Medicare programs designed to boost the care of chronically ill patients while reducing hospital admissions and saving costs have largely failed, a new government-contracted study concludes.
Many of the programs employ information technology and Web portals to track their patients.
Only two of the 15 Medicare programs resulted in reduced hospital admissions, and none generated net savings, according to a study in the Feb. 11 issue of the Journal of the American Medical Association.
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To study whether care coordination improves the quality of care and reduces Medicare expenditures, the Centers for Medicare & Medicaid Services in 2002 awarded 15 demonstration programs to various healthcare providers.
Deborah Peikes and colleagues from Mathematica Policy Research, Inc., of Princeton, N.J., analyzed the results from random controlled trials of these 15 programs on how they affected Medicare expenditures and quality of care.
The programs included eligible fee-for-service Medicare patients with congestive heart failure, coronary artery disease and diabetes who volunteered to participate between April 2002 and June 2005 and were randomly assigned to treatment or usual care. Many had several chronic illnesses.
Hospitalizations, Medicare expenditures and some quality-of-care outcomes were measured with claims data for 18,309 patients through June 2006. A patient survey conducted seven to 12 months after enrollment provided additional quality-of-care measures.
Nurses provided patient education and monitoring to improve the ability to communicate with physicians and adherence to medication, diet, exercise and self-care regimens. Patients were contacted twice per month on average; frequency varied widely.
The researchers found that 13 of the 15 programs showed no significant differences in hospitalizations.
Mercy Medical Center, in northwestern Iowa, significantly reduced hospitalizations by 17 percent, and the Charlestown retirement community in Maryland had a 19 percent increase in hospitalizations.
None of the programs reduced regular Medicare expenditures, the study found. Treatment group members in three programs - Health Quality Partners in Pennsylvania, the Georgetown medical center in Washington, D.C., and Mercy - had monthly Medicare expenditures of 9 percent to 14 percent less than the control group.
Savings offset fees for Health Quality Partners and Georgetown but not for Mercy; Georgetown was too small to be sustainable.