In State-by-State Analysis, New Jersey Emerges as State with Highest In-Network Costs for Complex Hospitalizations for COVID-19, Maryland the Lowest

NEW YORK, Dec. 15, 2021 /PRNewswire/ -- In a state-by-state analysis of private healthcare claims data from 2020 to 2021, New Jersey emerged as the state with the highest average allowed amount¹ for complex hospitalizations for COVID-19, while Maryland had the lowest. In New Jersey, the average allowed amount for such hospitalizations was $128,650 and in Maryland $49,127. These and other findings are reported in the new FAIR Health brief COVID-19 Treatment and Hospitalization Costs: A Descriptive Analysis of the FAIR Health COVID-19 Cost Tracker. The brief provides a descriptive analysis of the COVID-19 patient population whose treatment and hospitalization costs are tracked by FAIR Health's COVID-19 Cost Tracker, a free, online tool displaying typical, state-by-state COVID-19 costs.

Complex hospitalizations for COVID-19 are those that require ventilation and/or admission to the intensive care unit (ICU), while noncomplex hospitalizations do not. The state with the highest average allowed amount for noncomplex hospitalizations for COVID-19 was Alaska ($44,239), and the state with the highest average allowed amount for outpatient treatment for COVID-19 was Nevada ($1,538). Maryland was the state with the lowest average allowed amounts for noncomplex hospitalizations ($12,531) and outpatient treatment ($580) for COVID-19, as well as for complex hospitalizations.² 

Other findings in the new report include the following (from April 2020 to August 2021 unless otherwise indicated):

• Of COVID-19 patients with a complex inpatient stay, 48.4 percent had five or more comorbidities and 20.6 percent had zero comorbidities. By comparison, patients with zero comorbidities constituted nearly half (49.4 percent) of all patients diagnosed with COVID-19; patients with five or more comorbidities constituted only 13.7 percent of all patients diagnosed with COVID-19.
• In patients with a complex hospitalization for COVID-19, the most common comorbidity was hyperlipidemia and/or hypertension, which accounted for 14.7 percent of this population. In patients with a noncomplex hospitalization for COVID-19, the most common comorbidity was chronic breathing issues, at 6.5 percent of the distribution.
• December 2020 was the month with the most reported COVID-19 diagnoses.
• From January to June 2021, the distribution of COVID-19 diagnoses in urban areas was higher than in rural areas. But in July 2021, and even more in August 2021, rural areas had a greater distribution of COVID-19 cases than urban areas.
• The largest category of COVID-19 cases included those who tested positive for COVID-19 but did not receive any further services for COVID-related symptoms.³ That category was larger than outpatients with symptoms, complex inpatients or noncomplex inpatients.
• The largest percentage of complex hospitalizations occurred in those 70 years and older (17.2 percent of patients diagnosed with COVID-19 in this age group); an additional 15.7 percent of patients in this age group had a noncomplex hospitalization. In total, 32.9 percent of all patients 70 years and older had an inpatient stay for their COVID-19 diagnosis.
• In noncomplex hospitalizations for COVID-19, 57 percent of patients were female, but in complex hospitalizations, 57 percent of patients were male.
• The percentage of COVID-19 patients who died in April 2020 was 1.9 percent, but from February to July 2021, it was about half a percent each month.
• The median length of stay for patients with a complex hospitalization for COVID-19 decreased from a high of 13 days in April 2020 to a low of 7 days in July 2021. The median length of stay for a noncomplex hospitalization, however, remained relatively flat throughout this period, with most months having a median of four days and the rest three days.
• For complex and noncomplex hospitalizations for COVID-19 in 2020 and 2021, the West had the highest average allowed amounts and the South the lowest. For outpatient treatment for COVID-19, the West had the highest average allowed amounts and the Northeast the lowest.

FAIR Health President Robin Gelburd stated: "Behind the numbers of our COVID-19 Cost Tracker are the individuals who have contracted COVID-19. As a public service, this brief provides a descriptive analysis of that patient population, offering context for the COVID-19 Cost Tracker."

This is the ninth in a series of studies released by FAIR Health on the COVID-19 pandemic. The first study examined projected US costs for COVID-19 patients requiring inpatient stays, the second the impact of the pandemic on hospitals and health systems, the third the impact on healthcare professionals, the fourth key characteristics of COVID-19 patients, the fifth the impact on the dental industry, the sixth risk factors for COVID-19 mortality, the seventh the impact on pediatric mental health and the eighth post-COVID conditions.

For the new brief, click here.

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About FAIR Health
FAIR Health is a national, independent nonprofit organization that qualifies as a public charity under section 501(c)(3) of the federal tax code. It is dedicated to bringing transparency to healthcare costs and health insurance information through data products, consumer resources and health systems research support. FAIR Health possesses the nation's largest collection of private healthcare claims data, which includes over 35 billion claim records and is growing at a rate of over 2 billion claim records a year. FAIR Health licenses its privately billed data and data products—including benchmark modules, data visualizations, custom analytics and market indices—to commercial insurers and self-insurers, employers, providers, hospitals and healthcare systems, government agencies, researchers and others. Certified by the Centers for Medicare & Medicaid Services (CMS) as a national Qualified Entity, FAIR Health also receives data representing the experience of all individuals enrolled in traditional Medicare Parts A, B and D; FAIR Health includes among the private claims data in its database, data on Medicare Advantage enrollees. FAIR Health can produce insightful analytic reports and data products based on combined Medicare and commercial claims data for government, providers, payors and other authorized users. FAIR Health's systems for processing and storing protected health information have earned HITRUST CSF certification and achieved AICPA SOC 2 compliance by meeting the rigorous data security requirements of these standards. As a testament to the reliability and objectivity of FAIR Health data, the data have been incorporated in statutes and regulations around the country and designated as the official, neutral data source for a variety of state health programs, including workers' compensation and personal injury protection (PIP) programs. FAIR Health data serve as an official reference point in support of certain state balance billing laws that protect consumers against bills for surprise out-of-network and emergency services. FAIR Health also uses its database to power a free consumer website available in English and Spanish, which enables consumers to estimate and plan for their healthcare expenditures and offers a rich educational platform on health insurance. An English/Spanish mobile app offers the same educational platform in a concise format and links to the cost estimation tools. The website has been honored by the White House Summit on Smart Disclosure, the Agency for Healthcare Research and Quality (AHRQ), URAC, the eHealthcare Leadership Awards, appPicker, Employee Benefit News and Kiplinger's Personal Finance. FAIR Health also is named a top resource for patients in Dr. Marty Makary's book The Price We Pay: What Broke American Health Care—and How to Fix It and Dr. Elisabeth Rosenthal's book An American Sickness: How Healthcare Became Big Business and How You Can Take It Back. For more information on FAIR Health, visit fairhealth.org.

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¹ An allowed amount is the total fee negotiated between an insurance plan and a provider for an in-network service. It includes both the portion to be paid by the plan member and the portion to be paid by the plan.
² This may be partly explained by Maryland's all-payer rate-setting system. See Maryland Hospital Association, "The Maryland Model."
³ Patients who did not report symptoms on the index date of diagnosis may have experienced symptoms afterward and not incurred a claim because they were not sick enough to seek medical care or did not choose to do so.

SOURCE FAIR Health