COVID-19FinancialHospitalsRegulatory

Hospitals are paid more for Medicare patients confirmed or presumed to have coronavirus

May 4, 2020 / By Hollie McKay | Fox News

If a Medicare patient is diagnosed with – or even presumed to have contracted — coronavirus, hospitals across the United States are given more money from the federal government to treat that patient, economic assessments show. That amount can as much as triple if the patient requires a ventilator, making some wonder whether there is a financial impetus to overstate coronavirus numbers, with others calling such potential abuse “unlikely.”

Medicare, a long-running federal health insurance program for those aged 65 or over – which also happens to be the most vulnerable demographic for an acute coronavirus infection and mortality – functions by paying hospitals a fixed sum depending on which diagnosis the Medicare Severity Diagnosis Related Group (MS-DRG) it falls under.

“These DRG rates are adjusted each year, and that brings up [one] way in which the government has increased payments to hospitals. Budget rules referred to as sequestration, require across-the-board cuts in Medicare because the federal deficit is so high,” Doug Badger, visiting fellow for domestic policy studies at The Heritage Foundation, told Fox News. “Congress eliminated these across-the-board cuts during the COVID-19 epidemic. That translates to an across-the-board increase in Medicare payments to hospitals for any admission of any Medicare patient, whether or not they have COVID-19.”

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Chris J. Stewart

Chris currently serves as President and CEO of Surgio Health. Chris has close to 20 years of healthcare management experience, with an infinity to improve healthcare delivery through the development and implementation of innovative solutions that result in improved efficiencies, reduction of unnecessary financial & clinical variation, and help achieve better patient outcomes. Previously, Chris was assistant vice president and business unit leader for HPG/HCA. He has presented at numerous healthcare forums on topics that include disruptive innovation, physician engagement, shifting reimbursement models, cost per clinical episode and the future of supply chain delivery.

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