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To the Editor: Dr Erickson and colleagues¹ concluded that patients with managed care insurance were less likely than those with fee-for-service (FFS) insurance to undergo coronary artery bypass grafting (CABG) at hospitals with lower mortality rates. However, the data in Table 1 of their article provide evidence that CABG inpatient mortality rates among patients enrolled in managed care plans are equal to or better than mortality rates among those in non–managed care plans. The authors minimize this central finding because they focus on the likelihood of using "lower-mortality hospitals," a very difficult metric to interpret.

Hospital use does not necessarily represent insurer contracting decisions. Indeed, Erickson et al did not determine which hospitals managed care organizations did or did not typically contract with. Rather, they contrasted hospital choices of physicians for very dissimilar patient populations. Given the lower mortality rates among individuals in managed care organizations compared with those with . . . [Full Text of this Article]

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The Relationship Between Managed Care Insurance and Use of Lower-Mortality Hospitals for CABG Surgery
Lars C. Erickson, David F. Torchiana, Eric C. Schneider, Jane W. Newburger, and Edward L. Hannan
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