COMMENTARY

COVID-19 Data Dives: Claims About False COVID Deaths Are Reprehensible

Ashish K. Jha, MD, MPH

Disclosures

October 27, 2020

Medscape asked top experts to weigh in on the most pressing scientific questions about COVID-19. Check back frequently for more COVID-19 Data Dives, and visit Medscape's Coronavirus Resource Center for complete coverage.

Ashish K. Jha, MD, MPH

President Trump and his advisor, Scott Atlas, MD, argue that there is a lot of false coding of COVID deaths. This is junk news which, like junk food, tastes good but has no nutritional value.

So, what are the facts?

Do Hospitals Get More Money for COVID Patients?

Our payment system is extremely complex, so this is a simplification.

Hospitals get paid based on the condition that a patient has. Let's take a patient with pneumonia: A typical hospital might be paid between $8000 and $11,000 in reimbursement from Medicare, depending on whether the individual has any major comorbid conditions or not.

Now, what happened in the COVID era? The Coronavirus Aid, Relief, and Economic Security (CARES) Act gives hospitals a 20% bump (to about $9600 – $13,000) if the patient's pneumonia is a result of COVID. That comes to an additional $1600-$2000 for a typical COVID pneumonia patient. To get this bump, hospitals must document that the patient is COVID positive.

Do Incentives Change Billing Practices?

Yes, they do. Hospitals are famous for documenting comorbidities in order to receive higher reimbursement. However, what they don't do is make up false diagnoses. That will get them fined and/or jailed. Most physicians and hospitals would not lie about a positive COVID test.

Does that additional incentive result in hospitals and physicians testing more of their pneumonia patients for COVID? Keep in mind that even without incentives, any hospitalized patient with pneumonia today will get tested for SARS-CoV-2, and that is how it should be. If the test is positive, that patient has COVID.

Dying 'With' and 'Because Of' COVID

Which gets us to another trope...

The difference between saying someone died "with" COVID and not "because of" COVID is clinical nonsense.

If you have pneumonia and are COVID positive? You have COVID pneumonia. You are sick from COVID.

There have been arguments about car accident victims who tested positive for COVID. That is more nonsense: There is no higher reimbursement that I can find for car accident victims who are COVID positive. And if you bill these patients as COVID pneumonia, that is fraud. These stories are Facebook junk.

Why, then, did Congress and the president enact a law that gives hospitals extra money for COVID patients? Because policymakers knew that hospitals would need the extra money in order to provide their staff with appropriate personal protective equipment (PPE). The federal government was not going to be able to provide all of the needed PPE. The funds were a way to help make hospitals whole. But it hasn't. Most hospitals are bleeding money as a result of COVID.

Next, what about stories of $40,000 in reimbursement for a COVID death? That is code MS-DRG 207: respiratory system diagnosis with ventilator support for > 96 hours. That is a pneumonia patient who spent more than 4 days in an ICU.

Without COVID, Medicare pays about $35,000 for that patient's care. With COVID, about $40,000.

In conclusion, doctors aren't taking random deaths and calling them COVID deaths. That would be fraud.

Does a COVID diagnosis get a hospital a little extra money? Yes.

Are physicians and hospitals lying about who has COVID? No.

Are people dying "with" COVID, not "because of" COVID? That argument is clinical nonsense.

Let's ignore the noise and misinformation about COVID billing. While doctors and nurses are dying on the front lines, our leaders are not working to get them protective equipment.

Instead, they are falsely accusing our frontline providers of fraud.

It's reprehensible behavior.

Ashish K. Jha, MD, MPH, is a physician, health policy researcher, and the current dean of the Brown University School of Public Health. Before joining Brown, he was the K.T. Li Professor of Global Health at the Harvard T.H. Chan School of Public Health and director of the Harvard Global Health Institute. He is on the front lines of the COVID-19 response, appearing frequently on national television news outlets such as CNN, MSNBC, and Fox, and in written coverage from national newspapers including The New York Times and The Washington Post. Dr Jha is a vocal advocate for increased testing and contact tracing, and has written extensively on the subject with articles in The New England Journal of Medicine, Health Affairs, The Atlantic, The Wall Street Journal, and Stat News, among others. Follow him on Twitter.

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