By Simon Wheaton-Smith
All of us have at times expanded the facts to fit our desires, such as how big that fish was, and so on. But in these days where things happen quickly, and where tensions are taut, the more we can question what we are told the better. Stories go around the internet and are often repeated, expanded, and re-circulated. Myths, like internet stories almost always have the seeds of truth. Numbers are often quoted, however the meanings are then "adjusted." I would encourage everyone to think before repeating a story, do the smell test. I am neither a doctor nor lawyer, and I can be wrong in my take on such stories, but here is my personal take on one of them.
The quote I received was "My [relative of your choice] is an RN in [such and such hospital] in [city of your choice]. She/He verified to me on [a specific date] that hospitals receive $33,000 for every death diagnosed as COVID, so even if you had a heart attack and have COVID, your death certificate reads "COVID"! I had heard it several months ago, too."
I took the time to check this one. It originally came from a state senator who is also a doctor, Dr. Jensen, and he is credible. What he actually said was that Medicare has determined that if you have a COVID-19 admission to the hospital, you'll get paid $13,000. If that COVID-19 patient goes on a ventilator, you get $39,000, three times as much. Nobody can tell me after 35 years in the world of medicine that sometimes those kinds of things impact on what we do."
In following up on this I used several fact-checkers so I covered the political spectrum. Dr. Jensen in fact later stated that he did not think that hospitals were intentionally misclassifying cases for financial reasons. [NOTE: he did not say deaths, only cases]
Going a step further, many doctors working in hospitals are independent, my doctor is, and two of my cancer surgeons were; this is common. State statutes define who can sign a death certificate. According to the National Association of Medical Examiners some 20 percent are signed by a coroner or a medical examiner. The rest are signed by authorized persons such as primary physicians, attending or non-attending physicians, nurse practitioners, or forensic pathologists. This varies according to state. This suggests the death certificate signing is somewhat removed from the hospital administration.
Going further still, the $33,000 or $39,000 is not for cause of death; rather it is to reimburse a hospital for a patient on a respirator. Worth checking are: "The Centers for Medicare and Medicaid Services" and the CARES Act. Medicare pays set rates but the CARES Act increased Medicare payment to hospitals by 20% for cases involving COVID-19, but no extra money for a COVID-19 death. That tends to question the internet story. The two dollar amounts came from researchers' estimates; they do not include actual Medicare payments to hospitals for COVID-19 diagnosis. More money for COVID-19 patients is true; any extra for COVID-19 deaths is not.
The President of the Maine Hospital Association Steven Michaud says the federal government is paying out more for hospitals to care for COVID-19 patients because the resources to take care of COVID patients are enormous. Costs are sky high because of their length of stay, use of ICUs, and PPE used to take care of them. This is not a financial winner.
This story also touches on what is in a death certificate, and critical is part 1. Part 1 is the final cause of death and then below that its immediate cause, and below that its cause, and so on. Understanding the sequence leading up to death is helpful. The death certificate the USA uses matches international standards. I imagine there are screwups at times, but little evidence of systemic fraudulent use is available.
Conclusion: This story emanated from Dr Jensen who later clarified he did not believe fraud was significant. The story is questionable based on how death certificates are signed, especially as many signers are independent of the hospital in which they have privileges. Dr Jensen did not refer to death reimbursement, only to admitted cases. Mistakes can happen, however there are processes in place to minimize errors. I suggest that this story has more unproven elements than are ones shown to be true. We are all better served with factual rather than unverified information. And remember that different states have different rules and processes. I can be wrong; however I hope this article, one of several, helps.
My references below are a mix of government sources (some trust them, some do not) as well as news outlets (again, some trust them, some do not). Many other sources exist.
References:
https://www.factcheck.org/2020/04/hospital-payments-and-the-covid-19-death-count/
https://www.pbs.org/wgbh/pages/frontline/post-mortem/things-to-know/death-certificates.html
https://www.cdc.gov/nchs/data/dvs/blue_form.pdf
https://www.cdc.gov/nchs/data/misc/hb_cod.pdf
https://crvsgateway.info/The-International-Form-of-Medical-Certificate-of-Cause-of-Death~356