Concerns Remain As Quality of Care Improves, NCQA Reports

More Medicare patients are continuing to see better quality of care according to the National Committee for Quality Assessment’s (NCQA) 2013 State of Health Care Quality Report. Despite this, the NCQA was concerned with the high rate of antibiotics being prescribed to treat the common cold which adds to the increasing problem of antibiotic resistant bacteria, and the decline in the initiation and engagement of alcohol and other drug dependency treatments. These findings are based upon data in the Healthcare Effectiveness Data and Information Set (HEDIS) from 2012 provided by health plans covering 136 million people, or 43 percent of the U.S. population. More than 1,000 health plans voluntarily disclosed the clinical quality, consumer experience and resource data that are used to make the report.

Over Use of Antibiotics

The use of antibiotics to treat acute bronchitis, or the common cold, was a concern to the NCQA. Well over 75 percent of adults who were diagnosed with acute bronchitis were prescribed an antibiotic. Acute bronchitis is caused by a virus and there have been no studies that have shown the use of antibiotics are effective in treating a viral infection. Over 10 million people seek treatment for acute bronchitis from their physicians and 2 million people have reported to hospital emergency rooms with acute bronchitis. In more than 60 percent of these cases an antibiotic was prescribed.

The NCQA’s concern with this level antibiotic usage without a substantiated clinical reason is that it adds to the increase in bacteria that are resistant to antibiotics. In September of 2013, the Centers for Disease Control, (CDC) reported that 2 million people are sickened each year by an antibiotic resistant bacteria and that 23,000 die from the infection. The NCQA noted that the CDC reported that such infections can increase hospitalizations and require extensive treatments that can be avoided.

Alcohol and Chemical Dependency

Another area of concern for the NCQA was the continued decline in the initiation and continued engagement for the treatment of dependence on alcohol and other drugs. In 2012, the percentage of people who initiated dependency treatment declined by roughly 3 percent from 2011. The largest decline was among Medicare beneficiaries; whose treatment declined nearly 4 percent. This decline began in 2009. The decline in individuals who received two or more services within the 30 days of their initiation visit also continues. In 2012, roughly 13 percent of people who received an initial treatment for dependency had 2 or more visits in the following 30 days. In 2011, an estimated 21.6 million people needed treatment for chemical dependency with annual death rate of roughly 100,000 people.


Improvements were seen in Medicare HMOs on the delivery of a number of quality of care indicators. NCQA noted that the most improvement for Medicare beneficiaries was seen in screenings for colorectal cancer. In 2012, 62 percent of Medicare beneficiaries enrolled in HMOs and 58 percent of Medicare beneficiaries enrolled in a preferred provider organization (PPO) received a screening for colorectal cancer. These are increases of 2 and 3 percent respectively. In 2012, an estimated 140,000 people were diagnosed with colon cancer and there were approximately 48,000 deaths due to colon cancer. The decrease in the incidence and death rates associate with colon cancer is a result of early screenings, the NCQA reported.

Increases were also observed for Medicare beneficiaries in the persistent use of beta-blockers following a heart attack. In 2012, 89 percent of Medicare beneficiaries and 88 percent of Medicare beneficiaries in PPO received beta-blockers after having a heart attack. About 7.2 million people have had a heart attack and the use of beta blockers, which slows the heart beat and controls heart rhythms, is proven to decrease the likelihood of sudden cardiac death.