Wednesday, November 4, 2020

Very Brief Blog: Avalere Data on Medicaid, Medicare COVID DRG rates.

Early COVID law implemented a 20% increase in Medicare inpatient DRG payments, if the patient has a COVID diagnosis.  In August, CMS clarified it wanted a documented direct COVID test in the patient's record before certifying the case rates the 20% supplement (here).[FN1]

While it was published in September, Avalere has an excellent discussion of average DRG payments for different types of Medicare and Medicaid payments - find it here.   

  • Average COVID hospitalization payments were $23,489.
  • Average COVID hospitalization payments were $11,370 for Medicaid.
  • LOS with ventilator support was 14 days; otherwise, 8 days.
  • Medicare payments were $12,140 without ventilator support, and rise to $31,174 with ventilator support.
For more facts and figures and budget impact data, see Avalere.  



In late October, the President asserted that doctors get $2000 more if they certify someone died of COVID (e.g. when it may have been secondary to age and other illness) - e.g. here.  

The closest parallel I see is that hospitals get 20% more from Medicare if the patient has tested positive for COVID (which would typically be $2000 or more on a base DRG).  I don't see any increase beyond that for asserting the patient died of COVID versus having COVID.   Scott Gottlieb discusses the same fact pattern in the November 1 link just cited.