- Inaccuracies and other limitations in Medicare enrollment data on race and ethnicity are hampering the agency's ability to assess and combat health disparities among its 66 million beneficiaries, according to a new report from the HHS Office of Inspector General. The data contain more inaccuracies for people identified as American Indian/Alaska Native, Asian/Pacific Islander or Hispanic than for other groups.
- Limited race and ethnicity categories and missing information are part of the problem, and the enrollment figures are inconsistent with federal data collection standards, the OIG said. Use of an algorithm improves the data but falls short of self-reported information.
- The inaccuracies inhibit the work of identifying and reducing health disparities in the Medicare population, the report said.
Addressing inequitable care in the U.S. medical system is an urgent priority of both health providers and the government. Research has consistently revealed poorer outcomes from the way healthcare is delivered to Black patients. One recent study uncovered racial bias in how clinicians described patients in their electronic health records.
Race and ethnicity data are the foundation for identifying and understanding health disparities among Medicare beneficiaries and assessing the effectiveness of work to improve the quality of care, the OIG said. Inaccuracies in the data affect the understanding of disparities in the prevalence, severity and outcomes of diseases and conditions, including COVID-19, and in healthcare quality and access, the report said. The inaccuracies limit the ability to design and target efforts to address disparities in these areas and to measure the results of those efforts.
"It is critical that these data are accurate, complete and comprehensive," the OIG said. "The need for better data is pressing."
But improving Medicare's race and ethnicity data will be a significant undertaking. Medicare's enrollment database is the only source of race and ethnicity information for all beneficiaries. The data comes from the Social Security Administration and the results of an algorithm that the CMS applies to the source data.
To assess the accuracy of Medicare's race and ethnicity data for different groups, the OIG compared the numbers to self-reported data for a subset of beneficiaries living in nursing homes. Race and ethnicity data that are self-reported are considered the most accurate, the report said. The research also looked at federal standards for collecting race and ethnicity data as a benchmark.
To improve the quality of its data, the OIG recommended that the CMS develop its own source of information using self-reported details on race and ethnicity for current beneficiaries. The agency should develop a process to ensure that the data are as standardized as possible and should educate beneficiaries about its efforts to improve the information, the OIG said.
The CMS did not explicitly agree with the recommendation that it develop its own data source but did agree with the other suggestions.