HOSPITALS AT TIMES GET EXTRA MONEY AMID VIRUS
Yes, but reimbursements from government limited to specific cases
Reimbursements are limited to specific cases.
A claim that states and hospitals inflate coronavirus death counts so they’ll receive more money from the federal government has been circling for weeks on social media, with questions raised anew after Colorado’s health department recently changed how it reports COVID-19 fatalities.
The Denver Post sought to verify whether there’s any financial benefit related to coronavirus diagnoses, and found the government does pay hospitals a higher reimbursement for patients with COVID-19 under the federal Coronavirus Aid, Relief and Economic Security Act, or CARES Act.
But that’s limited to a specific patient population — those who are on Medicare, the federal health insurance that covers people 65 and older.
In Colorado, state health data shows people 60 and older make up 27.4% of all confirmed cases — and 91% of the state’s coronavirus-related deaths.
Yet industry experts say that even with that increase for COVID-19 patients, Medicare reimbursements still remain well below the actual cost of care.
“The idea that hospitals and doctors are falsely inflating COVID numbers and even putting patients on ventilators to drive up their payments is not just ridiculous, but it’s insulting to the doctors who are putting their own lives at risk,” said Joe Hanel, spokesperson for the Colorado Health institute.
As of Friday, the state Department of Public Health and Environment is breaking up its tally of
COVID-19 deaths into two categories.
The first category has been used by the health department since the start of the pandemic and includes the total number of people who died who have COVID-19, regardless of whether it was the virus that ultimately killed them. This number, which sat at 1,257 deaths as of Tuesday, comes from reports made to the state health department by doctors, laboratories and coroners.
The second comes solely from death certificates that listed COVID-19 as a cause of death. That data shows that there were 968 people who died directly from COVID19, as of Tuesday. There’s a several-week lag in the death certificate data so public health officials expect that number to increase.
“No additional funding” tied to deaths
But there is no financial benefit to having a death certificate state that a person’s cause of death was directly tied to COVID-19, said Dr. Leon Kelly, El Paso County’s coroner, who also has served as deputy medical director for the county’s public health department during the coronavirus crisis.
“The coroner’s office is obviously funded by the county budget and it’s a fixed budget decided the year before,” he said. “There’s no additional funding that’s tied to the number of COVID deaths that are ruled in your county, or even autopsied and ruled by your coroner’s office.”
Any money that a coroner’s office might get under the CARES Act is based on the county’s population and needs. For example, Kelly said, if the coroner’s office needs to order more refrigerator units to store bodies during a surge, it could receive a reimbursement from the government for the cost of the units.
“But it’s not tied in any way to the number of COVID deaths that you have,” he said.
In most cases, Kelly said, patients with COVID-19 are dying at hospitals, so medical examiners often are not directly involved in ruling the cause of death.
Under the CARES Act, the government will pay hospitals 20% more for Medicare patients with COVID-19.
These payments are for Medicare patients with the disease who are hospitalized, and doesn’t change based on whether someone is discharged or dies. They also do not cover those who seek medical care for the coronavirus at emergency rooms and are not admitted for hospital stays, said Julie Lonborg, senior vice president of the Colorado Hospital Association.
The Kaiser Family Foundation estimates that the total amount of payments to U.S. hospitals for treating uninsured patients during the pandemic could range from $13.9 billion to $41.8 billion.
The foundation found that the average Medicare payment to hospitals for respiratory infections in 2017 ranged from $13,297 to $40,218, depending on the severity of the illness.
In Colorado, Medicare reimbursement typically equates to 70 cents per dollar for the cost of care provided to a patient. Under the CARES Act, the reimbursement increases to 84 cents per dollar for care for COVID-19 patients, Lonborg said.
“They definitely pay us more for these patients but we still lose money for every (Medicare) patient that we provide this care,” she said.
Probable COVID-19 cases included
Part of the concern over hospital payments is driven by the fact that the U.S. Centers for Medicare and Medicaid has told providers they can use the COVID-19 diagnosis code for patients who not only have tested positive for the virus, but also those who are believed to likely have the respiratory disease. This is different from other illnesses, such as heart attacks, where the diagnosis is more concrete, Lonborg said.
The reason probable cases of COVID-19 are included, she said, is because testing for the disease has been limited.
“The notion that we get paid based on a code for a patient that died, in reality you get paid for the care that we provide and I think that’s a really big distinction,” Lonborg said.
Tracking the total number of deaths among people with COVID-19 is important because there’s much that medical and public health officials don’t know about the disease, Lonborg said.
For example, she said, there are concerns the new coronavirus is causing blood clotting that can lead to strokes.
“You want to know if it’s a coincidence,” Lonborg said. “Or is there something else in this virus that we don’t know yet.”
Overall, deaths in Colorado were up 20% in March and April, compared to the same period in 2019. The increase was largely due to COVID-19.
“That’s one way of kind of doing a reality check of the scope of the pandemic,” Hanel said. “In most cases that I’ve seen, if the COVID death counts are wrong, it’s that they are too low.”