Coronavirus
- Thread starter Hekate
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MVP
Well-Known Member
It is quite obvious... compare cases in Australia, NZ or other countries with strict lockdown strategies vs USA. You can't say you are better off with USA's approach when numbers are so not in your favor.
Beer
Well-Known Member
So compare these small ISLANDS with much much smaller populations and much much MUCH MUCH smaller economies and 0 borders. Let me repeat zero, none, zilch, nada, borders. None at all. Very easy to keep people out and also pretty much no one on earth needs to go there. Because if you are comparing the USA to New Zealand and or Australia you might be legitimately stupid.
MVP
Well-Known Member
One has amazing leader, the other has incompetent narcissist. I agree, it is no way to compare them.
There's a lot more to this discussion that is actually a part of many different discussion, but I'll try to address a couple things here that pertain to this post as well as the larger discussion:
That's complicated. We're conflating the idea of what a physician puts on a death certificate with what we're reporting as COVID deaths, as there are a lot of different channels that this will funnel through. The daily report of deaths aren't actually deaths that happened that day. Nor, often, are they deaths that the majority even happened that week. Added deaths are often coming from backlogs as far back as April in many cases, and there's been some death certificate matching. The WHO actually has guidelines for what is a COVID death, which a lot of places aren't really following:
I think a bad misconception is that COVID deaths come exclusively from physicians plugging this into some counter somewhere, when the answer is actually likely much more messy. Some places are going through and matching deaths with previous positive tests, as far out as a couple months from the positive test. A good follow regarding this data on twitter is @tlowdon
But to speak to the question re: COVID in the hospital and hospitals getting additional money. That's, again, more messy than it is clear, and it requires understanding a small amount of how hospital billing (in its many forms) currently functions. Hospitals getting money for COVID hasn't really been a big interest of mine and I haven't really dove too much into it because I feel it's quite peripheral to the real issues at hand, but my understanding is that there are legitimate funding streams for this through the CARES act. The USA Today reports this fact check as true.
Fact check: Hospitals get paid more if patients listed as COVID-19, on ventilators
Hospitals are paid more for Medicare patients with COVID-19, but a senator who first said that says he doesn't think the system is being gamed.
www.usatoday.com
That said, even independent of the figure that's thrown around as 39k, it is true that listing COVID and intubated patients will reimburse more to hospitals. This is because of increased complexity. This also doesn't have to be conspiratorial. And it doesn't mean that people labeled as a COVID hospitalization has to be not true. First, if we pretend that you have reflux for which you take Zantac and you are admitted to the hospital for, let's say, cellulitis, then the odds are highly likely that on one of your hospital problems it will list (and bill for) GERD, because you're technically being treated for that. To say that the reason you are in the hospital would be misleading, and this is often a point of concern for patients who are admitted under similar circumstances and see their bill and wonder why they are seeing charges for something that was completely unrelated to why they were in the hospital. As hospitals are trying to strictly control exposure, being tested for COVID (technically SARS-CoV-2), then you're going to have COVID listed as a hospital problem. As one's chances of dying in a hospital are much greater than anywhere else, and as one's chances of being tested for SARS-CoV-2 is very high in a hospital setting, then there's going to be some blurring of data there, though currently unknown how much. I'm not necessarily arguing this specific mechanism as the driver for higher rates, just introducing this as a legitimate variable that would be silly to scoff at.
But to speak more toward how hospitals generate money, and to emphasize that even people who appear to be in the know still have a lot they don't know, I will offer this example:
Physicians are paid (typically) through their billing. Physicians bill based on what are called Relative Value Units (RVUs), where the Centers for Medicare and Medicaid Services (CMS) arbitrarily determine how much certain procedures and services are worth in terms of RVUs. The rest of all insurance follow suit and RVUs are worth a certain dollar figure that varies slightly geographically. When physicians do work, the codes they bill associated with their services generate RVU which reimburses them, or the hospital system that in then pays the physician. Because there's a big push for using this as a way to gauge how much a physician can be reasonably paid, hospital systems have largely pulled the wool over physician's eyes to make them think they are only worth what they can generate in RVUs. But that only tells a very small fraction of the story. When a physician submits a bill for certain codes, there is the physician portion of that, but then there is also what's called a Facility Fee, which is often just as much, if not more, than what is paid to the physician (and there are separate hospital fees for inpatient care). This is true even for clinic visits associated with any hospital system (but not private practice). But the physician never sees this. Most physicians aren't even aware of this. So, as a result, physicians erroneously believe (because they've been told) that their salary can only be justified specifically in relation to their RVUs. But there are other reimbursement streams within this, and physician reimbursement is often just a red herring, and has been very successful in terms of administrative and bureaucratic slight-of-hand. Nothing happens in a hospital without the physician. If the physician isn't there to see, evaluate, and treat a patient, no money goes to the hospital from the insurance company. The insurance company pays the hospital in different ways based on many different things than what the physician is doing, but it's all predicated on what the physician is doing. The tl;dr on this is that physicians are a group of well trained, educated, and (relatively) not completely stupid individuals. Yet, they still know very little of what's actually happening in terms of finances and incentives that they are largely kept in the dark regarding and are unaware of what they don't know. To have people confidently state what does and what doesn't happen with regard to hospital reimbursements doesn't necessarily mean that it is the case, because this is very messy, but can be presented in incredibly simplistic fashion by people who see this from a very limited angle, and the messy-ness, to a large extent, allows for the leveraging of information imbalances to swindle even otherwise smart and aware individuals (such as physicians), so much so that they're completely oblivious to this, so the bottom line is to exhibit some caution when the variables in equations can be much larger and harder to account for than what we may realize. This applies to a number of different issues, but the idea here is that with so much bureaucracy and different points throughout this system, it's easy to conceal a lot of issues within this. The larger something is, the more plentiful the data to massage.
This is a response to beer's comment that I'll actually requote for context:
I had previously mentioned that I have had more than one patient where COVID prolonged their life. What I mean by that is these were individuals with end-stage dementia that were in the process of shutting down (1-2 weeks), weren't eating, and were otherwise going to be leaving with hospice care. Testing positive for COVID became misleading, which then led to intubation and feeding tubes. Each time were able to live long enough to then test negative for COVID, but I'm confident these were listed as COVID deaths. I haven't kept up, but back a few months ago it was something like 60% of all deaths were in long-term care facilities. I do think that's important, and for the past month I've been periodically writing a post regarding this issue, but people entering nursing homes have a mean life expectancy of 13 months, while the median life expectancy is 5 months. For me, I don't think the issue is really as much a question of if we're shortening lives, rather that we're not factoring in any human component to this issue that we're now going into 8 months in this and we're acting like isolating these people from everything that makes them human is somehow appropriate. I'll post more about this later, but I haven't had time to finish this post.
Anyway, that's a lot of rambling.
Lol. Sorry, I couldn't imagine you being so sensitive.
LogGrad98
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I don't really thumbs down this post, I just wanted to feel tough.
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Red
Well-Known Member
Debunking the False Claim That COVID Death Counts Are Inflated
President Trump and other conspiracy fantasists touted the fake claim that COVID death counts are exaggerated. But three kinds of evidence point to more than 350,000 deaths*
Beer
Well-Known Member
Debunking the False Claim That COVID Death Counts Are Inflated
President Trump and other conspiracy fantasists touted the fake claim that COVID death counts are exaggerated. But three kinds of evidence point to more than 350,000 deaths*www.scientificamerican.com
I don't believe for one second that only 6% of deaths are actually COVID. I'm not a Qanon moron. I think that a ton of these deaths these people were already knocking on deaths door and COVID might have pushed them over the finish line a little bit earlier. Or COVID was not a major contributing factor to their demise but being morbidly obese, in hospice already, things like that.
leftyjace
Well-Known Member
But..But...
What if COVID IS the cause of death?
Look, I could have cancer all damn day. I could even be dying from it, terminal, etc.
But if I have a heart attack and die, the cause of death will be heart attack - not cancer.
Beer
Well-Known Member
Sure, and maybe it's impossible to measure but if you have terminal cancer and die of a heart attack you were going to die really soon anyways so in the grand scheme of things who gives a ****? That's my general point. People are dying that are "supposed" to be dying. The very old, the very obese, the already very unhealthy. Too shut down the economy to give these people a small amount more of life is stupid. It just is. It's really really stupid.
Now if 30 year old mothers and fathers were dying leaving their children orphans that is a whole different story. But it isn't reality. If you are fat as **** or old as **** then take every single precaution you can. If you aren't live your life and do your best to avoid the very unhealthy and old. Life's not fair. If you are really fat and or old or sick then you got the short end of the stick and you need to be the one to bear the brunt of this.