Racial disparities in insurance reimbursement for physician professional services in the ED

We sought to determine whether racial disparities exist in emergency physician professional services reimbursement from insurance. We hypothesized that insured adult African American emergency department (ED) visits are reimbursed at a lower level than White visits.

We conducted a retrospective, observational cohort study of insured adult White and African American ED visits (January 1, 2012, to June 30, 2013) to a tertiary center. We downloaded for each included visit age, sex, race, residential zip code, insurance type, admission status, Current Procedural Terminology (CPT) Evaluation and Management (E/M) code charge reimbursement, and median household income for residential zip code. We chose as our primary outcome measure visit mean total insurance reimbursement/work relative value unit (wRVU). We report racial variation for this outcome measure with 95% confidence intervals (CI) and present the β coefficient related to African American race within a multivariable regression model.

A total of 50 297 visits met inclusion criteria (35 574 Whites and 14 723 African Americans). Overall, mean total insurance reimbursement/wRVU for White visits was $39.99 (95% CI, 39.80-40.18), for African American visits, $34.15 (95% CI, 33.88-34.42); P < .01. At the CPT E/M code level, African American visit reimbursement was lower than for White visits, ranging from $2.18/wRVU (95% CI, 0.87-3.49) (99282) to $7.55/wRVU (95 CI, 6.52-8.58) (99285). At the primary insurance level, African American visits showed lower reimbursement than White visits, ranging from $1.70/wRVU (95% CI, 0.75-2.65) in commercial insurance to $7.70/wRVU (95% CI, 5.42-9.98) in other insurance. Within the multivariable regression model, the β coefficient for African American race was -$1.51/wRVU (95% CI, -1.85 to -1.18); P < .001.

In this single-center study, professional services reimbursement was lower for African American ED visits compared with those of Whites.