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not_the_one

(2,227 posts)
7. This is what they are referring to....
Sat May 16, 2020, 01:15 PM
May 2020
Because if it's a straightforward, garden-variety pneumonia that a person is admitted to the hospital for – if they're Medicare – typically, the diagnosis-related group lump sum payment would be $5,000. But if it's COVID-19 pneumonia, then it's $13,000, and if that COVID-19 pneumonia patient ends up on a ventilator, it goes up to $39,000."

https://www.usatoday.com/story/news/factcheck/2020/04/24/fact-check-medicare-hospitals-paid-more-covid-19-patients-coronavirus/3000638001/

As explained by nurse Elizabeth Davis in her piece for verywellhealth.com, each hospital has a base payment rate assigned by Medicare. It takes into account nationwide and regional trends, including labor costs and varying health care resources in each market.

Then, each diagnosis-related group, which classifies various diagnoses into groups and subgroups, is assigned a weight based on the average amount of resources it takes to care for a patient. Those figures are multiplied to determine the payment from Medicare. A hospital in one city and state may be paid more or less for treating a patient than a hospital in another.


I added bold and italics for emphasis.

In other words they are using a pre-approved formula. I would imagine that by the time they are put on a ventilator it has been established beyond a shadow of a doubt that they are COVID-19 patients.

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