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Blacks are hospitalized for COVID-19 at four times the rate of whites, Medicare claims data shows

CMS Administrator Seema Verma promotes value-based payment models to address race, ethnic disparities and the social determinants.

Susan Morse, Managing Editor

Medicare claims data shows Blacks were hospitalized with COVID-19 at a rate nearly four times higher than whites.

Blacks had the highest hospitalization rate, with 465 per 100,000. Hispanics had 258 hospitalizations per 100,000. Asians had 187 per 100,000, and whites had 123 per 100,000.

The disparities go beyond race and ethnicity and suggest the impact of social determinants of health, particularly socioeconomic status, according to the Centers for Medicare and Medicaid Services in a snapshot of the impact of the COVID-19 pandemic on the Medicare population. 

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WHY THIS MATTERS

Over 325,000 Medicare beneficiaries have been diagnosed with COVID-19 this year through May 16, translating to 518 cases per 100,000 beneficiaries.

Of the 110,000 Medicare beneficiaries hospitalized with COVID-19, 28% died in the hospital, CMS Administrator Seema Verma said by blog. Another 27% were discharged to their homes. The remainder were discharged to skilled nursing facilities (21%) or other healthcare settings.

Half of hospitalizations (50%) were less than 8 days, while 9% were 21 days or longer.

Medicare payments for fee-for-service hospitalizations totaled $1.9 billion, with an average of $23,094 per hospitalization. 

The data shows that older Americans and those with chronic health conditions are at the highest risk for COVID-19 and confirms long-understood disparities in health outcomes for racial and ethnic minority groups and among low-income populations, CMS said.

The delay in releasing the data is due to a claims lag. The information has not been robust enough until now, Verma said.

CMS typically releases Medicare claims information on an annual basis when there are more complete claims and encounter data.

The data will be updated on a monthly basis as more claims and encounter records are received.

Verma had no data to compare the number of COVID-19 cases among the Medicare population to the population as a whole.

CMS anticipates releasing similar information on Medicaid beneficiaries in the future.

WHAT ELSE YOU NEED TO KNOW

End-stage renal disease patients – individuals with chronic kidney disease undergoing dialysis – had the highest rate of hospitalization among all Medicare beneficiaries, with 1,341 hospitalizations per 100,000 beneficiaries.

Patients with ESRD are also more likely to have chronic comorbidities associated with increased COVID-19 complications and hospitalization, such as diabetes and heart failure.

The second-highest rate was among dual eligible beneficiaries enrolled in both Medicare and Medicaid, with 473 hospitalizations per 100,000 beneficiaries.

Beneficiaries living in rural areas had fewer cases and were hospitalized at a lower rate than those living in urban/suburban areas (57 versus 205 hospitalizations per 100,000).

The snapshot also shows that, besides higher hospitalization rates, beneficiaries enrolled in both Medicaid and Medicare have a higher infection rate of COVID-19, with 1,406 cases per 100,000 beneficiaries.

By comparison, the coronavirus infection rate for beneficiaries enrolled only in Medicare was 325 cases per 100,000.

The rate of COVID-19 cases for dual eligible individuals is higher across all age, sex and racial/ethnic groups. Previous research has shown that these individuals experience high rates of chronic illness, with many having long-term care needs and social risk factors that can lead to poor health outcomes.

THE LARGER TREND

Verma and the administration are promoting value-based solutions rather than relying on a fee-for-service system. Fee-for-service is insufficient to address the social determinants and the needs of vulnerable Americans because it limits payment to what goes on inside a doctor's office, she said.

Any solution requires a multi-sectoral approach that includes federal, state and local governments; community-based organizations; and private industry, CMS said.

The agency is encouraging states to double down on efforts to protect low-income seniors and look at the data and determine what resources are available, both locally and federally, to improve disparity of health outcomes.

CMS has identified a range of operational opportunities for states to improve care for dually eligible individuals and a variety of models that states can participate in that focus on improving the quality and cost of care for individuals concurrently enrolled in Medicaid and Medicare.

The Center for Medicaid and Children's Health Insurance Program Services is developing guidance for states on new opportunities to adopt value-based payment design and implement strategies to address the social determinants of health for beneficiaries, including those who are dually-eligible for Medicare and Medicaid.

In addition to these ongoing efforts and programs, the CMS Office of Minority Health will be holding a series of listening sessions with key stakeholders responsible for providing care to racial and ethnic minorities.

ON THE RECORD

"The disparities in the data reflect long-standing challenges facing minority communities and low income older adults, many of whom face structural challenges to their health that go far beyond what is traditionally considered 'medical'," said CMS Administrator Seema Verma.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com