A: No. Healthcare professionals and hospitals are not inflating the numbers of COVID-19 cases to make more money.
If anything, the number of cases and deaths are undercounted. Many hospitals lost money during the pandemic.
Sadly, the rumor that clinicians and hospitals are inflating the number of COVID-19 deaths and cases to make more money is making the rounds once again. This one hurts, as healthcare workers are continuing to work extremely hard in very difficult conditions.
In the US, The Coronavirus Aid, Relief, and Economic Security (CARES) Act does allow hospitals to get a 20% add on payment for patients that have COVID-19. This only applies to Medicare patients or people who are uninsured, not to people who have Medicaid or private health insurance. This increase in reimbursement is to cover the higher costs of caring for people with COVID-19, the costs of personal protective equipment, the costs of additional equipment (like more ventilators), increased staffing needs, and the costs of shifting business away from other lines of care (like non-emergency surgeries). In fact, despite this increase in payment, many hospitals and doctor’s offices closed. The American Hospital Association projected that US hospital and health systems losses around $323.1 billion in 2020. Rural hospitals were hardest hit and sometimes closed altogether, taking away critical access to healthcare for many.
So, are hospitals falsely claiming that someone died from COVID-19 when they didn’t to bring in that 20% add on payment? The assertion goes like this: “Somebody has heart disease, catches COVID-19, and eventually dies from COVDI-19 pneumonia. If they didn’t have heart disease, maybe their case of Covid19 wouldn’t have been so bad. So, isn’t heart disease the real cause of death, not COVID-19?”
No. When somebody dies, a physician, medical examiner, or coroner completes a death certificate. The death certificate asks for the immediate cause of death and then for significant conditions that may have played a role. In our example, the immediate cause of death would be pneumonia from COVID-19. This is what caused the person to die the day that they did. Heart disease would be a significant contributing condition, or comorbidity. Any other medical problems that might have contributed to the cause of death are also explicitly reported on the form. Tracking comorbidities is one way we know which conditions increase someone’s risk of having severe disease from COVID-19.
This is how it works with any illness or disease state, not just in COVID-19 cases. Let’s consider an example where a person diagnosed with terminal cancer is killed in a tragic car accident. The medical examiner would report the trauma from the car accident as the immediate cause of death. Their cancer diagnosis in this situation may or may not even be documented on the form, unless it was felt that this impacted the car accident in some way. This person may have had some time left to live if the car accident hadn’t happened.
Death certificates are part of a public health system to track causes of death to help develop regulations, prevention strategies, and treatment so that communities and individuals can have longer, happier, healthier lives. It is a professional duty to make information on death certificates, medical records, and billing as accurate as possible. There is no evidence of fraud. Healthcare professionals are not putting their thumb on the scale.
Stay safe. Stay sane. Thank a healthcare worker. They are struggling.
Those Nerdy Girls
Links:
Dear Pandemic Post on the undercounting of COVID-19 deaths
Summary of CARES Act Provisions around payment
If you want to get really in the details of death certificates, here you go.
