The claim: Hospitals get paid an ext if patients are listed as COVID-19, and also on ventilatorsSen. Scott Jensen, R-Minn., a doctor in Minnesota, was interviewed by "The Ingraham Angle" hold Laura Ingraham on April 8 on Fox News and also claimed hospitals gain paid more if Medicare patients are detailed as having actually COVID-19 and get 3 times as lot money if they need a ventilator.
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The case was published April 9 by The Spectator, a conservative publication. WorldNetDaily mutual it April 10 and, follow to Snopes, a related image was shared on society media in mid-April.
Jensen took it to his very own Facebook page April 15, saying, in part:
"How have the right to anyone not believe that enhancing the number of COVID-19 deaths may produce an way for claims to get a larger part of federal dollars. Already some states are complaining the they space not getting sufficient of the care Act dollars because they are having actually significantly much more proportional COVID-19 deaths."
On April 19, that doubled under on his assertion via video clip on his facebook page.
Jensen said, "Hospital administrators could well want to see COVID-19 attached to a discharge an overview or a fatality certificate. Why? due to the fact that if it"s a straightforward, garden-variety pneumonia that a human is admitted to the hospital for – if they"re Medicare – typically, the diagnosis-related group lump sum payment would certainly be $5,000. Yet if it"s COVID-19 pneumonia, then it"s $13,000, and also if that COVID-19 pneumonia patient end up ~ above a ventilator, that goes up to $39,000."
Jensen clarified in the video clip that he doesn"t think physicians are "gaming the system" so much as various other "players," such as hospital administrators, that he said might pressure doctors to cite all diagnoses, including "probable" COVID-19, top top discharge documents or death certificates to acquire the greater Medicare allocation allowed under the Coronavirus Aid, Relief and Economic security Act. Past practice, Jensen said, did not encompass probabilities.
He provided that part states, including his home state of Minnesota, and California, list only laboratory-confirmed COVID-19 diagnoses. Others, specifically new York, list every presumed cases, which is allowed under guidelines native the Centers for an illness Control and also Prevention together of mid-April and i beg your pardon will result in a bigger payout.
Jensen said he think the overall number that COVID-19 instances have been undercounted based upon limitations in the variety of tests available.
Provision in the relief act
The coronavirus relief legislation developed a 20% premium, or add-on, for COVID-19 Medicare patients.
There have been no publicly reports that hospitals space exaggerating COVID-19 number to receive higher Medicare payments.
Jensen didn"t clearly make the claim. That simply said there is an "avenue" to execute so currently that "plausible" COVID-19, not just laboratory-confirmed, cases can be greenlighted for Medicare payment and also eligible for the 20% add-on permitted under the relief act.
The early stage $30 billion – out that $100 exchange rate – in the grants committed to health care providers to resolve the pandemic to be disbursed follow to 2019 Medicare reimbursements.
The second wave will emphasis on suppliers in areas much more heavily impacted by the outbreak, follow to Kaiser health and wellness News, giving rise to Jensen"s concern that hospitals might exploit the CDC"s guidelines allowing presumed cases.
Jensen did no return an email inquiry from USA this day for comment around his claim.
USA TODAY reached out come Marty Makary, a surgeon and also professor of wellness policy and also management at Johns Hopkins Bloomberg college of publicly Health, around the claim. Makary said in an email April 21 that "what Scott Jensen claimed sounds appropriate to me."
Makary did no elaborate, answer added questions or respond come a request for an interview.
USA TODAY reached out come the American Hospital Association and also Federation the American Hospitals on April 22, but as that publication had not obtained a response.
How go Medicare pay?
Snopes investigated the claim, finding it"s plausible Medicare pays in the range Jensen mentions but doesn"t have a "one-size-fits-all" payment to hospitals for COVID-19 patients.
As defined by nurse Elizabeth Davis in her piece for verywellhealth.com, every hospital has actually a basic payment price assigned through Medicare. The takes right into account nationwide and local trends, including labor costs and varying health treatment resources in each market.
Then, every diagnosis-related group, which classifies miscellaneous diagnoses right into groups and also subgroups, is assigned a weight based on the typical amount of sources it bring away to treatment for a patient. Those numbers are multiplied to recognize the payment native Medicare. A hospital in one city and state might be paid much more or much less for dealing with a patient than a hospital in another.
PolitiFact reporter Tom Kertscher wrote, "The dollar quantities Jensen cited are roughly what we uncovered in an analysis published April 7 by the Kaiser family Foundation, a leading source of wellness information."
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Ask FactCheck weighed in April 21: "The numbers cited by Jensen normally square with estimated Medicare payments for COVID-19 hospitalizations, based upon average Medicare payments because that patients with comparable diagnoses."
Ask FactCheck reporter Angelo Fichera, that interviewed Jensen, noted, "Jensen said he did not think the hospitals were purposely misclassifying cases for financial reasons. Yet that’s exactly how his comments have actually been widely interpreted and also paraded on society media."
Ask FactCheck"s conclusion: "Recent law pays hospitals greater Medicare rates for COVID-19 patients and also treatment, but there is no evidence of cheat reporting."
Julie Aultman, a member that the editorial board of the American medical Association’s journal of Ethics, said PolitiFact it is “very unlikely that doctors or hospitals will certainly falsify data or be motivated by money to perform so.”
Our ruling: True
We price the claim the hospitals acquire paid much more if patients are listed as COVID-19 and on ventilators as TRUE.
Hospitals and also doctors do obtain paid more for Medicare patient diagnosed through COVID-19 or if it"s taken into consideration presumed they have actually COVID-19 lacking a laboratory-confirmed test, and also three times much more if the patient are put on a ventilator to cover the expense of care and loss of service resulting native a change in focus to law COVID-19 cases.
This higher allocation of funds has actually been made possible under the Coronavirus Aid, Relief and also Economic defense Act through a Medicare 20% add-on to its regular payment for COVID-19 patients, as proved by USA this particular day through the American Hospital Association one-of-a-kind Bulletin top top the topic.
Our fact-check sourcesEmail an answer from Marty Makary, a surgeon and professor of health policy and management in ~ Johns Hopkins Bloomberg college of windy Health.
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