Earlier this year, the Department of Health and Human Services’ Office of Inspector General (HHS OIG) released a report showing inaccuracies and limitations in the Medicare enrollment data on race and ethnicity, concluding that the inaccuracies hinder the ability to assess health disparities.
In conducting the analysis, HHS OIG compared self-reported data for a subset of beneficiaries that reside in nursing homes to Medicare data. The Centers for Medicare and Medicaid Services (CMS) collects data from the Social Security Administration and then applies an algorithm to the data; the self-reported data came directly from nursing homes. The self-reported data was found to be the most accurate. HHS OIG also assessed the adequacy of CMS’ data using the Federal standards for collecting race and ethnicity data as a benchmark.
OIG found that the enrollment data from Medicare sometimes identified a beneficiary as a race or ethnicity that they do not identify themselves as in the self-reported data from the nursing home assessment. By way of example, HHS OIG notes that “28% of the beneficiaries identified as Hispanic in the enrollment data do not identify themselves as Hispanic on their nursing home assessments.” Similarly, 46% of beneficiaries identified in the Medicare data as Indian or Alaska Native did not identify that way in the nursing home data.
Going the other direction, 13% of beneficiaries that self-identified as Hispanic in the nursing home assessments were not identified that way in the Medicare data.
Additionally, HHS OIG noted that Medicare’s collection of enrollment data for race and ethnicity was not consistent with federal data standards.
HHS OIG Recommendations
HHS OIG noted that advancing health equity “is a priority” for both CMS and HHS as a whole. To that end, race and ethnicity data are critical to identifying and understanding health disparities among Medicare beneficiaries and to assessing the efforts made to reduce such disparities.
HHS OIG recommended that the Centers for Medicare and Medicaid Services create its own source of race and ethnicity data instead of relying on the Social Security Administration. HHS OIG noted that CMS may want to rely on self-reported race and ethnicity information to improve its current data.
Additionally, HHS OIG recommended that CMS create a new process for ensuring that the data are more standardized and conduct educational outreach to Medicare beneficiaries on CMS’ efforts to improve the race and ethnicity information.
CMS did not explicitly concur with the first recommendation to create its own source of race and ethnicity data, but did concur with the other three recommendations.