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Sebastian Smith | Alternative Column
United States Medicare Pays Hospitals More To List Deaths As Covid-19
Cover photo: Official White House by Tia Dufour
To sum up the past year, we have seen events from global lockdowns, mass house arrests, and a vast array of fear campaigns peddled by both the government and the media. Of course, the justification behind all that is an apparent Coronavirus Pandemic, but before you hide away in fear seeing the Coronavirus deaths, just know it isn’t all black and white.
This article aims not to give medical advice but instead to add perspective to the situation that the media turns its back on.
On the 27th of March, 2020, President Donald Trump signed the Coronavirus Aid, Relief and Economic Stimulus Act, otherwise known as the CARES Act. The act aimed to pass a $2.2 trillion economic stimulus bill to help individuals, businesses, and health care providers gain financial relief throughout the pandemic.
Part of the bill meant that Medicare, the government insurance agency for over 65’s – which happens to be the ones dying from covid, would now pay larger sums of money to hospitals. If a Medicare patient is diagnosed with, or is presumed to have contracted coronavirus, hospitals across the United States are given more money from the U.S government to treat the patient. The given amount can as much as triple if the patient requires a ventilator, bringing some concern of whether there is a financial incentive to overstate coronavirus numbers, with others calling such potential acts “conspiracy theories”.
The CARES Act authorized a temporary 20 percent increase in hospital Medicare payments for COVID-19 patients to account for increases in the cost of care for these medically complex patients.
The American Hospital Association (ASA) also released a report claiming: ‘During the emergency period, the legislation provides a 20% add-on to the DRG rate for patients with COVID-19. This add-on will apply to patients treated at rural and urban inpatient prospective payment system (IPPS) hospitals.’
To make things easier, currently, in the United States, the Centers for Disease Control and Prevention (CDC) conclude that Covid deaths include ‘deaths where COVID-19 is listed as a “presumed” or “probable” cause’.
On April the 8th Sen. Scott Jensen, R-Minn., a physician and sennetor in Minnesota, was interviewed by host Laura Ingraham on Fox News and claimed hospitals get paid more if Medicare patients are listed as having COVID-19 and get three times as much money if they need a ventilator.
Jensen later stated on his Facebook page on April 15, saying:
“How can anyone not believe that increasing the number of COVID-19 deaths may create an avenue for states to receive a larger portion of federal dollars. Already some states are complaining that they are not getting enough of the CARES Act dollars because they are having significantly more proportional COVID-19 deaths.”
Jensen said, “Hospital administrators might well want to see COVID-19 attached to a discharge summary or a death certificate. Why? Because if it’s a straightforward, garden-variety pneumonia that a person is admitted to the hospital for – if they’re Medicare – typically, the diagnosis-related group lump sum payment would be $5,000. But if it’s COVID-19 pneumonia, then it’s $13,000, and if that COVID-19 pneumonia patient ends up on a ventilator, it goes up to $39,000.”
”As soon as they get those other diagnoses into their data bank, they can go to their insurance payer or to medicare and say, see, we deserve more money because we have a more complicated group of patients.”
”We’re seeing an expansion of what that patient’s chart looks like, what their picture looks like. Why? Because if we can increase the index of severity of a patient, we get paid more”.
“I was a medical director of a nursing home for years. We constantly talked in our meetings about the need to elevate the index of severity because then the nursing home gets paid more per day per patient.
I know this is offensive, but this is the way it works.”
According to release from the Kaiser Family Foundation, a nonprofit organization focused on American health, the U.S. Department of Health and Human Services (HHS) increased its allocation from $30 billion to $50 billion to providers.
It wrote, “this more targeted funding will help address concerns from hospitals in the hardest-hit areas that they had not gotten sufficient funds to help them manage a surge in COVID-19 patients. To help HHS determine which facilities will qualify for this targeted distribution, each hospital must submit the number of ICU beds it has and its total COVID-19 admissions as of April 10, 2020”.
What do the 'fact checkers' think?
Usually, it’s the ‘independent’ fact-checkers who crave subjects like this, often rushing in to try and discredit anything that challenges the status quo. However, in this case, even that fact-checkers were unable to ‘debunk’ the facts.
Politifact claimed it is ‘half true’ stating that hospitals do get paid more by Medicare, but that does not necessarily mean physicians will fake data.
It is not to say that doctors would maliciously fake death certificates, but when money is on the table, things can get awkward.
Patients, of course, can be expensive to look after, particularly after a certain time. Would it come as such a surprise if hospital administrators wanted to slightly increase the severity index of a patient, to receive some extra insurance money?
Issues like this really do show the complexity of the situation.