Interfacility Transfers from the Emergency Department for Non-contracted Insurance Status Disproportionately Affect...

Transfers between emergency departments (ED) can have an important impact on patient care and experience. We examined interfacility transfers from an academic ED due to insurance status to determine whether they disproportionately affected minority demographics.

Our objective was to determine whether interfacility transfers for non-contracted insurance status disproportionately affected minority patients in our hospital ED.

We extracted data from the hospital's electronic health record system. Records for patients who underwent facility transfer were reviewed to determine which transfers were due to insurance contracting status. We compared the number of patients transferred for insurance incompatibility with the number admitted to the same hospital as initially seen in the ED, either to observation or inpatient status, for groups with socioeconomic minority status including Hispanic, Hispanic non-White, Black, Native American, and non-English speaking.

We identified 2,031 total interfacility transfers. Of these, 735 (36.2%) met inclusion criteria, and 49.7 % (366/735) of these transfers were due to insurance incompatibility. The total transfer rate for all patients was .93% (366/39,299). Increased transfer rates due to insurance incompatibility were observed for all minority demographics queried. The most severe disparity in effect size was for non-English speakers (2.06% compared to 0.90% for English-speakers; 2.32 odds ratio [OR], P < .001). Patients with Hispanic ethnicity experience insurance transfer in 1.31% of cases compared to 0.87% for non-Hispanic whites (OR 1.52, P < .001). The insurance transfer rate for all non-White patients was elevated at 1.11%, but this did not rise to the level of statistical significance (OR 1.28, P = .06).

In our single-center ED study, minority patient populations were disproportionately impacted by interfacility transfers for non-contracted insurance status. We found increased transfer rates due to insurance incompatibility for all minority demographics queried. The most severe disparity was found for non-English speakers and patients with Hispanic ethnicity.