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HExD: Improving Patient Outcomes and Hospital Reimbursements
This project seeks to address bias in clinical infrastructure.
By doing so, we can improve patient outcomes and hospital reimbursements.
Embedded Bias
Understanding Health Disparities and Embedded Bias
Health disparities are alarmingly prevalent, often driven by bias embedded in our healthcare infrastructure, including clinical calculations and medical equipment. These biases reinforce existing inequities, leading to poorer health outcomes for marginalized populations and perpetuating the cycle of disparity.
1.2x
COVID Mortality
Non-Hispanic Black patients had higher rates of hospitalization, ICU admission, and in-hospital death compared to non-Hispanic White patients.
1.78x
CKD Mortality
African Americans younger than 65 years are 78% more likely to die than White individuals in the same age group
Pulse Oximeters
Pulse oximeters have been shown to be less accurate in measuring blood oxygen levels in Black patients, potentially contributing to disparities in COVID-19 outcomes.
Nephrology Calculations
eGFR and KDRI calculations often use race as a factor, which perpetuates bias in diagnosis, treatment, and transplantation decisions for kidney disease in Black patients.

06:06

YouTube

PBS News Weekend: How racial biases in medical algorithms lead to inequities in care

Hospitals across the country are using software powered by algorithms with racial biases, according to a new report from a coalition of healthcare providers. This can cause physicians to misdiagnose medical conditions or delay critical treatment. Dr. Jayne Morgan, a cardiologist and president elect of Southeast Life Sciences, joins Geoff Bennett to discuss.

TheGrio

How a colorblind health care system results in Black death

Inequities in health care require that we ask questions at every level of our health care system to avoid unnecessary deaths.

Instagram

Joel Bervell on Instagram: "Up until the end of June 2024 (yes 2024!) kidneys donated from Black Americans were more likely to be discarded when compared to donors of any other race. That’s due to a clinical algorithm called the Kidney Donor Profile Index (KDPI) that assumed that all Black people’s kidneys were likely to function for a shorter amount of time than donors of other races. Thankfully, as of June 28th 2024, the Organ Procurement & Transplantation Network has voted to remove race as a factor in the KDPI algorithm. That could potentially decrease kidney transplant wait times for Black patients and improve overall health equity. #joelbervell #racialbiasinmedicine #kdpi #kidneyfunction"

18K likes, 611 comments - joelbervell on July 5, 2024: "Up until the end of June 2024 (yes 2024!) kidneys donated from Black Americans were more likely to be discarded when compared to donors of any other race. That’s due to a clinical algorithm called the Kidney Donor Profile Index (KDPI) that assumed that all Black people’s kidneys were likely to function for a shorter amount of time than donors of other races. Thankfully, as of June 28th 2024, the Organ Procurement & Transplantation Network has voted to remove race as a factor in the KDPI algorithm. That could potentially decrease kidney transplant wait times for Black patients and improve overall health equity. #joelbervell #racialbiasinmedicine #kdpi #kidneyfunction".

Additional examples of embedded bias

Scientific American

Racial Bias Found in a Major Health Care Risk Algorithm

Black patients lose out on critical care when systems equate health needs with costs

NPR

How A Vitamin D Test Misdiagnosed African-Americans

By a standard test most African-Americans have low levels of vitamin D. But most African-Americans also have strong bones. It turns out that the problem is with the test, which was looking for a form of D more common in Caucasians. The variation is a result of human evolution.

TRCG.ai

Section 1557 | TRCG.ai | Regulatory expertise in Digital Health

This white paper provides a comprehensive overview of the nondiscrimination provisions of Section 1557 of the Affordable Care Act, specifically focusing on care decision support tools and clinical algorithms. It outlines key compliance requirements, potential discriminatory pitfalls, and effective mitigation strategies.

Financial Impact of Health Disparities on Black-Serving Hospitals
Reimbursement practices often financially penalize Black-serving hospitals, which are already strained by systemic disparities. These hospitals face significant financial challenges as they serve communities using tools and equipment not designed with their patients in mind, leading to inadequate compensation and furthering the cycle of underfunding and inequity.
10%
Of US of hospitals are considered "Black Serving"
Approximately 10% (574) of hospitals in the United States are considered 'Black-serving,' meaning they serve a high percentage of Black patients. These hospitals often have a significantly higher percentage of Black inpatients compared to other hospitals
$1,673
More spent is spent on Black Medicare beneficiaries per year.
On average, non-Hispanic Black Medicare beneficiaries incur $1,673 more in adjusted total costs annually compared to their White counterparts. This cost difference is driven by higher rates of hospitalizations, emergency department visits, and preventable complications among Black patients
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P4P and HRRP inadvertently penalizes "Black Serving" institutions
While Pay-for-Performance and Hospital Readmission Reduction Programs aim to improve care quality, they can inadvertently worsen financial disparities by penalizing Black and Minority Serving institutions due to Health Disparities.
2x
More likely to be penalized than institutions with fewer minorities
Hospitals with a high percentage of Black patients are nearly twice as likely to be penalized compared to those serving fewer minorities
$300
Less per patient per day in reimbursement
Black-serving hospitals receive on average $283 to $475 less per patient day in reimbursements, which significantly impacts their financial performance and ability to invest in quality improvements
$40,000,000
A 400 bed Black Serving Hospital loses ~$40 MM in reimbursement every year.
$12.5 Billion
More in Medicare spending/year
But TRCG Can Help:
Improving Patient Outcomes and Profitability
TRCG partners with hospital Clinical, Procurement, Health Equity, and Patient Engagement teams to:
  • Address health disparities and Social Determinants of Health
  • Identify and manage sources of bias within clinical infrastructure
  • Develop culturally and community competent methods of improving patient engagement
Creating a more effective patient, clinician, and infrastructure team — working together to drive better patient outcomes, and reimbursement.
Why TRCG?
Led by a Quality Executive with experience ensuring the safety and efficacy of medical equipment from some of the worlds largest Medical Device manufacturers, TRCG understands how bias is designed into products, how it remains uncorrected, and how to get manufacturers to take action for your patient demographic.
Our teams leverage this deep understanding of Medical Device design and regulation to:
  • Identify potential sources of bias, and
  • Partner with manufacturers to identify root cause and implement remediations
Khalil Thomas
President, TRCG
With a 20 year career at some of the largest MedTech companies, Khalil leverages his experience as a Quality executive, DEI champion, and Health Equity stakeholder to address embedded bias in diagnostic equipment.

TheGrio

How a colorblind health care system results in Black death

Inequities in health care require that we ask questions at every level of our health care system to avoid unnecessary deaths.

Committed to systemically eradicating Health Disparities, TRCG President Khalil Thomas discusses his perspectives on embedded bias in his OpEd in TheGrio
Patient Engagement: Nephrology
Our engagement strategies empower patients to better manage all aspects of their condition so you can focus on medicine.
Adherence
African American patients may receive less frequent monitoring and follow-up care, leading to missed opportunities for early intervention and management of CKD
Dialysis
Black patients often receive dialysis in facilities that may lack the latest technology and equipment, which can affect the quality of care and patient outcomes
Diet
With studies showing the effectiveness of lean-protein diets to slow the progression of CKD, culturally competent meal guides are a great complement to clinical management
Managing Embedded Bias: Nephrology
Our teams follow patients through the care pathway identifying sources of bias within clinical infrastructure, and developing strategies to manage bias embedded bias in equipment, tools, and processes that have meaningful impact on care delivery.
These strategies help address multiple disparities including the following which impact Black CKD patients:
  • Three times more likely to develop end-stage renal disease (ESRD) compared to non-Hispanic whites.
  • Longer wait times and lower rates of kidney transplantation compared to whites, even when controlling for insurance status and other factors.
  • Less likely to be referred for transplant evaluation and are more likely to experience delayed referral.
  • 60% higher risk of graft loss within one year of transplant and a 93% higher risk at five years
Diagnostic Accuracy
The use of race-based adjustments in estimated glomerular filtration rate (eGFR) calculations can result in underestimating the severity of kidney disease in African American patients, leading to delays in diagnosis and treatment
Organ Availability
Removing the race adjustment from the KDRI formula results in the reclassification of nearly 50% of kidneys from Black donors into lower graft failure risk categories, potentially reducing the discard rates of these kidneys and improving overall transplant outcomes
Resource Allocation
Algorithms (like the UHC Risk Calculator) can unintentionally divert resources away from sicker minority patients by underestimating their health risks due to biased data. This misallocation can leave Black patients without the care they need.