ER Algorithm Found to Exacerbate Racial Disparities

By Consumers for Quality Care, on May 24, 2023

An algorithm utilized by emergency departments (EDs) to identify the overutilization of medical services runs the risk of unfairly penalizing Black and Hispanic consumers for seeking care compared to white consumers, according to a study conducted by JAMA Network Open and reported by Fierce Healthcare. 

Because emergency departments are costly, payers are always looking for ways to streamline services. One way to implement cost-saving measures is to identify what care should be considered “emergent,” i.e., a proper use of ED services. Unfortunately, the study found that an algorithm used by children’s hospitals disproportionally affected Black and Hispanic children, who according to the study were “significantly more likely to have their ED visits classified as nonemergent,” which can result in “relatively lower payment for ED clinicians caring for Black and Hispanic children” andhigher out of pocket expenses for families.

The researchers found that a higher percentage of Black and Hispanic children, 50.3 percent and 49 percent, respectively, were found to have nonemergent ED visits than white children (45.3 percent) according to the algorithm developed by the Virginia Department of Medical Assistance. 

The study noted that consumers may delay or avoid seeking the medical care they need for fear of incurring out-of-pocket expenses they cannot afford. The study’s corresponding author, Alon Peltz, M.D., addressed concern that the algorithm may be reducing quality of care for some consumers, particularly across racial and ethnic lines.

CQC urges lawmakers, providers, and regulators to do their part to identify and address racial disparities in our health care system.