gas_dr wrote:
“Except the DRG for CoVID U07.1 is $12,000 for the admission, and for MCC (vent support) is $36,000 for admission which is much higher than most respiratory failure DRGs. There is a lot of money in CoVID. A colleague of mine had seven CoVID admissions recently, all of which were young, floor patients that required no supplemental oxygen and were discharged within a day or so — DRG still applies, hospital came out well on those cases.”
Thanks for that info!
Big money making scheme, isn’t it?
Yes and no — there are two other laws — uninsured patients are granted Medicare rates for CoVID dx, so there is a way to recoup charges for the uninsured if they have the plague.
Additionally, if you have a case that is vented for 14+ days, the hospital takes a loss on it with that DRG.
Medical payments to hospital are the ultimately government Charlie Foxtrot. The geometric length of stay is calculated, and a flat fee is paid based on the highest diagnosis of severity. As such, If you beat the GLOS, the hospital makes money, if you exceed the LOS the hospital loses money. Its why surgery is often the economic generator because they have high DRGs that you can usually get a patient out the door quickly.
This is the reason that hospitals are forever pushing discharge, and baked into the system, then, was what happened in NYC — get the CoVID patient out to SNF, and you make money, and the patient goes to a different cost center. On the back end, if the patient dies, under the GLOS, the hospital still wins. So all the SNF patients that were infected that ended up in the hospital were probably $36000 payments and my guess passed pretty quickly
All of this is further perverse because physicians are paid fee for service. So this yields that physicians are incentivized to keep patients in the hospital, hospitals are incentivized to get rid of patients, and nonclinical administrators bully the physicians to get the patients out, often keeping LOS report cards to determine credentials.
The system, set up by nonclinical administrators and people who are experts at mathematical modeling (yeah I know) have created a system wherein the last metric considered for reimbursement is did the patient actually get good care
It is a hell of a way to run a railroad