The projected economic impact of the COVID-19 pandemic on the US healthcare system
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Brief (FAIR Health, Inc.)
- Contributor(s):
- FAIR Health, Inc., issuing body.
- Publication:
- New York, NY : FAIR Health, Inc., March 25, 2020
- Language(s):
- English
- Format:
- Text
- Subject(s):
- COVID-19 -- economics Delivery of Health Care -- economics Pandemics -- economics United States
- Genre(s):
- Technical Report
- Abstract:
- The current pandemic of coronavirus disease 2019 (COVID-19) is exacting heavy economic and social costs around the world. In the United States, one aspect of the costs of COVID-19 that is of great interest but little understood is the potential cost to the nation of inpatient services for those with the disease. In this study, FAIR Health draws 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. We estimated the costs of COVID-19 medical care based on proxy codes used by providers. We did so first on the basis of inpatient ICD-10 procedure codes and revenue codes (IIR) associated with influenza and pneumonia, then, as an alternative, on the basis of diagnosis-related groups (DRGs) associated with pneumonia. We also examined telehealth codes commonly used for respiratory infections and their costs. Among our findings: (1) On the basis of IIR, the total costs for all hospitalized COVID-19 patients range from a low of $362 billion in charges and $139 billion in estimated allowed amounts to a high of $1.449 trillion in charges and $558 billion in estimated allowed amounts, depending on the incidence rate of the infection in the US population. This is based on FAIR Health data regarding charges and allowed amounts for similar conditions, and published projections indicating 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. We also used current estimates from the Centers for Disease Control and Prevention of the age-range distribution of hospitalized COVID-19 patients, estimates of Medicare and Medicaid spending for similar procedures, and estimates of the proportion of the population that is covered by commercial insurance, Medicare and Medicaid. (2) On the basis of IIR, the total average charge per COVID-19 patient requiring an inpatient stay is $73,300 and the total average estimated allowed amount per commercially insured patient is $38,221. (3) On the basis of DRG, the per-patient average costs for hospitalized COVID-19 patients vary depending on severity. The total average charges per patient range from $74,310 for patients with major complication or comorbidity (indicated by DRG code 193), to $42,486 for patients with no complication or comorbidity (indicated by DRG code 195). The total average estimated allowed amounts per commercially insured patient range from $38,755 for DRG 193 to $21,936 for DRG 195. (4) 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 allowed amounts (for DRG 193) to $840 billion in charges and $329 billion in estimated allowed amounts (for DRG 195). (Total estimated allowed amounts include figures for commercially insured, Medicare and Medicaid patients.) (4) The telehealth code most often associated with all respiratory infections in 2019 was CPT6 99441 (physician/qualified healthcare professional telephone evaluation and management [E&M], 5-10 minutes), accounting for 50 percent of all such services. The average charge for CPT 99441 is $43 and the average estimated allowed amount is $34 for commercially insured patients, making it the lowest-cost service of CPT codes that are used only for telehealth. (5) Four of the top 10 codes most often associated with respiratory infections in 2019 were E&M codes that may be billed both for telehealth and non-telehealth. 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.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-ND license. (More information)
- Extent:
- 1 online resource (1 PDF file (28 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 101774907 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101774907