Dive Brief:
- White Medicare patients are 50% more likely to receive transcatheter aortic valve replacement (TAVR) than Black patients, according to a report conducted for Advamed.
- The analysis found the use of procedures for cardiovascular, neurovascular and other conditions varies by race. While Black patients were less likely to undergo TAVR and cardiac ablation, they were more likely to receive mechanical thrombectomy.
- KNG Health Consulting, which prepared the report for Advamed, has proposed interventions to decrease gaps in the use of medical technology, including the hiring of “pathway navigators” to help people access specialty cardiology care such as TAVR.
Dive Insight:
The report is split into three parts. In the first part, KNG looked at differences in the use of certain health services by Medicare by race in 2018 and 2019. The second part analyzes the factors that may contribute to racial and ethnic disparities in the use of five procedures, including TAVR. In the third part, KNG took a closer look at the demographics of the patient populations for the five procedures.
The TAVR analysis looked at patients diagnosed with aortic stenosis who were eligible for Medicare but not Medicaid. In that population, 5.1% of White patients underwent TAVR compared to 3.3% of Black people and 3.3% of patients of other races. Black patients were also identified with arrhythmias, angina and aortic stenosis at lower rates than their White counterparts. The researchers found similar differences in a range of therapeutic areas.
“Non-white beneficiaries were less likely to access indicated interventions for many of the cardiac, neurovascular, orthopedic, spinal and respiratory services analyzed as well as certain cancer screenings,” the authors wrote.
Limiting the analysis to patient groups with a relevant clinical condition reduced some of the disparities. However, the authors said the clinical populations, and by extension the disparities, may be understated because of “preexisting racial and ethnic differences in access to primary or specialist care to receive a diagnosis.”
KNG identified two broad categories of factors that may account for the disparities: accessibility and treatment. Limited access to care can delay or prevent treatment. The five procedures analyzed in part two of the report “typically require specialists’ referrals, but access by Black patients is hampered by access to smaller referral networks, which leads to fewer referrals and fewer visits to cardiologists.”
In its analysts of treatment-related factors, KNG explained how “differences in disease pathophysiology, help-seeking behaviors and implicit provider biases” can also delay diagnosis. The underrepresentation of Black patients in clinical trials affects treatment guidelines, the researchers found, and implicit biases contribute to lower provision of some procedures.
The suggestions for how to improve the situation vary by procedure. Efforts to increase the use of TAVR in Black patients “should target referral and follow-up processes to ensure that patients visit specialty cardiologists and follow pathways needed for TAVR treatment.” Pathway navigators could help patients to work through the complex process of getting referred to a specialty cardiologist.
For age-progressive diseases such as arrhythmias, the researchers found “interventions targeting early detection of the disease such as screening among racial minorities, as well as interventions that incentivize referrals to cardiologists could decrease delays and improve timely diagnosis.”