Outcomes for Patients With Stroke in Managed Care vs Fee-for-Service

To the Editor. —As a physician concerned about patient outcomes in the changing Medicare market place, I was interested in the article by Dr Retchin and colleagues.¹ However, close review of the article and the accompanying Editorial² greatly disappointed me. How the authors can boldly portray this to be a study comparing outcomes of stroke patients in managed care and FFS care systems based on 8-year-old data coming primarily from 2 states, measuring only 2 outcomes and 1 element of the process of care, is beyond my comprehension. When the authors failed to demonstrate any difference in 2 of the outcomes measured—death and rehospitalization—they assembled snippets of data from other studies designed to compare other outcomes and managed to infer that stroke care in the managed care setting is inferior. Moreover, Drs Webster and Feinglass chose to ignore half of the outcomes in this study (no difference in survival), the severe