COVID Costs Rise For W.Va. Healthcare System
The costs of treating COVID-19 patients are mounting, and they present a significant burden on the healthcare system in West Virginia, a state already hit by lost revenue from reduced visits to the emergency department and the canceling of non-emergency surgeries.
Many COVID-19 patients require long periods in the Intensive Care Unit and longer stays overall. Jeff Sandene, the executive vice president and chief financial officer at the Charleston Area Medical Center, pointed to one patient who was in the hospital for 34 days earlier this year. The total charges were $470,00.
“When I looked at the ICU stays, they were anywhere from one day to 49 days of stay,” Sandene said in July. “A lot of times they'll start off in the medical/surgical bed and then have to be intubated in an ICU. We had quite a few that required 30 to 40-plus days of ICU care.”
David Sanders is one such patient. He spent two months in the hospital and 32 days on a ventilator. He lost an entire month of his life with no memories of what happened.
“When I first got off the vent, I still had the trach in so I couldn't talk,” Sanders said. “That was very, very frustrating when I was trying to communicate with friends, family members and with the medical staff. I basically had to pass notes back and forth.”
Now that he is back home, Sanders’ medical bills continue to mount. After being physically inactive for nearly two months he requires physical therapy four days a week.
“The physician told me in the hospital that for every day that I was inactive, it takes three days to get my muscle back,” he said.
He expects it will be about 90 days until he is fully recovered since he did get some physical therapy in the hospital before he was discharged. A nurse also visits him once a week at home as well.
Sanders is a state employee and has PEIA insurance. He said his out of pocket expenses are approximately $1,500 and insurance paid the rest. He wasn’t able to provide a grand total of the charges the hospital billed for his care.
The West Virginia Hospital Association tracks patients in hospitals throughout the state. The latest numbers they have are for the month of April, but those figures show that charges for the average COVID patient are $21,000 higher than other in-patients and COVID patients stay in the hospital more than four days longer.
Data from the hospital association for April covers the average charges by primary insurance providers.
- Medicare: 48 patients with average charges of $59,000
- Commercial Insurance: 25 patients with average charges of $64,000
- Medicaid: 10 patients with average charges of $53,000
- Government: 6 patients with average charges of $71,000
- PEIA: 3 patients with average charges of $98,000
- Self-Pay: 2 patients with average charges of $180,000
That list, while likely not reflecting additional, out-of-hospital care, accounts for more than $6 million in healthcare costs and only covers April before the pandemic really took off in West Virginia.
Highmark Health replied in an email that the company had spent more than $40 million on COVID-19 treatment and care throughout West Virginia, Pennsylvania and Delaware as of June 30.
News reports indicate that men are more likely to have severe outcomes from COVID-19. In April, 48 women in West Virginia were hospitalized compared to 46 men, but the average charges for men were $73,700 versus $54,800 for women, for a difference of just under $19,000 per patient.
Even the relatively small numbers of deaths and hospitalizations in West Virginia add up to millions of dollars in expenses that will affect the healthcare and insurance industries. According to the hospital association statistics, of the 17 patients who died from COVID-19 in West Virginia hospitals in April, the average charges for each was $129,000.
Sandene said that many COVID patients in southern and central West Virginia have government-backed insurance. And that is a problem for the hospitals.
“Medicare and Medicaid, PEIA have always paid less than the cost of the care that we provide. COVID just compounded that because our length of stays are higher and we're using much more resources,” he said.
In the earlier example that Sandene provided of the $470,000 patient, the insurance provider paid $440,000, leaving a $30,000 bill.
Colton Mearkle is a charge nurse at Ruby Memorial Hospital in Morgantown, West Virginia. His floor in the hospital is dedicated to caring for COVID patients that aren’t in ICU and on ventilators. But even those patients require additional care and precautions. And that’s where the drain on resources comes in.
Before being converted to a COVID-19 floor, he and his team provided care for thoracic patients. They had one nurse for every three patients. They have lowered that ratio to 1:2 meaning they have added another 4 nurses per shift.
There has been much talk about the additional costs of personal protective equipment for health care providers. Mearkle detailed what he and his fellow nurses wear for each patient contact.
“We wear a capper, which consists of a helmet, that circulates the air on top of that, a shield hooks to it,” he said. “It filters the air inside this helmet. On top of that we have to wear the yellow gown. We double glove. And then we have shoe covers that we wear as well.”
For Sandene, the challenges are varied, but they all come down to forecasting the future.
"The thing that keeps me up at night is trying to understand and project what does the new normal look like," he said. "I think everything I've read, that's exactly what healthcare across the US is doing. How do you right-size the organization to take care of the new normal new volume that you have?”
Appalachia Health News is a project of West Virginia Public Broadcasting, with support from Marshall Health and Charleston Area Medical Center.