Medicare pays 15% higher for COVID-19 cases than other respiratory conditions, study finds

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Medicare pay was higher for COVID-19-related respiratory infections with major complications than non-COVID-19 cases at some major U.S. hospitals, according to a new study from Hospital Pricing Specialists

For the study, the healthcare research firm analyzed 350,501 Medicare hospital inpatient claims from April 1, 2020, through Dec. 31, 2020, that had a COVID-19-related diagnosis code of U071 or B9729. The majority of claims were attributed to DRG 177, respiratory infections with major complications. 

Hospital Pricing Specialists then analyzed price, length of stay, charge per case and other metrics for the 10 U.S. hospitals that had the highest volume of COVID-19-related claims. COVID-19 claims are defined as DRG 177 with the diagnosis codes U071 and/or B9729.

Five key findings from the study:

1. Among the 10 hospitals with the highest COVID-19 case volume, the average CMS payment for COVID-19 cases for DRG 177 was 14.8 percent higher than non-COVID-19 cases for respiratory infections with major complications. 

2. At the 10 U.S. hospitals, the average charge per case for COVID-19 was 5.4 percent less than non-COVID-19 cases for respiratory infections with major complications. 

3. At the 10 U.S. hospitals, the mortality rate for COVID-19 cases was 80.2 percent higher than non-COVID-19 respiratory infections with major complications. 

4. At the 10 U.S. hospitals, the average length of stay for COVID-19-related and non-COVID-19 respiratory infections with major complications was about the same.

5. At the 10 hospitals, COVID-19 cases accounted for 91 percent of all DRG 177 cases.

 

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