The National Committee for Quality Assurance has been tracking the use of antibiotic treatment in adults with acute bronchitis since 2006 and has found that compliance with not prescribing antibiotics has been "strikingly and perpetually low."
The nation's healthcare providers are making progress in improving care for Medicaid patients and addressing two pediatric issues, but have made little progress in addressing the overuse of antibiotics, a National Committee for Quality Assurance study finds. Instead, study results show "little or no progress on overuse of antibiotics, the main cause of antibiotic resistance."
The State of Health Care Quality Report 2013 [PDF], released Wednesday, reports progress in key areas that was attributed in part to greater collaboration and improved communication between providers and patients. "When we take the long view of progress we've made, we see a lot of good news," said NCQA President Margaret O'Kane at a media conference. "But we also see not-so-good news in some areas."
One area where physicians are persistently and increasingly fall short is in reducing the non-essential use of antibiotics for patients. According to the Center for Disease Control & Prevention, antibiotic-resistant infections are responsible for 23,000 deaths in the U.S. each year and 2 million illnesses. "We know that the main cause of antibiotic-resistant infections is the overuse of antibiotics among patients," said O'Kane.
Since 2006, the NCQA has been tracking the use of antibiotic treatment in adults with acute bronchitis and found that compliance with not prescribing antibiotics was "strikingly and perpetually low."
It also noted that the "only significant change" has been that fewer physicians have opted not to prescribe antibiotics, with compliance rates for HMO physicians dropping from 28.7% in 2009 to 24.2% in 2012. "In seven years, we haven't been able to exceed 30% and the rate in 2012 was worse than it was in 2009," said O'Kane.
Pediatrics
Another area of improvement was pediatric obesity screenings through regular body mass index (BMI) assessments. The study noted that "for the first time, the 'right thing' happened in more than half the cases, with physicians in Medicaid HMOs performing BMIs 51.8% of the time during regular checkups for children between the ages of 3 and 17.
"We exceeded 50% for the first time and we're making progress, but our goal is to see those measures exceed 90%," said O'Kane.
Childhood immunizations were another bright spot. The study found that, in 2012, 63.3% of children enrolled in Medicaid HMOs received influenza vaccinations, an increase of 6.2% from 2010. Immunization rates for the rotavirus, an inflammation of the stomach and intestines, were even higher at 76.7% in commercial HMOs, a 13.2% increase from 2010.
But O'Kane said childhood immunization rates are being hampered by what she calls "urban legends" that spread disinformation about vaccines and lead some parents to not allow their children to be vaccinated.
"A big problem is the urban legend that immunizations cause autism and other problems," said O'Kane. "Providers really need to get the word out to parents that these vaccinations are safe because we're seeing outbreaks of diseases that are entirely preventable."
Charles Homer, MD, CEO of the National Initiative for Children's Healthcare Quality, said the cost associated with some vaccinations may also be a factor in keeping vaccination rates low.
Managed Care
The study found that Medicaid and Medicare plans showed marked improvement in preventive care and patient satisfaction. It showed the percentage of Medicare HMO patients receiving recommended screenings for colon cancer increased from 57.6% in 2010 to 62.1% in 2012 and that the percentage of patients receiving beta-blocker treatment following a heart attack increased from 83.1% in 2010 to 88.9% in 2012.
Patient satisfaction ratings among Medicaid patients also rose. The percentage of Medicaid patients rating their primary care physician with either a 9 or a 10 increased to 63.1% in 2012 from 60.1% in 2009. During that same period, the percentage of medical specialists receiving a 9 or 10 rating increased from 62.1% to 64.4%.
The study attributed the increase in part to Medicaid Expansion under federal healthcare reform and increases in Medicaid reimbursement rates in some states. It suggested that those rate increases "send an important signal to providers that caring for Medicaid patients is financially attractive, a move that likely produced a more engaged primary care network for the safety-net system."
Another factor in improving patient satisfaction among Medicaid enrollees is how physicians and practices communicate with patients and keep them informed, whether it's an email or telephone call reminding them of an upcoming appointment or a call about test results.
Mark LePage, MD, is CEO of Security Health Plan, which was the 10th-ranked Medicaid plan in the U.S. in 2012. He said one way Medicaid plans can improve patient satisfaction is to implement plans designed to keep them in the loop.
"One thing we do is, with every touch point we have with a patient, we reconfirm their contact information to make sure we have their current phone number and email address," said LePage. "It's not the most glamorous plan, but it helps ensure that you can always get in touch with your patients."
LePage also said that setting goals for physicians and attaching incentive payments for reaching them is an important factor. "It helps to incentivize providers through a pay-for-performance program," said LePage. "Each year, we establish a new set of goals that providers must reach to qualify for incentive payments and it seems to be working very well."