Quality of Cardiac Surgeons and Managed Care Contracting Practices

Authors

  • Dana B Mukamel,

  • David L Weimer,

  • Jack Zwanziger,

  • Alvin I Mushlin


  • The authors thank the Agency for Health Care Research and Quality (formerly AHCPR) for funding this research (grant no. HS09803).

Address correspondence to Dana B. Mukamel, Ph.D., David Stewart Associate Professor of Health Policy, University of Rochester Medical Center, 601 Elmwood Ave, P.O. Box 644, Rochester, NY 14642. Jack Zwanziger, Ph.D., was with the University of Rochester Medical Center, Department of Community and Preventive Medicine at the time of the study, and is now with the School of Public Health at University of Illinois at Chicago. David L. Weimer, Ph.D., is with LaFollette School of Public Affairs, University of Wisconsin, Madison. Alvin I. Mushlin M.D., M.S., is with Weill Medical College at Cornell University.

Abstract

Objective. To evaluate the association between contracting practices of managed care organizations (MCOs) with cardiac surgeons and the quality of the cardiac surgeons.

Data Sources/Study Setting. The study included all cardiac surgeons offering coronary artery bypass graft (CABG) surgery and 78 percent of MCOs in New York State in 1998. Primary data: The MCOs' panel composition with respect to hospitals and cardiac surgeons. Secondary data: New York State (NYS) Cardiac Surgery Reports.

Study Design. Statistical analyses of the probability of a contract between cardiac surgeons and MCOs conditional on the surgeon's risk-adjusted mortality rates (RAMR), outlier and low volume status, and controlling for other confounding variables, were performed.

Principal Findings. Contract probability exhibited a tendency to decrease with RAMR, low volume and low-quality outlier status and to increase with high-quality outlier status. These effects were statistically significant for RAMR and high-quality outliers in Downstate and for low volume in Downstate and Upstate.

Conclusions. In some, but not all cases, MCOs are seeking higher-quality providers. Further research is required to understand regional variability and the effect of market structure on the quality profile of MCOs.

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