COVID-19 (f/k/a "the Coronavirus")

[Galway Eagle]

Do you suppose the soaking midwest rains and Tropical Storm Arthur are just God's way of saying get your butts back inside?

Hah id gladly become religious again if that's the case.

[warriorchick]

I am trying to ask an honest question, so please don't flame me.  I haven't seen it asked anywhere on this board.


Given that the federal government is providing special funds to care for Covid-19 patients, wouldn't that incentivize healthcare providers to rule an illness or death as Covid-related if the opportunity presents itself, especially if that patient is uninsured?

[forgetful]

I am trying to ask an honest question, so please don't flame me.  I haven't seen it asked anywhere on this board.


Given that the federal government is providing special funds to care for Covid-19 patients, wouldn't that incentivize healthcare providers to rule an illness or death as Covid-related if the opportunity presents itself, especially if that patient is uninsured?

The thing is. That compensation is for hospital treatment. So if they are treating a patient for a significant amount of time, they would have tested them. And have a positive test.

So unless it is a gun shot wound, or car accident, or something else unrelated, they would be accurately being listed as a COVID patient.

An example of where you can see some oddities. A friends kid (college soccer player), was playing soccer with friends. He ended up breaking his leg and was taken to the hospital. For whatever reason they ran a COVID test in the ER. He tested positive, so they ran a chest x-ray. Pneumonia, with ground glass opacities. Admitted as a COVID patient. Was up and running and playing soccer an hour earlier with friends.

Now on face value, one might say, "They are listing soccer accidents and broken legs as COVID," well know, they are listing a pneumonia case as COVID, they would have just been out still spreading this if they didn't break their leg. That's why this disease is kind of weird.

[TSmith34, Inc.]

Correct me if I am wrong, but as I understand it hospitals are getting paid more for the additional expense of COVID-positive cases, however there is no additional payment for a deceased person based on a COVID diagnosis. In other words, there is no financial incentive to list the cause of death as COVID-19, correct?

[GooooMarquette]

I am trying to ask an honest question, so please don't flame me.  I haven't seen it asked anywhere on this board.


Given that the federal government is providing special funds to care for Covid-19 patients, wouldn't that incentivize healthcare providers to rule an illness or death as Covid-related if the opportunity presents itself, especially if that patient is uninsured?

It is a possibility...but the False Claims Act provides significant disincentives, like up to 3x the damages, plus an additional $5-10K for each false claim, exclusion from participation in federal programs (like Medicare) and a whole bunch of headaches for the legal department.

And whistleblowers can report possible violations and share in a significant portion of the damages, so it can be pretty difficult even for unethical providers to hide truly false submissions.

[GooooMarquette]

CDC warns of possible measles outbreak as vaccinations for children fall during coronavirus pandemic

https://www.cnbc.com/2020/05/18/coronavirus-cdc-warns-of-possible-measles-outbreak-as-vaccinations-for-children-fall-during-pandemic.html

Routine vaccinations for young children in the United States fell during the first half of this year as more Americans skipped routine doctor visits and stayed home due to the coronavirus pandemic, according to a report published Monday by the Centers for Disease Control and Prevention. The CDC warned that measles outbreaks could result from fewer vaccinations.
...

For the 16-month age group, coverage with all recommended vaccines declined, with measles-containing vaccination coverage decreasing from 76.1% in May 2019 to 70.9% in May 2020, the agency said. The report also found that up-to-date vaccination coverage was lower for children enrolled in Medicaid, the federal government’s health insurance program for the poor, than for those who were not enrolled.

“The observed declines in vaccination coverage might leave young children and communities vulnerable to vaccine-preventable diseases such as measles,” the CDC wrote in its findings. “If measles vaccination coverage of 90%–95% (the level needed to establish herd immunity) is not achieved, measles outbreaks can occur.”

[forgetful]

Correct me if I am wrong, but as I understand it hospitals are getting paid more for the additional expense of COVID-positive cases, however there is no additional payment for a deceased person based on a COVID diagnosis. In other words, there is no financial incentive to list the cause of death as COVID-19, correct?

That is correct.

It is a possibility...but the False Claims Act provides significant disincentives, like up to 3x the damages, plus an additional $5-10K for each false claim, exclusion from participation in federal programs (like Medicare) and a whole bunch of headaches for the legal department.

And whistleblowers can report possible violations and share in a significant portion of the damages, so it can be pretty difficult even for unethical providers to hide truly false submissions.

Very excellent point.

[warriorchick]

It is a possibility...but the False Claims Act provides significant disincentives, like up to 3x the damages, plus an additional $5-10K for each false claim, exclusion from participation in federal programs (like Medicare) and a whole bunch of headaches for the legal department.

And whistleblowers can report possible violations and share in a significant portion of the damages, so it can be pretty difficult even for unethical providers to hide truly false submissions.

But if you don't test them, and they just "thought" it was Covid, how could you prove intent? 


I am not necessarily talking about outright fraud; I am talking about giving the benefit of the doubt to the diagnosis that pays more.

[GooooMarquette]

But if you don't test them, and they just "thought" it was Covid, how could you prove intent? 

I am not necessarily talking about outright fraud; I am talking about giving the benefit of the doubt to the diagnosis that pays more.

FCA violations don't require fraudulent intent; they just require knowing or reckless disregard for the accuracy of the claim. That requires providers to stay up to date on what CMS has said regarding how to submit claims.

Still, you are correct - if a provider who understands the law bills a '50-50 case' as COVID, it would be difficult for the government to prove it was a false claim.

[Lennys Tap]

FCA violations don't require fraudulent intent; they just require knowing or reckless disregard for the accuracy of the claim. That requires providers to stay up to date on what CMS has said regarding how to submit claims.

Still, you are correct - if a provider who understands the law bills a '50-50 case' as COVID, it would be difficult for the government to prove it was a false claim.

So the answer to Chick’s question is a qualified “yes”.

[mu03eng]

I don't it's with malice of foresight but yes the hospitals may be getting "overpaid" for Covid patience. Please note I'm not saying what is going on shouldn't be, simply reporting the facts as I know them. A bit of a long story first.

My wife is an outpatient PT in a hospital and during the pandemic has had to work regular shifts as well as in-patient for non-Covid folks and as a PPE observer(get the nurses/docs dressed and undressed as the come in and out of the Covid rooms). 3 weeks ago she was working a weekend in patient shift (basically go to the admitted patients rooms try to get them to walk, use the bathroom, etc) and had a patient that had just come in from a nurse home, one they've had a number of times because hes all f'd up but nothing to do with Covid symptoms. She went in, did her treatment stuff then left. Then the following Tuesday she was working Covid ICU and saw the patient in there from Saturday. Turns out he had tested positive for Covid but was asymptomatic, and this do had all the comorbids you could imagine but was asymptomatic. He died 48 hours later, but was listed as a Covid death.

That kind of story shouldn't happen anymore as there is now plenty of testing that anyone admitted gets tested, but the hospital is taking in a lot of nursing home patients that in ordinary times they would turn away. They are Covid postive for the most part, but a fair number are asymptomatic(at least 50%) as well. So those patients are being charged out as Covid without necessarily getting the full gamut of treatment(though they are taking up ICU beds).

Bottom line, I dont think anything nefarious is going on but I could see why there is concern or where conspiracy theories originate

[MarquetteDano]

Seems like people intrigued about incorrectly identified COVID cases (fraud or not).  Seems like it isn't that complex as per an earlier post I made.

Take the total US deaths in March-April-May (when it finishes) for 2019.  Take the same number for 2020.  Chances are the increase in deaths should be pretty close to what COVID deaths are reported.  Then you probably can take that additional death number and divide it by approx 1.8% (death rate) and that is how many cases we probably really had.

I would be shocked if calculated numbers will not be higher than the reported ones.  Chances are we are both under-reporting deaths and cases.  Unless someone can explain why the numbers of deaths would increase from 2019 to 2020 (other than some population growth perhaps?) this seems like a reasonable way to verify the numbers.

[Frenns Liquor Depot]

Seems like people intrigued about incorrectly identified COVID cases (fraud or not).  Seems like it isn't that complex as per an earlier post I made.

Take the total US deaths in March-April-May (when it finishes) for 2019.  Take the same number for 2020.  Chances are the increase in deaths should be pretty close to what COVID deaths are reported.  Then you probably can take that additional death number and divide it by approx 1.8% (death rate) and that is how many cases we probably really had.

I would be shocked if calculated numbers will not be higher than the reported ones.  Chances are we are both under-reporting deaths and cases.  Unless someone can explain why the numbers of deaths would increase from 2019 to 2020 (other than some population growth perhaps?) this seems like a reasonable way to verify the numbers.

Dano - there are a ton of reporting on this -- including WSJ and NY Times.  It found what you hypothesized. 

[MUBurrow]

(1) My wife is an outpatient PT in a hospital and during the pandemic has had to work regular shifts as well as in-patient for non-Covid folks and as a PPE observer(get the nurses/docs dressed and undressed as the come in and out of the Covid rooms). 3 weeks ago she was working a weekend in patient shift (basically go to the admitted patients rooms try to get them to walk, use the bathroom, etc) and had a patient that had just come in from a nurse home, one they've had a number of times because hes all f'd up but nothing to do with Covid symptoms. She went in, did her treatment stuff then left. Then the following Tuesday she was working Covid ICU and saw the patient in there from Saturday. Turns out he had tested positive for Covid but was asymptomatic, and this do had all the comorbids you could imagine but was asymptomatic. He died 48 hours later, but was listed as a Covid death.

(2) That kind of story shouldn't happen anymore as there is now plenty of testing that anyone admitted gets tested, but the hospital is taking in a lot of nursing home patients that in ordinary times they would turn away. They are Covid postive for the most part, but a fair number are asymptomatic(at least 50%) as well. So those patients are being charged out as Covid without necessarily getting the full gamut of treatment(though they are taking up ICU beds).

What I marked as (1) and (2) above for easy reference are very different cases, with very different purposes though, right? In (1) listing that as a covid death may throw off the statistics, but there is no financial incentive to doing so if, as TSmith said below, hospitals aren't being reimbursed at higher rates for covid deaths post mortem. 

From a billing standpoint, however, asymptomatic cases should be reimbursed at higher rates because they require the same precautions, PPE, etc., as symptomatic cases, correct?  So if there is a standard reimbursement bump for covid cases, it shouldn't really matter if they are symptomatic.  The bump isn't for the amount of care required, because medication, respirators, etc., are all coded and reimbursed on their previously established schedules anyway. So that would already be accounted for.  The bump is for the strain on the hospital to prevent spread?

[WarriorDad]

If only there were some sort of umbrella organization that could establish reporting standards for all the states so that we could get a clear understanding of the death toll.

We have federal standards for other areas not followed either.  Why will states do this in this case? 

Ultimately it will come down to individual hospital and their local county mechanism for cause of death which may or may not be adhered too, no different than today’s federal standards in anything from the EPA, to how tight to torque a nut on a wing assembly by the FAA by some mechanic for Delta.

[TSmith34, Inc.]

Ah, yes, Georgia...

https://twitter.com/Fahrenthold/status/1262029906512404480

"The state of Georgia made it look like its covid cases were going down ***by putting the dates out of order on its chart*** May 5 was followed by April 25, then back to May again, whatever made it look like a downslope."

https://news.yahoo.com/georgias-coronavirus-numbers-made-reopening-183733274.html

"Georgia’s flattening curve defied all scientific logic. Pandemics don’t end because the economy is suffering and we want them to.

And yet data don't lie. Or do they?

Thanks to the Atlanta Journal Constitution, we now know things did indeed look too good to be true. Georgia’s coronavirus numbers looked so rosy because officials misrepresented the data in such a way it's difficult to believe it wasn't done on purpose."

"I have a hard time understanding how this happens without it being deliberate," microbiology and molecular genetics PhD and state Rep. Jasmine Clark told the Journal Constitution. "Literally nowhere ever in any type of statistics would that be acceptable."

[WarriorDad]

https://coloradosun.com/2020/05/15/colorado-coronavirus-death-certificate/


 and smith, you can go suck it!!

Not sure what your point is.  Colorado dropped their death rate by more than a third because of the overstated numbers.  In some case overstated and in some cases understated. 

The idea that the federal govt or state gov’t can count accurately is a wish.  There is a reason why the term GOOD ENOUGH FOR GOVERNMENT WORK exists.  They have never been very good at counting people (legal and illegal) money, fraudsters, dead voters, alive voters, the debt, or anything else. 

[mu03eng]

What I marked as (1) and (2) above for easy reference are very different cases, with very different purposes though, right? In (1) listing that as a covid death may throw off the statistics, but there is no financial incentive to doing so if, as TSmith said below, hospitals aren't being reimbursed at higher rates for covid deaths post mortem. 

From a billing standpoint, however, asymptomatic cases should be reimbursed at higher rates because they require the same precautions, PPE, etc., as symptomatic cases, correct?  So if there is a standard reimbursement bump for covid cases, it shouldn't really matter if they are symptomatic.  The bump isn't for the amount of care required, because medication, respirators, etc., are all coded and reimbursed on their previously established schedules anyway. So that would already be accounted for.  The bump is for the strain on the hospital to prevent spread?

Seems a reasonable conclusion, I didn't really take into account that the individual procedures would have stand alone coding.

[WarriorDad]

More doctor views banned by Youtube.  This time epidemiologist is banned.  Early we were told to listen to doctors, then we were told not any old doctors but epidemiologists.  Now we are told only some epidemiologists can be heard.

Have people not learned their history for examples when conventional wisdom called the minority group crazy and they turned out right?

What is with YouTube deciding who is right or wrong here?  Maddening and the gov’t should regulate these digital behemoths. 

[wadesworld]

More doctor views banned by Youtube.  This time epidemiologist is banned.  Early we were told to listen to doctors, then we were told not any old doctors but epidemiologists.  Now we are told only some epidemiologists can be heard.

Have people not learned their history for examples when conventional wisdom called the minority group crazy and they turned out right?

What is with YouTube deciding who is right or wrong here?  Maddening and the gov’t should regulate these digital behemoths.

Lol.

[tower912]

More doctor views banned by Youtube.  This time epidemiologist is banned.  Early we were told to listen to doctors, then we were told not any old doctors but epidemiologists.  Now we are told only some epidemiologists can be heard.

Have people not learned their history for examples when conventional wisdom called the minority group crazy and they turned out right?

What is with YouTube deciding who is right or wrong here?  Maddening and the gov’t should regulate these digital behemoths.

Government regulating the behemoths would be censorship.    The behemoths choosing to take crazy down is no different than what the mods do here.   Their platform, their rules.   

[reinko]

More doctor views banned by Youtube.  This time epidemiologist is banned.  Early we were told to listen to doctors, then we were told not any old doctors but epidemiologists.  Now we are told only some epidemiologists can be heard.

Have people not learned their history for examples when conventional wisdom called the minority group crazy and they turned out right?

What is with YouTube deciding who is right or wrong here?  Maddening and the gov’t should regulate these digital behemoths.

Interesting take from someone who has never voted for republican in their life.

[Pakuni]

What is with YouTube deciding who is right or wrong here?  Maddening and the gov’t should regulate these digital behemoths.

"We quickly remove flagged content that violates our Community Guidelines, including content that explicitly disputes the efficacy of local health authority recommended guidance on social distancing that may lead others to act against that guidance."

YouTube isn't deciding who's right and wrong. YouTube is deciding that it doesn't want to host  content that endangers the public's welfare.
Weird to see a "Blue Dog Democrat" such as yourself demanding more government regulation of private enterprise.

[GooooMarquette]

So the answer to Chick’s question is a qualified “yes”.

Correct. And the magnitude of the issue would be related to the clarity of the rules.

[reinko]

Some promising signs about re-infection:

https://www.bloomberg.com/news/articles/2020-05-19/covid-patients-testing-positive-after-recovery-aren-t-infectious