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HMOs may skimp on care for stroke patients, study says
July 8, 1997
Web posted at: 11:41 p.m. EDT (0341 GMT)WASHINGTON (CNN) -- HMOs may be skimping on costly health care that could help stroke victims during recovery, a new study says.
Stroke victims in managed-care or health maintenance organizations are more likely to go to nursing homes and less likely to go to specialized rehabilitation centers than are patients who are covered by traditional insurance.
Findings from the study, led by Dr. Sheldon M. Retchin of Virginia Commonwealth University in Richmond, are published in Wednesday's issue of The Journal of the American Medical Association.
Some stroke experts find the study results disturbing.
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"It's shortsighted in terms of cost," Dr. Mark Ozer of National Rehabilitation Hospital said. "It's not just shortchanging the person, it's shortchanging the country, because the ultimate result is less satisfactory."
Strokes are the third leading cause of death in the United States. They are caused when blood vessels in the brain are blocked, restricting the flow of blood to brain tissues. The ailment can result in paralysis, weakness, speech defects and possible death.
A spokesman for HMOs noted the study did not look at the functioning ability of stroke victims, such as how well they walk or care for themselves as they recover, and failed to distinguish between nursing homes and skilled nursing centers, which offer more specialized care than nursing homes.
Also, some of the patients may have gone to rehab centers after receiving nursing facility care. "Most nursing homes now have a skilled nursing unit," said Marcie Snyder, a registered nurse from Integrated Health Services.
But in an editorial accompanying the study, doctors cite extensive research confirming the improved recovery of patients in specialized rehabilitation programs.
"It's unclear that rehabilitation makes them live longer," Dr. James Webster of Northwestern University Medical School said. "It is very clear that it makes their lives better."
The researchers studied records of a nationally representative sample of Medicare beneficiaries: 402 patients covered by 19 HMOs in 12 states and 408 comparable patients covered by traditional insurance in the same states.
The study found that 42 percent of stroke patients who belong to HMOs and are covered by Medicare went to nursing homes after their initial hospitalization, compared to 28 percent of those with traditional fee-for-service insurance.
Only 16 percent of HMO patients went to rehab centers after being released from the hospital, compared to 23 percent of similar patients with traditional insurance.
Although the researchers admit more study is needed to find out how HMOs make their treatment decisions, doctors agree that the best prescription for helping stroke patients recover is intensive -- and ongoing -- rehabilitation.
Correspondent Al Hinman contributed to this report.
Related stories:
- HMOs: The cost of cutting prices - May 23, 1997
- Former HMO reviewer: Patient died, but HMO saved money - April 15, 1997
- Are HMOs the wrong prescription for patients? - April 2, 1997
- HMOs defend doctor-patient rules of communication - December 9, 1996
- Poor and elderly do worse in HMOs - October 1, 1996
- Critics say HMOs hiding facts to save bucks - May 31, 1996
Related sites:
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- Glossary of HMO Terms
- The HMO Page
- HAA-Legislative Update
- American Academy of Ophthalmology
- White Paper on Cataract Surgery - American Academy of Ophthalmology
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