USA Today Fact Check: It’s True Hospitals Are Paid More If Patients Listed as COVID-19, on Ventilators

Don't worry, nobody has ever acted on a powerful financial incentive

The claim: Hospitals get paid more if patients are listed as COVID-19, and on ventilators

Dr. Scott Jensen, a senator and 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 end up needing a ventilator.

While his claim originated during an interview on Fox News, it was published on April 9 by The Spectator, a conservative publication and syndicator. WorldNetDaily shared it on April 10 and, according to Snopes, a related meme was shared on social media in mid-April.

Jensen took it to his own Facebook page on April 15, saying, in part:

“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.

https://www.facebook.com/1492673654369368/videos/654105868720634/

Jensen said in the video: “Hospital administrators might well want to see COVID-19 attached to a discharge summary or a death certificate. Why? Because if it’s a straight-forward, 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.”

He noted that some states, like his home state of Minnesota, as well as California, are only listing laboratory-confirmed COVID-19 diagnoses. But others, specifically New York, are listing all presumed cases, which is allowed under CDC guidelines as of mid-April, and that will result in a larger payout.

Jensen, however, added that he thinks the overall number of COVID-19 cases have been undercounted based on limitations in the number of tests available.

Provision in the CARES Act

The CARES Act 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.

And 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 green-lighted for Medicare payment and eligible for the 20 percent add-on allowed under the CARES Act.

The initial $30 billion — out of $100 billion — in the CARES Act grants dedicated to health care providers to address the pandemic was disbursed according to 2019 Medicare reimbursements.

The second wave, however, will focus on providers in areas more heavily impacted by the outbreak, according to to Kaiser Health News, thus 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 Dr. Marty Makary, a surgeon and professor of health policy and management at John Hopkins Bloomberg School of Public Health, about the claim. Makary said in an email on April 21, “… what Scott Jensen said sounds right to me.”

Makary did not elaborate, answer additional questions or respond to a request for an interview.

USA TODAY also reached out to both the American Hospital Association and Federation of American Hospitals on April 22, but as of publication had not received a response.

How does Medicare pay?

Snopes investigated the claim, finding it’s plausible Medicare is paying 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 takes into account nationwide and regional trends, including labor costs and varying health care resources in each market.

Then, each diagnosis-related group, which classifies various diagnoses into 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. So, 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 writes, “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 also weighed in on April 21, stating: “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 AMA Journal of Ethics, told PolitiFact it is “very unlikely 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 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 CARES Act through a Medicare 20% add-on to its regular DRG payment for COVID-19 patients, as verified by USA TODAY through the American Hospital Association Special Bulletin on the topic.

Our fact-check sources

Source: USA Today

Subscribe
Notify of
guest
13 Comments
Oldest
Newest Most Voted
Inline Feedbacks
View all comments

Jerry Wayne Carver
Jerry Wayne Carver
10 months ago

comment image

Rowdy-Yates
Rowdy-Yates
10 months ago

There is an excellent article in Associated Press titled “Coronavirus shakes the conceit of ‘American exceptionalism” and it needs quoting:
“A nation with unmatched power, brazen ambition and aspirations through the arc of history to be humanity’s “shining city upon a hill” cannot come up with enough simple cotton swabs despite the wartime manufacturing and supply powers assumed by President Donald Trump.”
and
“At the time of greatest need, the country with the world’s most expensive health care system doesn’t want you using it if you’re sick but not sick enough or not sick the right way.”
and
“That is one iteration of American exceptionalism now — a national government responding to a national crisis by getting out of the way. The cavalry isn’t coming”

https://apnews.com/1283d176484e133f31080227bb15c5d1

Maxwell
Maxwell
10 months ago

Illinois Director of Public Health Let’s Cat out of the Bag- COVID Deaths Are Overstated

Here is the exact quote from the director of Illinois Department of Health, Dr. Ngozi Ezike, transcribed from Illinois Governor’s health briefing on April 19th :

“I just want to be clear in terms of the definition of people dying of COVID. The case definition is very simplistic. It means at the time of death it was a COVID positive diagnosis. So that means if you were in hospice and had already been given a few weeks to live, and then you also were found to have COVID, that would be counted as a COVID death. It means technically even if you died of a clear alternate cause, but you had COVID at the same time, it’s still listed as a COVID death. So, everyone who’s listed as a COVID death doesn’t mean that that was the cause of the death, but they had COVID at the time of the death.”

Southern
Southern
10 months ago
Reply to  Maxwell

I stumbled upon this ”overstating” a week ago – since I’m not a medical professional I forwarded a video to someone who is however and here’s the thing she did not agree which makes sense from the perspective that it’s too early to force people to return to work.

See – this

Whatever the motivation for incorrectly filling out death certificates – one reason could be securing desperately required funds for hospitals while the other is political and plays into the hands of the far right who need workers to return early regardless of the risks involved.

Maelstrom_19
Maelstrom_19
10 months ago
Reply to  Southern

Read that also.

Southern
Southern
10 months ago
Reply to  Maelstrom_19

The strangest thing was that the doctor in question, the one who claimed that the death certificates were filled out incorrectly appears to be wearing a doctors coat just for the video.

Sharon Marlowe
Sharon Marlowe
10 months ago

It’s just like what an OffGuardian commenter posted a few weeks ago, that State members of the European Union would get more relief money if they claim more citizens died of the virus;)

Ort
Ort
10 months ago
Reply to  Sharon Marlowe

Hey, from the pro-pandemic perspective, the more the merrier!

As a thoughtful skeptic and cynic, after the still-mysterious events of September 11, 2001 I was outraged when credulous, authoritarian-submissive anti-skeptics coined the pejorative, derisive epithet “Truther” to put down anyone who didn’t obediently and unquestioningly accept the official narrative. Accordingly, I coined the counter-epithet “Trutherphobe” for these aggressive, bumptious anti-skeptics– including distinguished Trutherphobes like Noam Chomsky and Glenn Greenwald.

Within the past day or two, with a sort of déjà vu echo, the term “pro-pandemic” has spontaneously arisen in my inner monologue, or babbleogue. I apply it to both the powers and principalities who are directing and exploiting the alleged pestilence and its operational consequences– the vast “Cui bono?” bloc– as well as bloggers and other public figures and media “influencers” who have obviously bought into the official narrative.

I realize that the latter group, the pro-pandemic “laypersons”, so to speak, would indignantly deny that they are buying into anything; for them, it’s a simple matter of remaining sane, sensible, rational, and appropriately respectful of science and the governmental and public-health authorities who ostensibly administer science-driven policies. So they seem oblivious or indifferent to the observation that they’re really into the pandemic, and defend it to the, er, death against any analysis or criticism that supports the skeptical “plandemic” assessment.

There are a broad variety of circumstances, motivations, and attitudes inside the pro-pandemic “big tent”. Doubtless its denizens would be furious or wounded at the charge that they are in any way “pro” pandemic. But their views and recommendations validate, reinforce, promote, and reify the dubious worst-case official/mass-media driven Narrative of Doom, and they’re effectively staking their reputations on the belief that the Narrative of Doom is true, correct, and incontrovertibly real. To me, that’s being pro-pandemic!

Sharon Marlowe
Sharon Marlowe
10 months ago
Reply to  Ort

Hi Ort:)
Agreed. Did you see the Rania Khalek video? It’s the same as the Polly Boiko video. So In The Now and Greyzone are on the same page.
Here it is:

Edit: It looks like the twitter link won’t work, so this link has the twitter link for the video:
https://raniakhalek.com/anti-lockdown-idiots-are-mad-at-the-wrong-people/

But really, it isn’t worth watching.

Ort
Ort
10 months ago
Reply to  Sharon Marlowe

The twitter link did work for me, so I watched it.

Ugh. Another independent journalist/pundit I generally thought well of has succumbed to pro-pandemia.

I’m not up to thrilling you with one of my long-winded reflections, although I reserve the right to revisit the topic.

For now, what strikes me is how too many independent “alternative” or “contrarian” journalist/pundits– or whatever the correct term is for the Greyzone, Moderate Rebels, Red Lines, etc. types– have bought into the official “megadeath” spin of the plandemic.

Once you buy into the premise that the hyped worst-case infoganda should be reliably taken at face value, it’s like opening a Pandora’s Box– lots of other demons fly out. Although Rania doesn’t trash Trump specifically, there’s a whiff of TDS in her rant. I just remarked elsewhere that as soon as the plandemic was launched, or announced, it was obvious to me that pandemic hysteria was highly compatible with TDS.

And Rania isn’t the only one who tries to analyze plandemic responses according to the traditional left/right dichotomy that is really not operational, or at least reliably operational, any more. So she more or less shrieks that right-wingers protesting the indefinite shutdown– the people Hillary infamously branded the “basket of deplorables”– are misguided deathmongers who are ignorantly defying reasonable public-health policies. I’m not sure how she expects them to “attack capitalism” instead– like “terror”, in this context “capitalism” is an abstraction.

The pro-pandemic “left”‘s mindset is appallingly muddled at best.

Sharon Marlowe
Sharon Marlowe
10 months ago
Reply to  Ort

I think you’re right on the nose comparing what we’re seeing as like TDS, Ort. It’s gaslighting when they act like Trump is some unique demon and/or this virus is the black death, when in both cases there’s nothing uniquely terrifying about them. All it takes is to remember what the other Presidents have done and to remember what the seasonal flu does. They keep acting like we don’t remember. That all the propaganda we read everyday somehow just disappears from our minds and we become trusting-things again.
I can’t stand how they’re gaslighting, and who they think they can gaslight.
And Rania was wrong about Syria, it took her a couple years to change her mind, and now again she fails. These people are either not learning, and not learning in the same way, or they’re sockpuppets–someone/some org. is behind them.
But Eva Bartlett and Vanessa Beeley have risen to the occasion and have been critical of the general alternative media failure on this virus. They were right on Syria and they’re on the right side again. There’s something positive:)

Ort
Ort
1 year ago
Reply to  Sharon Marlowe

Speaking of long-winded reflections, you might find this one interesting.

BTW, I had seen Vanessa Beeley rising to the occasion, and I’m happy to hear that Eva has too. It will be interesting to see where US-based nominal colleagues like Aaron Maté, Ben Norton, Max Blumenthal, and Anya Parampil are on this question.

Also, since writing the previous post I realized that TDS and pro-pandemic derangement syndrome are far more deeply connected than I realized when the compatibility first struck me. I think they are fundamentally separate and distinct, but I’m surprised that I didn’t see right away that the pro-pandemic position is an ideal platform for the continuation of TDS, and its objective of annihilating Trump, by other means.

ke4ram
ke4ram
10 months ago

We don’t need MSM to verify anything except how they are lying and promoting this illegal sh*tshow.

Anti-Empire