NEW YORK, March 25, 2020 /PRNewswire/ -- The total costs
for all hospitalized COVID-19 patients may range from a low of
$362 billion in charges and
$139 billion in estimated in-network
amounts to a high of $1.449 trillion
in charges and $558 billion in
estimated in-network amounts, depending on the incidence rate and
severity of the infection in the US population. As reported in a
FAIR Health brief released today, COVID-19: The Projected
Economic Impact of the COVID-19 Pandemic on the US Healthcare
System, this finding is based on FAIR Health projections,
derived from estimates issued by public health experts, that from
66 million to 198 million Americans may become infected with the
novel coronavirus that causes COVID-19, and that from 4.9 million
to 19.8 million of them may require inpatient stays.
![The Projected Economic Impact of the COVID-19 Pandemic on the US Healthcare System: A FAIR Health Brief, March 25, 2020 The Projected Economic Impact of the COVID-19 Pandemic on the US Healthcare System: A FAIR Health Brief, March 25, 2020](https://mma.prnewswire.com/media/1137445/COVID_19_Impact.jpg)
The total average charge per COVID-19 patient requiring an
inpatient stay is estimated at $73,300 and the total average estimated
in-network amount per commercially insured patient at $38,221.
A national, independent nonprofit organization dedicated to
bringing transparency to healthcare costs and health insurance
information, FAIR Health drew on its database of over 30 billion
private healthcare claim records, and on estimates of Medicare and
Medicaid costs, to project US costs for COVID-19 patients requiring
inpatient stays. FAIR Health estimated the costs of COVID-19
medical care based on proxy codes used by providers. The findings
stated above were based on inpatient ICD-10 procedure codes and
revenue codes associated with influenza and pneumonia.
DRGs
As an alternative, FAIR Health also calculated US costs for
hospitalized COVID-19 patients on the basis of diagnosis-related
groups (DRGs) associated with pneumonia. On the basis of DRG,
the per-patient average costs for hospitalized COVID-19 patients
vary depending on severity as indicated by the DRG code, with DRG
193 for major complication or comorbidity, DRG 194 for complication
or comorbidity and DRG 195 for no complication or comorbidity. The
total average charges per patient range from $74,310 for DRG 193 to $42,486 for DRG 195. The total average estimated
in-network amounts per commercially insured patient range from
$38,755 for DRG 193 to $21,936 for DRG 195.
Total costs for all hospitalized COVID-19 patients vary on the
basis of which DRG code is used. Assuming the highest projected
numbers of infected patients needing inpatient stays, the costs
range from $1.469 trillion in charges
and $575 billion in estimated
in-network amounts (for DRG 193) to $840
billion in charges and $329
billion in estimated in-network amounts (for DRG 195).
Telehealth
FAIR Health also examined telehealth codes commonly used for
respiratory infections and their costs. Of the top 10 telehealth
codes most often associated with all respiratory infections, the
predominant one in 2019 was CPT®1 99441
(physician/qualified healthcare professional telephone evaluation
and management [E&M], 5-10 minutes), which accounted for 50
percent of all telehealth services for respiratory infections. The
average charge for CPT 99441 is $43
and the average estimated in-network amount for those commercially
insured is $34, making it the
lowest-cost service of CPT codes that are used only for
telehealth.
E&M codes billed both for telehealth and non-telehealth
include 4 of the top 10 codes most often associated with
respiratory infections. Among these codes, having telehealth as the
place of service in most cases yields cost savings by comparison
with all places of service for the same code.
FAIR Health President Robin
Gelburd stated: "In this time of profound uncertainty and
shared purpose, we hope that the information in this brief is
useful to policy makers, payors, providers, researchers and other
healthcare stakeholders, and to the country as a whole."
Marty Makary, MD, MPH, a
professor of health policy and management at the Johns Hopkins
Bloomberg School of Public Health and a professor of surgery at the
Johns Hopkins University School of
Medicine, commented: "As we as a country mobilize every
resource to fight COVID-19, people want to know how much it will
cost. FAIR Health has helped put a price tag on medical services to
care for these patients based on the best available projections
using real-world data."
Follow us on Twitter @FAIRHealth
About FAIR Health
FAIR Health, a national, independent nonprofit organization that
qualifies as a public charity under section 501(c)(3) of the tax
code, is dedicated to bringing transparency to healthcare costs and
health insurance information through data products, consumer
resources and health systems research support. FAIR Health
possesses the nation's largest collection of private healthcare
claims data, which includes over 30 billion claim records
contributed by payors and administrators who insure or process
claims for private insurance plans covering more than 150 million
individuals. FAIR Health licenses its privately billed data and
data products—including benchmark modules, data visualizations,
custom analytics and market indices—to commercial insurers and
self-insurers, employers, providers, hospitals and healthcare
systems, government agencies, researchers and others. Certified by
the Centers for Medicare & Medicaid Services (CMS) as a
national Qualified Entity, FAIR Health also receives data
representing the experience of all individuals enrolled in
traditional Medicare Parts A, B and D; FAIR Health houses data on
Medicare Advantage enrollees in its private claims data repository.
FAIR Health can produce insightful analytic reports and data
products based on combined Medicare and commercial claims data for
government, providers, payors and other authorized users. FAIR
Health's systems for processing and storing protected health
information have earned HITRUST CSF certification and achieved
AICPA SOC 2 compliance by meeting the rigorous data security
requirements of these standards. As a testament to the reliability
and objectivity of FAIR Health data, the data have been
incorporated in statutes and regulations around the country and
designated as the official, neutral data source for a variety of
state health programs, including workers' compensation and personal
injury protection (PIP) programs. FAIR Health data serve as an
official reference point in support of certain state balance
billing laws that protect consumers against bills for surprise
out-of-network and emergency services. FAIR Health also uses its
database to power a free consumer website available in English and
Spanish and an English/Spanish mobile app, which enable consumers
to estimate and plan for their healthcare expenditures and offer a
rich educational platform on health insurance. The website has been
honored by the White House Summit on Smart Disclosure, the Agency
for Healthcare Research and Quality (AHRQ), URAC, the eHealthcare
Leadership Awards, appPicker, Employee Benefit News and
Kiplinger's Personal Finance. FAIR Health also is named a
top resource for patients in Dr. Marty Makary's book The Price
We Pay: What Broke American Health Care—and How to Fix It and
Elisabeth Rosenthal's book An American Sickness: How Healthcare
Became Big Business and How You Can Take It Back. For more
information on FAIR Health, visit fairhealth.org.
Contact:
Dean
Sicoli
Chief Communications Officer
FAIR Health
646-664-1645
dsicoli@fairhealth.org
1 CPT © 2019 American Medical Association (AMA). All
rights reserved.
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