Hospitals not profiting from COVID-19 deaths

May 15, 2020

Copy of letter sent to Alaska Chief Medical Officer Dr. Anne Zink by Rep. Sarah Vance.
Credit Rep. Sarah Vance

After an older Anchor Point man, reportedly with underlying health problems, was admitted to South Peninsula Hospital in Homer about two weeks ago, he was tested for the coronavirus that causes COVID-19 and was found to be positive. The man, whose name was not officially released, subsequently died on May 6, and his death was reported in that day’s State of Alaska COVID-19 figures.

“So yeah, South Peninsula Hospital is doing COVID-19 testing on all patients that are admitted.” ~ Derotha Ferraro
 

That listing caused an outcry from a sliver of the population who claim the man’s death is being used to profit the hospital. That prompted state Rep. Sara Vance to raise questions about the Anchor Point man’s death at South Peninsula Hospital and why his death was listed as from COVID-19 when he was ill from something else. Vance also asked, generally, if hospitals receive additional funding from reporting deaths as being from COVID-19.
    The questions were in a letter sent May 8 to Dr. Anne Zink, Alaska’s Chief Medical Officer at the Department of Health and Social Services. Vance, a Homer Republican, also published her letter online. Vance has not, as of press time, published the response she received back from Zink’s office, which was sent to her on May 11, according to the Department.
    Instead, South Peninsula Hospital’s Derotha Ferraro and Homer Public Health Nurse Lorne Carroll addressed some of the points during Monday night’s Homer City Council meeting, and again on KBBI’s COVID Brief Thursday morning.
    As far as testing for the virus upon admittance, Ferraro says that was not done regularly until a few weeks ago for a variety of reasons.
    “It has been changing. First we had a lack of testing available in the state. So we had to really conserve and be particular with where the tests were being used,” Ferraro said. “But as more testing has become available we are able to do that and as more knowledge became available on the spread, and how the virus spread.”
    Ferraro says the mandates give general direction, but the state testing guidelines are more direct.
    “In the testing guidelines, it is very clear that the state is asking hospitals to test all admissions if and when possible for COVID-19. And it really does help us as providers stay safe and have good practices in place and protect PPE as much as possible because it's not like there's an endless supply of equipment and supplies,” Ferraro said. “But it also helps the physician come to a diagnosis faster based on symptoms and conditions of admissions and also rule things out.
    “So yeah, South Peninsula Hospital is doing COVID-19 testing on all patients that are admitted.”
    And what is listed on a death certificate when a person dies while suffering from a multitude of ailments? The experts say the information is necessarily detailed and sometimes complex.
     “There's a lot of answers and lots of data and information that gets put onto the death certificate,” Ferraro said. “So I think that the concept of contributing causes, underlying, intermediate, and immediate, I think that really helps people understand, 'Oh, this isn't just one answer, COVID-19 or not.' It's  a pretty layered, complicated answer.”
    “In terms of what's the difference between dying with COVID and dying from COVID, one of the main things is dying from COVID, it would mean that COVID-19 goes on the death certificate as the primary or contributing cause of death,” said Nurse Carroll. “For someone, say dying from a car crash while having a positive COVID test, (COVID-19) would not be listed on a death certificate.”
    “Just to kind of help people visualize things,” Ferraro said of death certificates. “There are four lines on a death certificate, or four areas, if you will, and there's kind of meanings behind each of those areas, whether it's the the immediate cause, the intermediate cause of death, underlying cause or contributing conditions. And so there's lots of different layers and opportunities for the physician to be really telling the whole story of that person's condition and all of the factors that might have gone in to that person's passing.”
    “And it is just also noting the cause of death, a section of the death certificate, that's a standardized process across the nation,” Carroll said. “And within that process, it's the healthcare provider, (it’s) their role and responsibility to complete that death certificate. So the determination comes from the healthcare provider.”
    Another question posed to Dr. Zink, which South Peninsula Hospital’s Derotha Ferraro answered, is if hospitals are given extra money for listing deaths as being caused by COVID-19.
    “It doesn't matter your diagnosis, we're not entering that diagnosis when we're asking Medicare for reimbursement. We’re entering that a person was hospitalized and using the formula for what the average cost is. We’re not reimbursed based on the diagnosis and we are absolutely not reimbursed based on a death,” Ferraro said. “A death is something that happens at the hospital and is reported from the hospital, but we are not reimbursed in any way for a death, no matter what the cause or diagnosis.”
    Ferraro also explained that the hospital does not get extra funding for personal protective equipment by adding more COVID-19 cases to its reports. The stimulus funding provided by Congress was awarded to offset lost revenue due to the physical distancing restrictions imposed after the pandemic hit America.

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