Medicare Claims

Imbalance in COVID-19 Patients Emerge Through Medicare Claims Data

According to a recently published study by the Centers for Disease Control and Prevention (CDC), there were substantial disparities in Medicare fee-for-service beneficiary spending. The study revealed that non-White race and ethnicity, rural residency, and male sex were linked to higher spending on medical grounds.

Researchers took the data of 2020 administrative claims from CMS and analyzed it, with the primary focus being on patients who were 65 or more years of age and had either hospitalization or an outpatient visit claim between April and December 2020.

Around 28.1 million beneficiaries for Medicare fee-for-service met the inclusion parameters during the time. Of them, approximately 4.2 percent of patients received COVID-19 care. These beneficiaries were almost 62 percent of the total Medicare participants. Most of these beneficiaries receiving COVID-19 care were female (around 57 percent), about 77.2 percent were residents of urban counties, and 79.6 percent were non-Hispanic white. Moreover, non-Hispanic white patients incurred much lower costs than any other ethnicity or race for outpatient visits and hospitalization.

Medicare Claims Data

The total cost for COVID-19 care in Medicare fee-for-service was around $6.3B, while the mean hospitalization cost going up to $21,752. Hospitalization was more common among patients aged 75 years or above. However, it was the younger patients who incurred higher costs.

According to the researchers conducting the study, medical costs were defined as the total of patients’ cost-sharing (including coinsurance, co-payments, and deductibles) and reimbursements from Medicare for both inpatient and outpatient services.

Among the 4.2 percent of the beneficiaries who received COVID-19 care, 77 percent opted for only outpatient visits, along with around 97 percent of the hospitalized patients. Approximately 18.5 percent of the hospitalized patients died in the hospital, while 8 percent needed ventilator support. However, the majority of the hospital deaths did not comprise ventilator support.

The results pointed towards the fact that the non-Hispanic black and Hispanic patients have experienced hospitalizations and inpatient deaths at a higher rate than that of the overall patient population. Apart from that, rural residents were more likely to be hospitalized than urban patients, and the difference was around 2.2 percentage points.

Outpatient visits cost around $466.8 million, and hospitalizations cost near about $5.8B. Apart from that, hospitalizations requiring ventilation support cost around $1.1B, and hospitalizations resulting in death cost around $1.6B.

Surprisingly, the financial impact of COVID-19 on Medicare in the previous year was low. The average cost of hospitalization and treatment was considerable. However, the care costs for milder cases, which were most common in the country, were relatively small.

Researchers feel that the claim data is limited, and is not of much use in tracking health emergencies in real-time. However, the data seems to be competent enough in indicating the estimated costs of preventing and treating illness. Last year witnessed around a 7 percent decline in hospital care spending, and a 4.2 percent decline in physician and clinical services spending. The decline was prominent (around 20.2 percent) in dental care spending.

Though the costs are lower than expected, issues like disproportionate health risks along with financial burden on vulnerable communities have been made prominent by the pandemic.