Todd Shryock

 done by the Peterson Center on Healthcare and the Kaiser Family Foundation estimates that preventable hospitalizations required by patients who are unvaccinated against COVID-19 have cost upwards of $5 billion.

Taxpayers, whether through publicly funded health plans or through increased rates of private insurance, are ultimately picking up the tab for these avoidable expenses.

Despite the availability of safe and effective COVID-19 vaccines, vaccination rates have lagged, particularly in some states and among younger people. As of early September 2021, 25% of adults over the age of 18 in the U.S. remain unvaccinated for COVID-19. As a result of lagging vaccinations and the more infectious delta variant, COVID-19 cases, hospitalizations, and deaths are increasing.

Not only are these COVID-19 hospitalizations devastating for patients, their families, and health care providers, but it is putting financial strain on payers. As a result, insurers are beginning to reinstate cost-sharing for COVID-19 treatment, though patients still only pay a small share of the total costs. The study estimates that the average hospitalization for COVID-19 about $20,000, though the costs for those requiring a ventilator are much higher.

The analysis of HHS and CDC data indicates there were 32,000 preventable COVID-19 hospitalizations in June, 68,000 preventable COVID-19 hospitalizations in July, and another 187,000 preventable COVID-19 hospitalizations among unvaccinated adults in the U.S. in August, for a total of 287,000 across the three months.

If each of these preventable hospitalizations cost roughly $20,000, on average, that would mean these largely avoidable hospitalizations have already cost more than $5 billion since the beginning of June.

The study authors say this figure is likely an understatement of the cost burden from preventable treatment of COVID-19 among unvaccinated adults, because it does not include the cost of outpatient treatment, which is likely substantial. A Medicare study found patients with COVID-related admissions had multiple outpatient visits (3.2 on average) that cost approximately $164 each (and this is only for those COVID-19 patients who were hospitalized at one point). An analysis of the privately insured found COVID-19 outpatient treatment costs can average $500-$1,000 per patient. In addition, there is reason to believe average costs for COVID-19 hospitalizations may be even higher than $20,000 based on other studies of privately insured and Medicare. One study that has not yet been peer reviewed found that while the median hospitalization costs private payers $25,339, the mean cost was $42,200. Similarly, in their justification for charging higher premiums to unvaccinated employees, Delta Airlines said their average hospitalization cost was $50,000 (though it is unclear if this is the median or mean cost).

Additionally, although breakthrough infections and hospitalizations are rare, unvaccinated people are also more likely to spread the virus to those who have taken measures to protect themselves and others, and those costs are not included in the estimate.

This article was originally posted on Medical Economics®. 

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Taxpayers are ultimately picking up the tab for those refusing the jab.

Billions of dollars spent on hospitalization for unvaccinated patients

Additional funds will be made available to reimburse physicians for telecommunications services, information services, and connected devices necessary to enable telehealth during COVID19.

The Federal Communications Commission’s Wireline Competition Bureau will begin accepting applications for Round two of the COVID-19 Telehealth Program on April 29, 2021, at noon ET at 

. The filing window will last seven days, closing May 6, 2021, at noon ET. Round two of the COVID-19 Telehealth Program is a $249.95 million federal initiative that builds on the $200 million program established as part of the CARES Act.

“For over a year, health care providers have fought on the front lines of this pandemic and have had to rapidly innovate to support the health and well-being of all Americans,” said Acting Chairwoman Jessica Rosenworcel in a statement. “Telehealth has been at the forefront of this effort and I’m pleased to announce that additional support is just around the corner.”

For additional information on eligibility and the application process, go to 

https://www.usac.org/about/covid-19-telehealth-program/

This article was originally published on Medical Economics®. 

Round two of the program will provide $249 million to support physicians by providing reimbursement of services necessary for telehealth.

Telehealth reimbursement program opens April 29

Office of the Inspector General recommends CMS conduct targeted hospital reviews for possible upcoding violations.

A review by the Office of the Inspector General found that hospitals increasingly billed for inpatient stays at the highest severity level from 2014 to 2019, and recommended that CMS conduct targeted reviews to check for unnecessary upcoding.

The OIG found that the number of stays at the highest severity level increased almost 20 percent during the time reviewed, ultimately accounting for nearly half of all Medicare spending on inpatient hospital stays. The number of stays billed at each of the other severity levels decreased. The average length of stay decreased for stays at the highest severity level, while the average length of all stays remained largely the same.

Hospitals varied significantly in their billing of these stays, with some billing much differently than most. The increase in the number of stays billed at the highest severity level implies that beneficiaries were sicker overall. However, the decrease in the average length of stays at the highest severity level potentially undermines that idea because it is not consistent with sicker beneficiaries. Length of stay generally has a positive relationship to severity of stay; sicker beneficiaries stay in the hospital longer. Given the decrease in the average length of stays at the highest severity level and the indication that beneficiaries in general were not sicker, the increase in stays billed at the highest severity level likely was driven by changes in hospital billing practices rather than by changes in the beneficiary population.

According to OIG, shorter stays are not inherently problematic, but the number of these stays raises questions about the accuracy and appropriateness of the complications billed by the hospital. Although the complications billed suggest sicker beneficiaries, the shorter lengths of stay point to beneficiaries who are less sick. For this reason, these stays suggest potential upcoding. Medicare potentially overpaid hospitals by a significant amount if even a small fraction of these stays were billed inappropriately.

The OIG recommends that CMS should target stays at the highest severity level with certain characteristics, such as those that are particularly short or that have only one major complication. CMS should also focus on MS-DRGs that have a high proportion of stays with these characteristics and on the hospitals that frequently bill them. CMS’s Recovery Audit Contractors currently conduct coding validation reviews that incorporate some of these targeting strategies. However, stays billed at the highest severity level continue to increase and OIG says more must be done.

This article was originally posted on Medical Economics®.

Todd Shryock

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Billions of dollars spent on hospitalization for unvaccinated patients

Telehealth reimbursement program opens April 29

Increase in more expensive hospital stays draws government scrutiny