CMS Releases COVID-19 Data, with SDoH Front and Center

I’m a longtime fan of “wholistic” healthcare and case management processes, with a “W” as opposed to an “H” for holistic. This approach addresses whole-person care of physical health, behavioral health, and psychosocial circumstances, taking care not to leave any holes in care; it’s an approach that’s even more vital for today’s populations. This approach is also in sync with value-based reimbursement methods.

Due to COVID-19’s rising numbers, especially amid communities and populations most vulnerable to racial and socioeconomic disparities, the Centers for Medicare & Medicaid Services (CMS) is again emphasizing the power of value-based reimbursement. Considering that national health expenditures for 2020 are expected to more than double to over $7 trillion, courtesy of the pandemic, the industry will be even more fixated on high-cost populations and defined strategies to rein in future costs.

COVID-19 outcomes were released by CMS last week. Health disparities and the social determinants of health (SDoH) were front and center in the data. Based on Medicare claims for beneficiaries from Jan. 1 through May 16 of 2020, the data revealed spending of $1.9 billion in fee-for-service payments for 81,227 COVID-19 hospitalizations. Other notable statistics included:

  • Average hospital reimbursement was $23,000.
  • Black beneficiaries accounted for almost four times more hospitalizations than whites, with:
    • Black adults having the highest hospitalization rate among racial and ethnic minority groups: 465 hospitalizations per 100,000, compared to whites, at 123 per 100,000.
    • In comparison, Hispanic beneficiaries had 258 hospitalizations per 100,000, and

Asian beneficiaries had 187 per 100,000.

  • End-stage renal disease patients – individuals with chronic kidney disease undergoing dialysis – had the highest rate of hospitalization among all Medicare beneficiaries: 1,341 hospitalizations per 100,000 beneficiaries.
    • A majority of these persons live with several challenges related to the SDoH, among them food insecurity, transportation challenges, access to healthcare, medication access, and prescription drug costs, health literacy, and of course, major financial challenges.
  • These patients also have chronic comorbidities associated with increased COVID-19 complications and hospitalization, such as diabetes and heart failure, which prompt increased hospital utilization, including increased emergency department visits, admissions, length of stay, and overall resource use.
  • Dual-eligible beneficiaries had the second-highest overall hospitalization rate, at 473 hospitalizations per 100,000 beneficiaries, with:
    • Higher COVID-19 infection rates: 1,406 cases per 100,000 beneficiaries.
    • By comparison, the infection rate for beneficiaries enrolled only in Medicare was 325 cases per 100,000,

CMS is echoing what industry providers, practitioners, and payors have been saying for the past several years: clinicians must have access to a payment structure that accounts for “wholistic” healthcare, addressing pathophysiology, psychopathology, and psychosocial risk factors to improve quality of life for beneficiaries and the financial health of health organizations. 

Today’s Monitor Mondays survey digs deep into the impact of this latest data on the reimbursement for health systems and organizations. You can view the survey results here.

Facebook
Twitter
LinkedIn

Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP

Ellen Fink-Samnick is an award-winning healthcare industry expert. She is the esteemed author of books, articles, white papers, and knowledge products. A subject matter expert on the Social Determinants of Health, her latest books, The Essential Guide to Interprofessional Ethics for Healthcare Case Management and Social Determinants of Health: Case Management’s Next Frontier (with foreword by Dr. Ronald Hirsch), are published through HCPro. She is a panelist on Monitor Mondays, frequent contributor to Talk Ten Tuesdays, and member of the RACmonitor Editorial Board.

Related Stories

Special Bulletin

The Undoing of SDoH Reporting

In a sweeping policy shift, the Centers for Medicare & Medicaid Services (CMS) has proposed significant rollbacks to Social Determinants of Health (SDoH) and equity-related

Read More

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

The Cost of Ignoring Risk Adjustment: How HCCs Impact Revenue & Compliance

The Cost of Ignoring Risk Adjustment: How HCCs Impact Revenue & Compliance

Stop revenue leakage and boost hospital performance by mastering risk adjustment and HCCs. This essential webcast with expert Cheryl Ericson, RN, MS, CCDS, CDIP, will reveal how inaccurate patient acuity documentation leads to lost reimbursements through penalties from poor quality scores. Learn the critical differences between HCCs and traditional CCs/MCCs, adapt your CDI workflows, and ensure accurate payments in Medicare Advantage and value-based care models. Perfect for HIM leaders, coders, and CDI professionals.  Don’t miss this chance to protect your hospital’s revenue and reputation!

May 29, 2025
I050825

Mastering ICD-10-CM Coding for Diabetes and it’s Complications: Avoiding Denials & Ensuring Compliance

Struggling with ICD-10-CM coding for diabetes and complications? This expert-led webcast clarifies complex combination codes, documentation gaps, and sequencing rules to reduce denials and ensure compliance. Dr. Angela Comfort will provide actionable strategies to accurately link diabetes to complications, improve provider documentation, and optimize reimbursement—helping coders, CDI specialists, and HIM leaders minimize audit risks and strengthen revenue integrity. Don’t miss this chance to master diabetes coding with real-world case studies, key takeaways, and live Q&A!

May 8, 2025

Trending News

Featured Webcasts

Navigating the 3-Day & 1-Day Payment Window: Compliance, Billing, and Revenue Protection

Navigating the 3-Day & 1-Day Payment Window: Compliance, Billing, and Revenue Protection

Struggling with CMS’s 3-Day Payment Window? Join compliance expert Michael G. Calahan, PA, MBA, CCO, to master billing restrictions for pre-admission and inter-facility services. Learn how to avoid audit risks, optimize revenue cycle workflows, and ensure compliance across departments. Critical for C-suite leaders, providers, coders, revenue cycle teams, and compliance teams—this webcast delivers actionable strategies to protect reimbursements and meet federal regulations.

May 15, 2025
Audit-Proof Your Wound Care Procedures: Expert Insights on Compliance and Risk Mitigation

Audit-Proof Your Wound Care Procedures: Expert Insights on Compliance and Risk Mitigation

Providers face increasing Medicare audits when using skin substitute grafts, leaving many unprepared for claim denials and financial liabilities. Join veteran healthcare attorney Andrew B. Wachler, Esq., in this essential webcast and master the Medicare audit process, learn best practices for compliant billing and documentation, and mitigate fraud and abuse risks. With actionable insights and a live Q&A session, you’ll gain the tools to defend your practice and ensure compliance in this rapidly evolving landscape.

April 17, 2025
Utilization Review Essentials: What Every Professional Needs to Know About Medicare

Utilization Review Essentials: What Every Professional Needs to Know About Medicare

Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.

March 20, 2025

Rethinking Observation Metrics: Standardizing Data for Better Outcomes

Hospitals face growing challenges in measuring observation metrics due to inconsistencies in classification, payer policies, and benchmarking practices. Join Tiffany Ferguson, LMSW, CMAC, ACM, and Anuja Mohla, DO, FACP, MBA, ACPA-C, CHCQM-PHYADV as they provide critical insights into refining observation metrics. This webcast will address key issues affecting observation data integrity and offer strategies for improving consistency in reporting. You will learn how to define meaningful metrics, clarify commonly misinterpreted terms, and apply best practices for benchmarking, and gain actionable strategies to enhance observation data reliability, mitigate financial risk, and drive better decision-making.

February 25, 2025

Trending News

Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →

CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24