Fee-For-Service, Medicare, and. Managed, Care Organizations

The objective was to compare practice patterns of hypercholes- terolemia management among payor types and to compare treatment of patients by gender and age in two practice settings. A retrospective study used chart review of patients to assess practice patterns among fee-for-service (FFS), Medicare, restricted (R), and nonrestricted (NR) managed care plans. The medical records of 928 patients treated in lipid clinics and nonlipid clin- ics in a private cardiology practice were randomly selected from a pool of 4,314 patients with identified International Classification of Diseases, Ninth Revision, . Clinical Modification codes 410-414 (ischemic heart disease), Outcomes mea- surements included documentation of low.,density lipoprotein cholesterol (LDL- C), initiation of lipid-lowering pharmacotherapy, the achievement of the National Cholesterol Education Program goal of LDL -Cs:1 00 mg/dL, and the measure- ments of LDL -C, total cholesterol, and high-density lipoprotein cholesterol. In the nonlipid clinic (NLC) setting, LDL-C was documented more often in patients in the NR (81 %j, FFS (73%), and Medicare (65%) payor groups than in the R payor group (31 %) (p=0,001): More patients were'on' lipid'iowering drug - therapy in the NR (66%), FFS (63%); and Medicare (54%) groups than those in the R payor group (28%) (p=0,001). Among patients with a documented LDL -C, more patients in the NR (41 %), FFS (29%), and Medicare (33%) groups achieved .the goal of LDL-CS:100mg/dL than in R group (14%), (p=0.021).ln the NLC set-