- More than 325,000 Medicare beneficiaries have been diagnosed with COVID-19 from Jan. 1 to May 16 and about a third of them were hospitalized, according to data CMS released Monday night that show stark racial disparities as well as major differences between urban and rural areas.
- The numbers from CMS show that Black beneficiaries were hospitalized at a rate four times higher than white patients. People dually eligible for Medicare and Medicaid were also about four times more likely to be hospitalized than those with just Medicare coverage. Urban areas had about 205 hospitalizations per 100,000 beneficiaries while rural areas had 57 per 100,000.
- Medicare fee-for-service payments for COVID-19 hospitalizations totaled $1.9 billion over that time period, with an average payment of $23,094, according to the data.
The data for Medicare beneficiaries, while limited in scope, jibes with trends already observed about the effects and outcomes related to the COVID-19 pandemic, still ravaging the country as multiple states recorded their highest case numbers in recent days.
It shows a disproportionate effect on people of color, people with pre-existing conditions and those with lower incomes.
CMS Administrator Seema Verma said in a statement it was not typical for the agency to release such incomplete data, but it will do so on a monthly basis to assist researchers and the general public understand more about the novel coronavirus pandemic.
Verma also said the information should be a call to action for better-aligned payment models.
“Now more than ever, it is clear that our fee-for-service system is insufficient for the most vulnerable Americans because it limits payment to what goes on inside a doctor’s office,” she said in a statement. “The transition to a value-based system has never been so urgent. When implemented effectively, it encourages clinicians to care for the whole person and address the social risk factors that are so critical for our beneficiaries’ quality of life.”
For the 109,607 who were hospitalized, 28% of them died, 27% were released home and 21% were sent to a skilled nursing facility. The most common length of stay for hospitalizations was eight to 10 days (18%), followed by 11 to 15 days (16%). Half of all people who were hospitalized, however, stayed for less than a week.
The most common other condition among FFS beneficiaries who were hospitalized was hypertension at 79%, followed by hyperlipidemia at 60% and chronic kidney disease, anemia and diabetes all at 50%.
The week with the largest number of beneficiaries testing positive was May 2 at nearly 53,000. The most recent week for which data is available, May 16, shows a little more than 30,000 cases. Hospitalizations, however, were highest in the data set at the week of April 18, although the last weeks of the data set are lower than should be expected because of claims lag.
Recent research from Avalere also looked at Medicare fee-for-service claims data for COVID-19. It estimated the total U.S. healthcare system cost for hospitalizations from the disease will range from $9.6 billion to $16.9 billion in calendar year 2020, depending on whether and how much hospitalizations decline.
Commercial payers will bear the largest portion of that, with Medicare covering the second largest portion — $3.5 billion to $6.2 billion, that report found.