Let’s be honest from the beginning: Medicare patients — 65 and older — are those who reside in the epicenter for this COVID explosion. What does that mean? It means that Medicare dollars are snatched up in much greater numbers for COVID-19 treatment of Medicare patients than private insurance companies pay for in-patient care for non-Medicare patients.
Crazy numbers have been thrown about by many making outlandish claims that hospitals are gouging the federal government for their treatment of Medicare patients. But, in our commitment to total honesty, hospitals DO get much more reimbursement from the Centers for Medicare and Medicaid Services (CMS) for treating in-patient Medicare patients for COVID-19 treatment while they are hospitalized.
Before we clear the air for you on this subject, let’s look at a reimbursement claim made publicly by a well-known physician. That’s interesting, but what is MORE interesting are the results of that doctor’s claims when several Fact-Check organizations took him to task:
The claim: Hospitals get paid more if patients are listed as COVID-19, and on ventilators
Sen. Scott Jensen (R-MN), a physician in Minnesota, was interviewed by “The Ingraham Angle” host Laura Ingraham on April 8 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. The claim was published April 9 by The Spectator, a conservative publication. WorldNetDaily shared it on April 10 and, according to Snopes, a related meme was shared on social media in mid-April.
“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.”
On April 19, he doubled down on his assertion via video on his Facebook page.
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 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.”
Jensen clarified in the video that he doesn’t think physicians are “gaming the system” so much as other “players,” such as hospital administrators, who he said may pressure physicians to cite all diagnoses, including “probable” COVID-19, on discharge papers or death certificates to get the higher Medicare allocation allowed under the Coronavirus Aid, Relief and Economic Security Act. Past practice, Jensen said, did not include probabilities.
He noted that some states, including his home state of Minnesota, as well as California, list only laboratory-confirmed COVID-19 diagnoses. Others, specifically New York, list all presumed cases, which is allowed under guidelines from the Centers for Disease Control and Prevention as of mid-April and which will result in a larger payout.
Jensen said he thinks the overall number of COVID-19 cases have been undercounted based on limitations in the number of tests available.
Provisions in the relief act
The coronavirus relief legislation created a 20% premium, or add-on, for COVID-19 Medicare patients. There have been no public reports that hospitals are exaggerating COVID-19 numbers to receive higher Medicare payments.
Jensen didn’t explicitly make that claim. He simply suggested there is an “avenue” to do so now that “plausible” COVID-19, not just laboratory-confirmed, cases can be greenlighted for Medicare payment and eligible for the 20% add-on allowed under the relief act. The initial $30 billion – out of $100 billion – in the grants dedicated to health care providers to address the pandemic was disbursed according to 2019 Medicare reimbursements.
The second wave will focus on providers in areas more heavily affected by the outbreak, according to Kaiser Health News, giving rise to Jensen’s concern that hospitals could exploit the CDC’s guidelines allowing presumed cases.
Jensen did not return an email request from USA TODAY for comment about his claim.USA TODAY reached out to Marty Makary, a surgeon and professor of health policy and management at Johns Hopkins Bloomberg School of Public Health, about the claim. Makary said in an email April 21 that “what Scott Jensen said sounds right to me.”
What Did the “Experts” — the Fact-Checkers — Say About These Numbers?
- Snopes investigated the claim, finding it’s plausible Medicare pays in the range Jensen mentions but doesn’t have a “one-size-fits-all” payment to hospitals for COVID-19 patients. As explained by nurse Elizabeth Davis in her piece for verywellhealth.com, each hospital has a base payment rate assigned by Medicare. It considers national and regional trends, including labor costs and varying health care resources in each market. Then, each diagnosis-related group, which classifies various diagnoses in groups and subgroups, is assigned a weight based on the average amount of resources it takes to care for a patient. Those figures are multiplied to determine the payment from Medicare. A hospital in one city and state may be paid more or less for treating a patient than a hospital in another.
- PolitiFact reporter Tom Kertscher wrote, “The dollar amounts Jensen cited are roughly what we found in an analysis published April 7 by the Kaiser Family Foundation, a leading source of health information.”
- Ask FactCheck weighed in on April 21: “The figures cited by Jensen generally square with estimated Medicare payments for COVID-19 hospitalizations, based on average Medicare payments for patients with similar diagnoses.” Ask FactCheck reporter Angelo Fichera, who interviewed Jensen, noted, “Jensen said he did not think that hospitals were intentionally misclassifying cases for financial reasons. But that’s how his comments have been widely interpreted and paraded on social media.” Ask FactCheck’s conclusion: “Recent legislation pays hospitals higher Medicare rates for COVID-19 patients and treatment, but there is no evidence of fraudulent reporting.”
Julie Aultman, a member of the editorial board of the American Medical Association’s Journal of Ethics, told PolitiFact it is “improbable that physicians or hospitals will falsify data or be motivated by money to do so.”
Our ruling: True
We rate the claim that hospitals get paid more if patients are listed as COVID-19 and on ventilators as TRUE. Hospitals and doctors do get paid more for Medicare patients diagnosed with COVID-19 or if it’s considered presumed they have COVID-19 absent a laboratory-confirmed test, and three times more if the patients are placed on a ventilator to cover the cost of care and loss of business resulting from a shift in focus to treat COVID-19 cases.
This higher allocation of funds has been made possible under the Coronavirus Aid, Relief and Economic Security Act through a Medicare 20% add-on to its regular payment for COVID-19 patients, as verified by USA TODAY through the American Hospital Association Special Bulletin on the topic.
Please note the following for clarification on the taxpayer dollars expended for COVID-19 hospital care:
- Indeed, the additional reimbursement for COVID-19 patients comes chiefly (but not solely) from CARES Act funding;
- You might remember we reported exactly what CMS released as to the specifics to be paid to Medicare patients for the “add-ons:” in-patient treatment including formal Intensive Care hospitalization, Remdisivir IV treatment, intubation, and a massive financial boost for placing a patient on a ventilator. However, shortly after we published that story, the CMS retracted that bulletin;
- The “bonus” hospitals receive from Medicare for an ill COVID-19 patient is between 20% additional to the amount paid for similar respiratory treatments to 80% more. A critical COVID-19 patient that receives the “whole banana” of these treatments will have a Medicare bill of at least $75,000, and if patient survival is longer than one week, it can reach $100,000-$150,000;
- There definitely are massive financial incentives for hospitals to “up-code” the status of Medicare COVID-19 patients to assure they receive ALL of the above treatments.
To get a handle on the gross revenue and profit pictures of hospitals during the COVID-19 pandemic, all one must do is find their publicly released financial profit and loss statements. (If they’re publicly-traded “for-profit” hospitals, their P&L reports are published online) Ask for the previous two years of such statements for comparison purposes.
The bottom line is this: hospitals have made BILLIONS of net dollars through the pandemic, much of which is due to their treating Medicare patients. No one should denigrate hospitals for additional profits for simply responding to the needs of the critically ill. But we should examine — no, “investigate” — hospitals that have very publicly taken advantage of critically ill seniors by forcing these COVID-specific and costly treatments on patients without consultation with family members.
You DO know that patients have legal rights regarding medical treatment by any healthcare provider, don’t you? There have been numerous cases of hospitals treating COVID-19 patients whose family members wanted to alter their care, and the hospitals refuse to do so. We reported one such case in Chicago recently when an Asian daughter rushed to her father’s side when the hospital declared his case hopeless. She wanted to try Ivermectin. The hospital refused that treatment. She was forced into a legal battle that raged between the hospital and a district judge for a week. The hospital declined to follow the judge’s ruling and allow treatment by Ivermectin.
That story ended well. A doctor of the daughter’s choosing came to the hospital, treated her father with Ivermectin, and he walked out of the hospital days later.
A similar case was resolved only last week in an identical case in North Carolina.
Again, don’t assume that EVERY healthcare institution and healthcare professional are “in-the-tank” for profit and therefore are gouging Medicare. But also, don’t assume that NO ONE is doing that!
What do we warn you often here at TruthNewsNetwork? “The love of money is the root of all evil.”
When there are ever any questions about the motive of those involved in any type of operation, one should always “follow the money!”
COVID-19 World is NO different.