110,000 Medicare beneficiaries were hospitalized for COVID-19 by mid-May

• COVID-19 hospitalizations for Medicare beneficiaries were 175 per 100,000 by mid-May.
• Nationally, COVID-19 hospitalizations have declined since mid-April.
• Hospitalization costs for Medicare enrollees were much higher than had been previously projected for all patients.

The most vulnerable population to the COVID-19 pandemic experienced nearly 110,000 hospitalizations for the disease by mid-May, according to preliminary Medicare data.

Medicare claims data examined by CMS for Jan. 1-May 16 identified nearly 110,000 hospitalizations of mostly elderly beneficiaries for COVID-19 care, or 175 hospitalizations per 100,000 Medicare beneficiaries. More than 325,000 beneficiaries (518 per 100,000) were diagnosed with the disease.

Other key COVID-19 findings included:

• Patients with end-stage renal disease had the highest rate of hospitalizations (1,341 per 100,000).
• Beneficiaries enrolled in both Medicare and Medicaid had the next-highest rate (473 per 100,000).
• Black beneficiaries had the highest rate of hospitalization among races/ethnicities (465 per 100,000).
• Rates also were higher for Hispanics (258 per 100,000) and asians (187 per 100,000) compared with whites (123 per 100,000).

“At the end of the day it reconfirms long-standing issues around disparities and vulnerable populations,” Seema Verma, administrator of CMS, said during a call with reporters.

Low socioeconomic status “wrapped up with the racial disparities” was found to be “a powerful predictor of complications from COVID-19,” Verma said.

“Now we know it’s not only our seniors but [that we need] to really focus on our low-income seniors,” she said.

Verma also noted that dual-eligibles were more likely to live in nursing homes, where many of the COVID-19 fatalities have occurred.  The infection rate for dually eligible individuals was 1,406 cases per 100,000.

Beneficiaries living in rural areas constituted fewer cases and were hospitalized at a lower rate (57 per 100,000) than those living in urban or suburban areas (combined rate of 205 per 100,000).

Outcomes for the hospitalizations included:

• 28% died in the hospital
• 27% discharged to their homes
• 45% discharged to other healthcare settings

The claims data is not complete since providers may take months to submit claims. CMS plans to update data monthly and to release similar information on Medicaid beneficiaries “in the future” as it receives the data from states.

National hospitalization trends

The Medicare-specific cumulative findings came amid steady declines in national COVID-19 hospitalization rates since the week of April 16, according to tracking by the Centers for Disease Control and Prevention (CDC). More than 3,000 COVID hospitalizations occurred that week, compared with less than 1,000 during the week of June 13.

The CMS data echoed CDC tracking data on age, which used different data sources but found by far the highest rates of hospitalization throughout the pandemic among those at least 65 years old. Rates for that age group reached a high of 287 per 100,000 the week of June 13, according to the CDC’s data.

Costs of COVID-19 care

Medicare paid $1.9 billion for COVID-19 fee-for-service hospitalizations, or an average of $23,094 per case.

That followed the $14,366 median cost of COVID hospitalizations as estimated by an April study. The Medicare COVID-19 payments include a 20% add-on, but Medicare payments average about half of what commercial health plans pay for the same diagnoses.

Commercial plans were projected to spend nearly twice as much on COVID-19 care as Medicare, according to a recent analysis by Avalere Health.

CMS’s response to the findings

CMS urged states to “double down on efforts to protect low-income seniors and look at the data and determine what resources are available, both locally and federally, to improve this disparity of health outcomes.” For example, the agency urged states to take advantage of various “operational opportunities” to improve care for dual-eligibles and implement value-based payment (VBP) models to improve quality.

Verma said many states have not pursued options offered by CMS to improve care for dual-eligibles. She urged more to do so, notwithstanding the operational demands of the ongoing pandemic.

“Like those facing racial and ethnic minorities, these stark disparities should spur us to be creative and bold in addressing the challenges of dually eligible individuals,” Verma said. “Any such efforts will inextricably be connected with our broader push to value-based care.”

CMS said it is developing new VBP models for Medicaid and CHIP programs to implement strategies to address social determinants of health.

The CMS Office of Minority Health plans a series of listening sessions with “key stakeholders responsible for providing care to racial and ethnic minorities. These listening sessions are intended to help refine the ongoing outreach and work by CMS to improve future efforts on this issue,” the agency stated.