Medicare Beneficiaries Hospitalized With COVID-19 Experienced a Wide Range of Serious, Complex Conditions

WHY WE DID THIS STUDY

Coronavirus disease 2019 (COVID-19) has affected millions of Americans, resulting in more than 600,000 deaths. Medicare beneficiaries have been particularly affected and remain vulnerable to new variants and additional surges of the virus. Clinicians and researchers are still working to fully understand the damage to the body from the disease and what underlying chronic conditions potentially lead to more severe complications or hospitalization.

Understanding the types of conditions for which Medicare beneficiaries with COVID-19 are being treated and who was more likely to be hospitalized with COVID-19 can help hospitals and health officials better prepare for and address the wide-ranging and extensive needs of COVID 19 patients, particularly in the event of localized surges of cases. Such knowledge will also assist in the Federal, State, and local response to the pandemic by providing a better picture of the needs of these hospitalized beneficiaries.

This report describes the complex care needs of beneficiaries hospitalized with COVID-19. It focuses on surges in COVID-19 hospitalizations in six localities and builds upon prior OIG work that describes the extent to which hospitals have been strained by COVID-19. As we noted in the 2021 report about hospital experiences during the pandemic, hospitals have been operating in "survival mode" for an extended period of time. They have also experienced difficulty balancing the complex and resource-intensive care needed for COVID-19 patients with efforts to resume routine hospital care.

HOW WE DID THIS STUDY

We reviewed hospital inpatient claims and enrollment data to identify all Medicare beneficiaries who were hospitalized in a short-term acute-care hospital at any point from April 1 through July 31, 2020. We then identified six localities that experienced a surge in hospitalizations of Medicare beneficiaries with COVID-19 over a 3-week period. We analyzed the diagnoses on the claims of beneficiaries hospitalized with COVID-19 in those six selected localities to identify the conditions for which they were treated during their hospital stays. The percentages presented in this report represent averages among the six localities.

WHAT WE FOUND

During surges in hospitalizations, hospitals in the six localities treated Medicare beneficiaries with COVID-19 for a wide range of serious, complex conditions. Almost all of these beneficiaries were treated for acute respiratory issues, such as viral pneumonia. Many of these beneficiaries were also treated for other types of serious conditions including:

• almost half were treated for acute kidney failure,
• almost half had acute circulatory issues,
• almost two-thirds were treated for significant endocrine, nutritional, or metabolic issues, and
• more than one-third had sepsis.

More than 50 percent of Medicare beneficiaries hospitalized with COVID-19 received intensive care or mechanical ventilation. Additionally, dually eligible, Black, Hispanic, or older beneficiaries were disproportionately hospitalized with COVID-19 relative to the Medicare population in these localities.

WHAT WE CONCLUDE

The complex needs of hospitalized Medicare beneficiaries—combined with surges in hospitalizations-may create substantial challenges in meeting the needs of these patients, particularly in light of the staffing and other problems that hospitals have reported. Gaining a better understanding of Medicare beneficiaries hospitalized with COVID-19—including the conditions for which they were being treated and demographic characteristics—can assist Federal, State, and local efforts in the COVID-19 pandemic and may be used to provide additional guidance to hospitals. This information can also help hospitals, physicians, and other practitioners better prepare for the complex and resource-intensive care needs of Medicare beneficiaries with COVID-19, which may be particularly important during continued surges of the virus. CMS can also use this information to identify beneficiaries who are particularly vulnerable to hospitalization as well as to understand the needs of these beneficiaries during their hospitalizations. In addition, this analysis shows that Medicare claims data can be used to enhance our knowledge of the treatment of COVID-19 and help inform additional research efforts.