Among the many provisions included in the CARES Act of 2020 were two reimbursement codes funded by the federal government designed to get data on COVID-19 deaths (mortality) and get money to hospitals for the treatment.
The first reimbursement code was to be used when the hospital confirmed the presence of the virus by a diagnostic blood test.
The second reimbursement code was to be used if the hospital had ‘suspected’ the COVID-19 but had not confirmed its presence. The reimbursement for the use of either code is $39,000 per case, whether the case lasts a day, three days, a week, or longer.
Three weeks after the CARES Act was passed, a spokesperson for the Center for Medicare/Medicaid (CMS) clarified they would not penalize hospitals for using the second reimbursement code. CMS creates disease codes and pays claims under them. Get the hint?
Every day in a typical year, thousands of older adults spend their last days in a hospital and succumb to death from heart disease, cancers, COPD, and other diseases.
This year, researchers at Johns Hopkins epidemiology center noted a substantial drop in deaths coded as heart disease and cancers, usually the two leading causes of death. The number of COVID-19 coded deaths roughly equaled the drop in heart disease and cancer deaths. Also, seasonal influenza deaths coded are next to zero.
Suspicious? Surely. But we probably never really know since there are 5,000 acute care hospitals in the U.S. with thousands of nurses and doctors involved in the treatment (and coding) of deaths. The use of the COVID-19 codes has amounted to $11.7 billion in reimbursement to hospitals so far in 2020.
In November, New Castle County, Delaware, hit a very high infection rate of 84 persons per 100,000 people per day. This infection rate is twice of most states, including Florida and Georgia, that have not had lock-downs.
Delaware recently ranked 6th in the country in the virus spread rate, with its viral reproduction rate (Rt) significantly higher than surrounding states. Because of its high infectivity and ability to spread from asymptomatic people, COVID-19 has defeated our attempts to slow the spread via lock-downs and .50 cent paper masks.
Delaware's death rate is 9% higher than statistically expected compared to the national rate of 12%, both of which are well within the parameters of any significant flu season. It is nowhere near the 40% more than expected flu of 1957-the Spanish flu of 1918 far eclipses COVID-19 by many multiples.
Nevertheless, there is no lack of hysteria, panic, and overreaction.
We will do better next time.