Healthcare News of Note: Average billed charge for complex COVID-19 hospitalizations is more than three times the allowed amount

• The average billed charge for a complex COVID-19 hospitalization in the United States is $317,810, while the average estimated allowed amount paid to an in-network provider is $98,139.
• A new infographic details how people with disabilities have been uniquely impacted by the pandemic as they face a greater risk of poor health outcomes, reduced access to routine services and care, and adverse social outcomes.
• A recent study showed fewer posthospital inpatient admissions and decreased costs in a large group of patients with medically complex chronic conditions who were referred to and seen in an outpatient critical care transition clinic compared with a group who were referred but not seen.

Over the last few weeks, I have found these industry news stories that should be of interest to healthcare finance professionals.

1. FAIR Health: $317,810 is the average billed charge for complex COVID-19 hospitalizations in the U.S.

“The average billed charge for a complex COVID-19 hospitalization in the United States is $317,810, according to new cost estimates from FAIR Health,” a Sept. 21 press release states. “The average estimated allowed amount (the total amount paid to an in-network provider, including payments from both the plan and the patient) is $98,139.”

According to FAIR Health, COVID-19 hospitalizations with complexities include, but are not limited to:

Hospital inpatient services such as laboratory tests, durable medical equipment (such as ventilators), blood and blood components, treatments and specialty drugs, radiology and ICU room and board

Outpatient and provider services such as follow-up office visits, lab tests, radiology services, echocardiography procedures, immunology procedures and transfusions 

Cost of other COVID-19 categories

Two other categories of COVID-19 are detailed in the release, providing the latest national numbers on estimated costs for COVID-19  in September 2021:

• General COVID-19 hospitalization has an average charge amount of $74,591 and an average estimated allowed amount of $33,525.
• COVID-19 non-hospitalization has an average charge amount of $2,557 and an average estimated allowed amount of $1,008.

The press release also provides details about what constitutes the above categories of COVID treatment and how FAIR Health calculates COVID-19 cost benchmarks.

2. NIHCM infographic: The pandemic places people with disabilities at greater risk

 “People with disabilities have been uniquely impacted by the pandemic as they face a greater risk of poor health outcomes, reduced access to routine services and care, and adverse social outcomes,” according to a new infographic titled “Disability, health equity and COVID-19.”

The infographic was published Sept. 21 by the National Institute for Health Care Management (NIHCM) Foundation, which derived the information from multiple sources.

People with disabilities at greater risk of dying and mental stress due to the pandemic

Although the infographic details several challenges that people with disabilities face, including poorer overall health and barriers to inclusion and healthcare access, the focus here is on how COVID-19 disproportionately impacted people with disabilities, including:

• Individuals with intellectual and developmental disabilities had a higher risk of dying than those without such disabilities
• Those with intellectual disabilities were 6 times more likely to die from COVID-19 than other members of the population
• Mental health stress due to activity restrictions imposed by the pandemic especially affected those on the autism spectrum

People with disabilities also fared worse during the pandemic due to issues with telehealth access for those with vision, hearing or cognitive issues, disrupted access to caregivers and intervention services, unemployment, and unmet needs including access to transportation, medication, food and other basic necessities, according to NIHCM.

Number of people with disabilities in the U.S.

One in four people in the U.S. has a disability, according to NIHCM. Of those in the U.S. with disabilities:

• 12.8% have a mobility disability
• 12% have a cognitive disability
• 7% have an independent-living disability
• 5.9% have a hearing disability
• 5% have a vision disability
• 3.8% have a self-care disability

3. Study shows reduction in hospital readmissions for medically complex patients seen in an outpatient critical care transition clinic

A study published Sept. 21 in The American Journal of Managed Care showed fewer posthospital inpatient admissions and decreased costs “in a large group of patients with medically complex chronic conditions” who were referred to and seen in an Indianapolis-based outpatient critical care transition clinic compared with those who were referred but did not attend the clinic.

According to the study outcomes:

• Critical care transition clinic patients with chronic conditions had a 31% reduction in relative risk for inpatient admissions.
• The clinic reduced costs by more than $1 million.

“In patients with complex chronic medical conditions with recent hospital admissions, the HTC [Healthy Transitions Clinic] model appears to reduce both admissions and encounter costs,” the authors wrote. “Further community/regional studies are needed to better define this observation on a longitudinal basis.

“We suggest that other health care systems could benefit from setting up similar programs to help these patients manage their medically complex chronic conditions and reduce health care costs nationwide.”

HFMA bonus content

Mayo Clinic’s Sean C. Dowdy, MD, discusses the system’s COVID-19 modeling efforts and how healthcare professionals can stay safe when traveling and attending in-person conferences in this Q&A.