Inaccuracies in Medicare's Race and Ethnicity Data Hinder the Ability To Assess Health Disparities

WHY WE DID THIS STUDY

The disparate impacts of the COVID-19 pandemic on various racial and ethnic groups have brought health disparities to the forefront. Health disparities are differences in health that adversely affect certain groups. People of color have been found to experience disparities in areas such as access to care and quality of care. Such disparities have profound implications for the health and well-being of these individuals.

Medicare is an essential part of the Nation's health care system, with 66 million beneficiaries enrolled. CMS has made advancing health equity a top priority. Ensuring that Medicare is able to assess disparities is key to this goal. The ability to assess health disparities hinges on the quality of the underlying race and ethnicity data.

HOW WE DID THIS STUDY

We analyzed the race and ethnicity data in Medicare's enrollment database, the only source of this information for all enrolled beneficiaries. These race and ethnicity data are derived from source data from the Social Security Administration and the results of an algorithm that CMS applies to the source data. We assessed the accuracy of Medicare's enrollment race and ethnicity data for different groups by comparing them to self-reported data for a subset of beneficiaries who reside in nursing homes. Race and ethnicity data that are self-reported are considered the most accurate. We also assessed the adequacy of Medicare's data using the Federal standards for collecting race and ethnicity data as a benchmark.

WHAT WE FOUND

Medicare's enrollment race and ethnicity data are less accurate for some groups, particularly for beneficiaries identified as American Indian/Alaska Native, Asian/Pacific Islander, or Hispanic. Data that are not accurate limit the ability to assess health disparities. Limited race and ethnicity categories and missing information contribute to inaccuracies in the enrollment data. Although the use of an algorithm improves the existing data to some extent, it falls short of self-reported data. Finally, Medicare's enrollment data on race and ethnicity are inconsistent with Federal data collection standards, which inhibits the work of identifying and improving health disparities within the Medicare population.

WHAT WE RECOMMEND

Advancing health equity is a priority for CMS and the Department. Race and ethnicity data are foundational to identifying and understanding health disparities among Medicare beneficiaries and to assessing the effectiveness of efforts to reduce such disparities. It is critical that these data are accurate, complete, and comprehensive. Therefore, CMS must improve its race and ethnicity data; though a significant undertaking, the need for better data is pressing. Accordingly, we recommend that CMS: (1) develop its own source of race and ethnicity data, (2) use self-reported race and ethnicity information to improve data for current beneficiaries, (3) develop a process to ensure that the data are as standardized as possible, and (4) educate beneficiaries about CMS's efforts to improve the race and ethnicity information. CMS did not explicitly concur with the first recommendation and concurred with the other three recommendations.