Do MCOs dictate eye care?
August 1, 1997 less than 1 minute read
Do MCOs dictate eye care?
Cataract extraction is in the best interest of patients, yet Medicare patients in fee-for-service settings are twice as likely to undergo the extractions as patients in HMO settings, say researchers.1 Data gathered in a recent study comparing rates of cataract removal could have a substantial impact on vision care for older persons. Uncorrected visual disability can lead to poor quality of life and future cost drains. The study included 43,000 staff-model HMO enrollees, 19,000 IPA enrollees, and 47,000 fee-for-service Medicare patients. Both prepaid settings restrict referrals to ophthalmologists by gatekeepers.
Cataract extractions account for Medicare’s single largest expenditure. Given the rapid expansion of prepaid care and the political movement to expand Medicare managed care, say the investigators, the quality implications of these rate differences are enormous.
Reference
1. Goldzweig CL, Mittman BS, Carter GM, et al. Variations in cataract extraction rates in Medicare prepaid and fee-for-service settings. JAMA 1997; 277:1765-1768.
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