Is the profit motive pushing more deaths into the daily coronavirus account? Federal funding based on COVID-19 fatalities are fueling allegations that hospitals are over-reporting the real numbers.
On April 15, the Centers for Medicare & Medicaid Services (CMS) began implementing the Coronavirus Aid, Relief, and Economic Security (CARES) Act that increases payment for cases where an individual diagnosed with COVID-19 is discharged — or died — during the COVID-19 Public Health Emergency (PHE) period.
The 20 percent increase is not a bonus but a boost in Medicare inpatient hospital payments provided for under the law for beneficiaries diagnosed with COVID-19 and treated during the COVID-19 PHE, a CMS spokesman told InsideSources.
If a person has coronavirus in their diagnosis — whether they were hospitalized for COVID-19 or not — the reporting hospital receives a reimbursement of $13,000 — and an extra $39,000 if the patient is put on a ventilator.
Moreover, the CARES Act established a $100 billion fund to aid hospitals — of which some $30-$50 billion is “used to reimburse healthcare providers, at Medicare rates, for COVID-related treatment of the uninsured,” the U.S. Department of Health and Human Services (HHS) stated.
Provisions in the act also allow for hospitals to receive three times more per patient in need of a ventilator, multiple analyses have confirmed.
This has led to speculation that patients who merely test positive but die from other causes are listed as coronavirus deaths to benefit the hospital’s bottom line.
Republican State Sen. Scott Jensen, a Minnesota-based physician, set off a firestorm in April, when he questioned the reimbursement system and whether hospitals were adding COVID-19-related deaths to their death certificates to get increased funds.
Jensen was responding to infectious disease expert Dr. Anthony Fauci, who said during a coronavirus task force briefing “you will always have conspiracy theories when you have very challenging public health crises. They are nothing but distractions.”
“I would remind him that anytime health care intersects with dollars it gets awkward,” Jensen wrote. “Right now Medicare has determined that if you have a COVID-19 admission to the hospital, you’ll get paid $13,000. If that COVID-19 patient goes on a ventilator, you get $39,000, three times as much.
“Nobody can tell me after 35 years in the world of medicine that sometimes those kinds of things impact on what we do.”
Doug Badger, a visiting fellow for domestic policy studies at The Heritage Foundation, sees the potential problem.
“The way the [congressional] language is written, is if it’s a COVID-19 admission — whether or not the patient recovers — hospitals get the add-on payment,” Badger told InsideSources. “If you have a COVID-19 diagnosis in your submission to Medicare, you get a 20 percent bump up.”
The Foundation for Economic Education says simply that “the economic incentive to add COVID-19 to diagnostic lists and death certificates is clear and does not require any conspiracy.”
In Colorado, when officials stopped reporting all deaths of infected people as COVID-19 fatalities and instead only included those who died from the virus’s impact, their death toll fell from 1,150 to 878 — a 24 percent decrease.
“We recognize that there certainly has been confusion around this topic,” Dr. Rachel Herlihy, the state epidemiologist, said during a media call.
Jensen insists he never insinuated that hospitals were listing coronavirus admissions — or “presumptive cases” — as a cause for increased funding, but “facilities are incentivized to raise the index of severity.”
“I think there has been unintentional, inaccurate coding and the motivation for that could be haste… I think there is the potential — if you will — [for] administrative guidance or encouragement [to] contribute to unintentional, inaccurate coding,” Jensen told InsideSources.
“I’ve gotten letters from physicians across the country saying: ‘Thank you Dr. Jensen for being transparent on this, we all know that coding is squishy business’ and I’ve heard from other people that are just furious with me.