News Release | Measuring the Quality of Pennsylvania's HMOs | MCPR 2003

MCPR 2003 - Measuring the Quality of Pennsylvania's Commercial HMOs - News Release

FOR IMMEDIATE RELEASE

Contact: Joe Martin, Communications Director
717-232-6787 or

PENNSYLVANIA HMOs RATE HIGH ON PREVENTIVE CARE, BUT HOSPITALIZATION RATES RISE FOR SOME CONDITIONS

Harrisburg, PA - March 31, 2005 - Pennsylvania HMOs performed better than the national HMO average in testing blood sugar levels, cholesterol screening and controlling "bad" cholesterol for members with diabetes. HMOs in the state also did better than the national average in providing the recommended childhood immunizations, controlling high blood pressure, and controlling "bad" cholesterol after acute cardiovascular events.

"Pennsylvania HMOs have been doing a good job of providing services to their members for the prevention and early detection of health problems," said Marc P. Volavka, Executive Director of the Pennsylvania Health Care Cost Containment Council (PHC4). "However, hospitalization rates are up for urinary tract infections, ear, nose and throat infections and asthma - areas where HMOs could focus quality improvement efforts."

According to the PHC4 report, Measuring the Quality of Pennsylvania's Commercial HMOs, on average, Pennsylvania HMOs showed improvements over the prior year in their rates of controlling the "bad" cholesterol of members with diabetes (an 11.2% improvement), providing childhood immunizations (a 10.3% improvement), and controlling high blood pressure (an 8.8% improvement). On average, Pennsylvania HMOs improved from the prior year in 12 of the 16 "Staying Healthy" measures.

According to member satisfaction surveys for calendar year 2003, Pennsylvania HMOs, on average, outperformed their national counterparts in all the member satisfaction measures for which a national average was available. Furthermore, all plans reported an increase from the prior year in the percent of plan members who gave their HMO the highest satisfaction rating.

However, the report showed significant increases in HMO hospitalization rates since last year for: asthma (up 40.4% for adults and 27.1% for children under age 18), ear nose and throat infections (up 14.0% for adults and 22.0% for children under age 18), and kidney/urinary tract infections (up 16.5%). With effective primary care, hospitalization for these conditions should not be necessary. The report shows 4,418 hospitalizations, 11,268 inpatient days, and $51.8 million charges in 2003 for adult and pediatric ear, nose, and throat infections; high blood pressure; gastrointestinal infections; and kidney/urinary tract infections.

Other findings:

Hysterectomy: The report found that hysterectomy procedure rates vary widely among HMO plans: adjusted rates varied from 33.3 to 89.9 per 10,000 adult female members, and the state average was 56.8. Five of the HMOs had lower than expected rates and the other five HMOs had higher than expected hysterectomy rates. While the HMO in-hospital complication rate for abdominal hysterectomy decreased significantly (-22.7%) from 2000 to 2003, the complication rate for HMOs was significantly higher (25.5%) than the rate for fee-for-service plans.
Neck and Back Procedures: The neck and back procedure rate for HMOs increased significantly (+8.4%) over the previous year; significantly more (9.4%) of those procedures also included a fusion.
The Pennsylvania Health Care Cost Containment Council is an independent state agency charged with collecting, analyzing, and reporting information that can be used to make more informed decisions, thereby improving the quality and restraining the cost of health care in Pennsylvania. Copies of the report are free and can be ordered by calling PHC4 at 717-232-6787 or can be downloaded from PHC4's website at http://www.phc4.org.

Go to 2003 MCPR Home