Key result
Dual eligible and Black Medicare beneficiaries show up to ~80% higher rural ER utilization.
Why the study?
This study evaluated how race and dual eligibility influence emergency room utilization among older adult Medicare beneficiaries treated by rural health clinics in CMS Region 4.
Do race and dual Medicare/Medicaid eligibility influence emergency room utilization among older adult Medicare beneficiaries?
Cohort
Yes
Do race and dual Medicare/Medicaid eligibility influence emergency room utilization among older adult Medicare beneficiaries?
Dual Medicare/Medicaid eligibility and Black race are associated with persistently higher rates of emergency room utilization among older adult Medicare beneficiaries in the Southeastern United States.
Disparities warrant monitoring in RHCs; leaves open effective strategies to mitigate higher ER use in dual-eligible and Black patients.
PURPOSE: This study analyzed individual factors of race and dual eligibility on emergency room (ER) utilization of older adult Medicare patients treated by RHCs in CMS Region 4. METHODOLOGY/APPROACH: A prospective, longitudinal design was employed to analyze health disparities that potentially exist among RHC Medicare beneficiary patients (+65) in terms of ER use. The years of investigation were 2010 through 2012, using mixed multilevel, binary logistic regression. FINDINGS: This study found that dual eligible RHC patients utilized ER services at higher rates than non-dual eligible, Medicare only RHC patients at: 77%, 80%, and 66%, in 2010, 2011, and 2012, respectively; and above the White reference group, Black RHC Medicare patients utilized ER services at higher rates of: 18%, 20%, and 34%, in 2010, 2011, and 2012, respectively. RESEARCH LIMITATIONS/IMPLICATIONS: Regarding limitations, cohort data observations within the window of 3 years were only analyzed; regarding generalizability, in different CMS regions, results will likely vary; and linking other variables together in the study was limited by the accessible data. Future research should consider these limitations, and attempt to refine. The findings support that dual Medicare and Medicaid eligibility, as a proxy measure of socio-economic status, and race continue to influence higher rates of ER utilization in CMS Region 4. ORIGINALITY/VALUE: In terms of ER utilization disparities, persistently, as recent as 2012, Black, dual eligible RHC Medicare beneficiary patients age 65 and over may be twice as likely to utilize ER services for care than their counterparts in the Southeastern United States.
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Bagwell et al. (2020) conducted a cohort in Medicare beneficiary patients treated by Rural Health Clinics. Dual Medicare and Medicaid eligibility and Black race vs. Medicare only eligibility and White race was evaluated on Emergency room (ER) utilization. Dual eligible and Black Medicare beneficiaries aged ≥65 at Rural Health Clinics utilized ER services at up to 80% and 34% higher rates, respectively, than non-dual and White counterparts.
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