Medicare Claims Data Further Highlight Pandemic's Toll on Racial Minorities

Preliminary data released by CMS show black Americans with Medicare coverage are nearly 4 times more likely than their white counterparts to be hospitalized for coronavirus disease 2019 (COVID-19). Medicare claims data show black individuals were hospitalized at a rate of 465/100,000 beneficiaries compared with 123/100,000 white individuals.

For Hispanic beneficiaries, the rate of hospitalizations was 258/100,000, and for Asian beneficiaries, 187/100,000. Meanwhile, this number increased to 379/100,000 for all individuals age 85 and older.

“The disparities in the data reflect longstanding 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.

The analysis, which included claims from January 1 through May 16, 2020, also found beneficiaries with end stage renal disease (ESRD) have the highest COVID-19 hospitalization rate (1341/100,000). They are also more likely to have chronic comorbidities such as diabetes and heart failure, which can exacerbate COVID-19 infections. The second highest hospitalization rate was among dual-eligible beneficiaries enrolled in Medicare and Medicaid, at 473/100,000. COVID-19 infection rates were also higher in this subpopulation.

In total, 325,000 beneficiaries received a diagnosis of COVID-19, while 110,000 were ultimately hospitalized (175/100,000), costing Medicare an average $23,000 per case and a total of $1.9 billion. The 5 most prevalent chronic conditions among beneficiaries were hypertension (79%), hyperlipidemia (60%), chronic kidney disease (50%), anemia (50%), and diabetes (50%).

The figures add more gravity to previous conclusions that racial and ethnic minorities and the economically disadvantaged bear the brunt of this pandemic.

CMS plans to update the data on a monthly basis as more records are received. Similar information on Medicaid beneficiaries is expected to be released in the future.

How Will the Administration Address Disparities?

In response to the figures, the Trump administration issued a call to action for a “renewed national commitment to value-based care.”

Highlighting the shortcomings of a fee-for-service model, Verma noted that when implemented effectively, a value-based system encourages care for the whole person while addressing social risk factors detrimental to beneficiaries’ quality of life.

One solution proposed by CMS includes a multisectoral approach including federal, state, and local governments; community-based organizations; and private industries. Increased implementation of a value-based system should reward providers for keeping patients healthy and provide consumers with information about disease prevention needed to help make health care choices on the basis of quality, the agency argues.

An additional facet will be states’ doubling down on efforts to protect low-income seniors and “determine what resources are available, both locally and federally, to improve this disparity of health outcomes.”

Currently, the Center for Medicaid and Children’s Health Insurance Program Services is developing guidance for states to implement value-based payment design and strategies to address social determinants of health.

The CMS Office of Minority Health (OMH) will also be holding a series of listening sessions with stakeholders responsible for providing care to racial and ethnic minorities, which are “intended to help refine the ongoing outreach and work by CMS to improve future efforts on this issue.” Meanwhile, HHS today announced a $40-million partnership between OMH and the Morehouse School of Medicine to fight COVID-19 in racial and ethnic minority and vulnerable communities.

“The Trump administration has made it a priority to support and empower Americans who have been most impacted by COVID-19, including minority, rural, and socially vulnerable communities,” HHS Secretary Alex Azar said.

The administration released the initiatives as President Trump has come under fire for racially tinged remarks he made during a Tulsa, Oklahoma, rally on Saturday. Since the pandemic began, there have been reports of increasing attacks on East Asian individuals living in the United States.

COVID-19 Cases Continue to Swell

As the CMS figures were only measured through May 16, the data showed those living in rural areas have fewer cases of COVID-19 and were hospitalized at a lower rate than those in urban or suburban regions (57 vs 205 hospitalizations/100,000).

However, this week several Southern and Western states reported surging COVID-19 cases, prompting fears that progress made reducing transmission is ebbing, the Associated Press reports. Resistance among many Americans to socially distance and wear masks is contributing to the outbreak, while easing of lockdowns in Texas and Georgia have led to spikes in hospitalizations.

“It is snowballing. We will most certainly see more people die as a result of this spike,” said Marc Boom, MD, CEO and president of Houston Methodist Hospital. “It is possible to open up at a judicious pace and coexist with the virus, but it requires millions and millions of people to do the right thing.” The governors of Texas, Arizona, Alabama, Florida, and South Carolina have all opposed state-wide mask requirements, instead putting the onus on local authorities.

Across the South, more young people are testing positive for COVID-19. As the virus tends to impact older Americans and those with underling health conditions, this new trend may result in asymptomatic youths unknowingly spreading COVID-19 to vulnerable populations. Gatherings of protestors in the wake of the death of George Floyd may also threaten efforts to track and contain COVID-19.

Rising cases throughout the country have prompted concerns about upcoming primaries. Recent elections in Georgia and Wisconsin previewed the challenges states face when conducting primaries in a pandemic. In Georgia, individuals waited in line for up to 6 hours to vote.

This week, Kentucky is scheduled to hold its primary which was originally supposed to take place in May. Due to the pandemic, state election officials drastically reduced the number of in-person polling places, from just under 3700 to 170, CNN reports, a move that Democratic leaders say will result in voter suppression.

“Who needs to vote in person? The disabled. The homeless or displaced. Voters with language barriers. Folks who didn't get their ballots in time. Americans,” said Stacey Abrams, D-Georgia, on Twitter.

Last week, a bipartisan group challenged election day concerns in a Kentucky court, arguing the lack of in-person voting sites could disenfranchise black voters. However, a judge denied the claim, noting that any action by the court this close to voting would adversely affect the election.