Medicare Star excludes diabetes patients with poor CVD risk factor control.

  • Schmittdiel J
  • Raebel M
  • Dyer W
 et al. 
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Abstract

OBJECTIVES: CMS recently added medication adherence to antihypertensives, antihyperlipidemics, and oral antihyperglycemics to its Medicare Star quality measures. These CMS metrics exclude patients with
STUDY DESIGN: Cross-sectional, population-based analysis of 129,040 patients with diabetes aged ≥65 years in 2010 from 3 Kaiser Permanente regions.

METHODS: We estimated adjusted risk ratios to assess the relationship between achieving Star adherence and being excluded from Star adherence metrics, with CVD risk factor control (glycated hemoglobin [A1C]
RESULTS: Star metrics excluded 27% of patients with diabetes prescribed oral medications. Star-defined nonadherence was negatively associated with CVD risk factor control (risk ratio [RR], 0.95, 0.84, 0.96 for A1C, LDL-C, and SBP control, respectively; P
CONCLUSIONS: Medicare Star adherence measures underestimate the prevalence of medication nonadherence in diabetes and exclude patients at high risk for poor CVD outcomes. Up to 3 million elderly patients with diabetes may be excluded from these measures nationally. Quality measures designed to encourage effective medication use should focus on all patients treated for CVD risk.

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Authors

  • Julie A Schmittdiel

  • Marsha A Raebel

  • Wendy Dyer

  • John F Steiner

  • Glenn K Goodrich

  • Andy Andrew J Karter

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