medicare Advantage beneficiaries as compared to Medicare Fee for Service.

“As Medicare Advantage continues to enroll a higher proportion of beneficiaries each year, it will be important to monitor both quality and outcomes of care to determine whether these patterns ultimately lead to better outcomes in Medicare,” wrote study authors who were led by Jose Figueroa, M.D., MPH, Harvard Medical School, Boston.

Roughly one-third of Medicare beneficiaries are enrolled in Medicare Advantage, which provides a managed care private plan option. It also offers incentives to physicians for providing evidence-based care. Enrollment in Medicare Advantage has risen substantially over the last decade. Current political pressure to support market-driven health reform may further increase enrollment. That underscores the importance of understanding whether quality of care and healthcare outcomes differ between Medicare Advantage and Medicare Fee for Service.

To shed light on the issue, researchers analyzed data from the Practice Innovation and Clinical Excellence (PINNACLE) study, a national quality improvement registry of outpatient cardiology.  The study included data from about 35,000 people with coronary artery disease enrolled in Medicare Advantage and about 172,000 people with coronary artery disease enrolled in Medicare Fee for Service. 

Medicare Advantage beneficiaries were significantly more likely than those with Medicare Fee for Service to receive guideline-recommended treatment for secondary prevention of cardiac events, including β-blockers, ACE-inhibitors or ARBs, statins, or all three medications when eligible.

After controlling for age, sex, race/ethnicity, current tobacco use and cardiac-related comorbidities, those with Medicare Advantage remained 10 percent more likely to receive guideline-recommended care.

Other outcomes, like blood pressure and LDL levels, did not differ between those with Medicare Advantage and Medicare Fee for Service.

“Whether or not our findings of higher quality with similar intermediate outcomes represent high-value care under Medicare Advantage compared with Fee for Service Medicare is an important area for future work,” authors wrote.

Participation in the PINNACLE registry is voluntary and may have influenced practices to provide higher quality care, which could have affected results.

ABOUT THE AUTHOR

Veronica Hackethal, M.D., MSc, is a medical journalist based in New York City who is a long-time contributor to the Modern Medicine Network publications. Her writing has also appeared in the New York Times, Chicago Tribune, NBCNews.com, Reuters Health, Nature Medicine News and Medscape. She is a graduate of Harvard University, Oxford University and Columbia College of Physicians and Surgeons (M.D.).

REFERENCE
Figueroa JF, Blumenthal DM, Feyman Y, et al. Differences in management of coronary artery disease in patients with Medicare Advantage vs traditional fee-for-service Medicare among cardiology practices. JAMA Cardiol. Published online February 20, 2019. doi:10.1001/jamacardio.2019.0007