Government pays hospitals more money for Covid-19 patients than non-Covid patients

LAREDO, Tex. (KGNS) - According to the state, since Covid hit Webb County in March of 2020, about 85-thousand people have contracted the virus, with roughly half of them serious enough to be admitted into the hospital. Almost immediately, the federal government stepped in to help pay for their care with millions of dollars.

KGNS took a deeper look into this to answer the question, “Is there a difference in how much hospitals get paid back by the government when caring for a positive Covid patient versus a non-Covid patient?” The answer to that is ‘yes’. People on government programs, such as Medicare, are worth more.

According to section 3710 of the Cares Act, hospitals are reimbursed by the government an extra 20-percent for each hospitalized Medicare patient. The only criteria for that extra money? A positive Covid test.

For instance, hospital Medicare patient with Pneumonia--without Covid--is worth about $7,700 to the hospital. But with Covid, that reimbursement jumps to over $9,200. A Medicare patient with Acute Respiratory Distress Syndrome requiring a ventilator? Without Covid, the bill is around $34,000. But with Covid, that Medicare patient now worth almost $40,000. And the list goes on.

Rick Pollack, President of the American Hospital Association, tells us the additional 20% cash for the hospital per Covid patient is, “meant to recognize the additional costs associated with caring for Covid positive patients – such as additional PPE for staff, as well as the additional costs in cleaning and taking special precautions while moving in and out of the patient’s room, and additional costs in caring for the patient, such as therapeutics.”

Speaking of therapeutics or treatments, there’s also extra funding for that. Under the government’s new “Covid-19 Treatments Add-On Payment” program, hospitals get extra money for every Covid-19 patient they treat with one of the FDA approved or Emergency Approved Covid medications.

According to the Journal of the American Medical Association, the bonus gives hospitals an incentive to use the medications because prior to Covid, hospitals were not typically reimbursed by Medicare for these expensive drugs. The Covid drugs reimbursed are Remdesivir, Convalescent Plasma, Baricitinib, Molnupiravir and Nirmatrelvir, with incentives for Convalescent Plasma and Remdesivir given for both hospitalized patients and patients receiving the medication in an outpatient infusion center.

So with so much money at stake, one might wonder what’s keeping hospitals or providers in check? According to Pollack, it’s the penalties if any kind of fraud is found. He says, “Hospitals and health systems adhere to strict coding guidelines, and use of the Covid-19 code for Medicare claims is reserved for confirmed cases. Coding inappropriately can result in criminal penalties and exclusion from the Medicare program altogether.”

Along with the 20% add on and the incentive money to treat patients with Covid medications, the government also saw a need to send medical facilities millions of dollars to use to keep their doors open during Covid. So how was that money used? We’ll break it down for you in Part 2 of our special series called, ‘Cashing in on Covid’.

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