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The Man in Blue

The COVID-19 Thread - Discussion & Cancellations

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On 5/13/2020 at 12:37 PM, aaluck said:

I won't live in fear.

It's a fine line between fear and caution.   Do you look both ways before you cross the street because you are being cautious...or because you fear the consequences of not doing so?  Or can it be both?

What you call fear I call vigilance.  Fear keeps us alive.   Some fear can keep us in place...other fear can drive us.

One end of the fear/no fear scale is never leaving your home and never opening the door...the other end is changing nothing.   There's a lot of room in between those points.

In the animal kingdom there are two fundamental responses to fear - fight or flight...you could say there's a third when there's no response - paralysis, not knowing what to do, curling up in a ball and waiting to die, etc.

My positions and opinions and how I act in public fit none of those categories...the real fear I'm seeing is those protesting the rules, and those who are shooting, or breaking arms of, retail minimum wage workers when asked to wear a mask...they're afraid of not being in control, afraid (irrationally) that their freedoms are being stolen...and the fear comes from the delusion that freedom means "you can't tell me what to do", or the more pathetic fear of looking weak....and their response is to fight.   Lots of lizard brain going on there.

So, yeah, I went and got blood work today, and wore a mask, and sanitized before and after.

And tomorrow i will be golfing, and following the rules put in place.

And next weekend I'm taking the RV out to camp.  Respecting the rules in place, and taking my own precautions too.

But, yes, there are lines I won't cross, and risks I don't feel are worth taking...neither for me, nor for others.

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On 5/13/2020 at 9:16 AM, kylehutson said:

5) One size does not fit all. My area of rural Kansas should have a different response from NYC. But even at that, NYC may need to look different than LA, which will need to look different than Houston. Even on a personal level, we have different risks. I can feel comfortable taking a risk of working a game (and just knowing that may mean I will have to avoid contact with some extended family for a few weeks after), whereas somebody else who is living with a high-risk individual may not be comfortable taking a risk on that same exact game, even with more precautions.

 

I agree with what you have said, including #5, but here is the problem with it ... (and I am open for any different suggestions!)

New York City needed to "close down" to try to stop the spread.  Fine and good.  Except, as soon as that was announced (and for a time afterwards) residents of New York City who could "flee" the city -- to a second home, to a relative's house, etc. -- began doing so.  They began tracking the virus all over the place.

Use that same concept where I am.  I am in Illinois, not too far from multiple borders.  Illinois is still riding high on the virus wave and has not reached the peak by some models.  Missouri started playing tournaments this past weekend.  (I even received e-mails asking if I would come down there and work.)  Do you really think people in Illinois are not going to take their team across the border and play?

We have cities and counties that have decided they are no longer going to play by the rules and are going ahead with their own plans.  Do you really think the customers for those businesses are going to come exclusively from those specific cities or counties?

I agree that the same response is not called for in all areas.  However, without some other intervening factor (e.g., travel restrictions), varied responses equate to increased mobility which leads to increased transmission.

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On ‎5‎/‎11‎/‎2020 at 10:02 AM, beerguy55 said:

This is why a million Americans will die of COVID by year end

When hospitals are classifying any death they can as Covid-19, the number will be high, but I doubt a million.  I've heard from nurses that had patients that passed of "insert given cause not related to covid", only to come in the following day to find out that it was classified as covid.  Until hospitals stop price gouging (yes, they get more from medicare if it is listed as covid related), the numbers will NEVER be accurate.

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4 hours ago, Aging_Arbiter said:

When hospitals are classifying any death they can as Covid-19, the number will be high, but I doubt a million.  I've heard from nurses that had patients that passed of "insert given cause not related to covid", only to come in the following day to find out that it was classified as covid.  Until hospitals stop price gouging (yes, they get more from medicare if it is listed as covid related), the numbers will NEVER be accurate.

They aren't. It's funny how these FOAF stories keep coming up, yet no one has provided evidence. It's simple, really--it isn't happening. 

Hospitals are not making money off of this. They make more money off of other things they could be doing. So for this to be occurring, providers would be gouging so they can make less money.

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It all comes down to your own risk tolerance. We need to protect the most vulnerable, which we are. If you are not comfortable going out, then don't.

There is risk in everything in life. You can go out and risk any number of calamities happening to you. You can hunker down at home and risk blood clots from inactivity or falling down the stairs or literally going crazy from boredom.

We need to open up the country and get people back to work. Let those who accept the risk go for it.

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On 5/13/2020 at 1:37 PM, aaluck said:

Yet this is the dilemma. Ill take my son for example. 20, strong as an ox. Works at Sam's Club and Door Dash (since there is no umping to do). He wears a mask, washes hands constantly, has a pocket size bottle of hand sanitizer with him and another big jug in his truck. So, I believe he is being as responsible as humanly possible. BUT, he could be infected and asymptomatic AND give it to someone else--including me, my wife or daughter. This is the problem with this whole thing. We can all be as safe as possible (or responsible as you correctly state) and still not prevent the spread.

This is why I take such exception with those that say if you pass it to someone else (despite taking every precaution humanly possible) it is your fault if they get sick and die.

I won't live in fear. I have made changes, huge changes, to my life, but I still go to shop, work at the office and conduct daily activities. And yes, I will umpire baseball and football this year if there are any games to ump.

Agreed with most of what you say on part 1 (my exception is below).  The issue with that logic though is that many people are using it to leap to "why bother to take ANY precautions".  (And kudos to your son for trying to be responsible!)

I will agree somewhat on part 2 ... but "every precaution humanly possible" includes limiting contacts with stay-at-home and self-quarantining.  Things like those would not have led to "you" spreading the disease further (in your scenario), but we don't want to do those things.  So it really isn't "every precaution humanly possible" in that scenario.  It's more "I've done everything that I want to do". 

No matter what you do once you are there, going to a baseball tournament with a few hundred or a thousand people is not "every precaution humanly possible".  You can take a good many valuable precautions, but please don't paint it as "I couldn't do anything else".  Accept YOUR choice and the accountability and responsibility that come with it.  This, to me, is probably the scariest part of the whole thing: PEOPLE.  People do not want to take responsibility or have any accountability for their own decisions.  We do not need laws protecting employers, businesses, etc. if every thing is fine, yet businesses and politicians are clamoring for NO ACCOUNTABILITY OR RESPONSIBILITY for people and organizations who don't care.

I don't believe we need to live in irrational fear or even continue to maintain stay-at-home orders ... but a good dose of fear leads to a healthy amount of respect.  We (as a generality) do not have enough respect for the situation.  There are other measures which could be taken instead, but too many people have decided they are not going to follow any rules when it comes to this and nobody is holding anybody accountable.

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12 hours ago, JonnyCat said:

Info on certifying death with regards to Covid19.

https://www.cdc.gov/nchs/data/nvss/vsrg/vsrg03-508.pdf

For anybody who doesn't click, here is the TLDR:

 

Part I

This section on the death certificate is for reporting the sequence of conditions that led directly to death. The immediate cause of death, which is the disease or condition that directly preceded death and is not necessarily the underlying cause of death (UCOD), should be reported on line a. The conditions that led to the immediate cause of death should be reported in a logical sequence in terms of time and etiology below it.

The UCOD, which is “(a) the disease or injury which initiated the train of morbid events leading directly to death or (b) the circumstances of the accident or violence which produced the fatal injury” (7), should be reported on the lowest line used in Part I.

Approximate interval: Onset to death

For each condition reported in Part I, the time interval between the presumed onset of the condition, not the diagnosis, and death should be reported. It is acceptable to approximate the intervals or use general terms, such as hours, days, weeks, or years.

Part II

Other significant conditions that contributed to the death, but are not a part of the sequence in Part I, should be reported in Part II. Not all conditions present at the time of death have to be reported—only those conditions that actually contributed to death.

If COVID–19 played a role in the death, this condition should be specified on the death certificate. In many cases, it is likely that it will be the UCOD, as it can lead to various lifethreatening conditions, such as pneumonia and acute respiratory distress syndrome (ARDS). In these cases, COVID–19 should be reported on the lowest line used in Part I with the other conditions to which it gave rise listed on the lines above it.

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If only it were as simple as" risk go for it." By "going for it," you risk infection, which you can then spread, perhaps while asymptomatic, to others, who, in turn.... And the virus spreads.

Your analogies to blood clots and falling down stairs (and risks generally) are inapposite: neither is contagious.

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On 5/11/2020 at 1:16 PM, kylehutson said:

I completely get that. That's why I put it out there early. If that's a requirement, they can find somebody else to work it, and I'm fine with that, too.

Why, if a mask would help to slow the spread,  would you risk giving a kid the coronavirus by you not wearing a mask?   And you may be healthy, not have the virus.  Or you might just be asymmetrical and not realize you actually have the virus.  Why take that chance and not wear the mask?  Why let the Mo. tournaments influence your decision?  Just wear a mask.

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6 minutes ago, umpstu said:

Why, if a mask would help to slow the spread,  would you risk giving a kid the coronavirus by you not wearing a mask?   And you may be healthy, not have the virus.  Or you might just be asymmetrical and not realize you actually have the virus.  Why take that chance and not wear the mask?  Why let the Mo. tournaments influence your decision?  Just wear a mask.

I think I've already gone through this in great detail, and I don't care to do so again.

Turns out it's all moot in my case, because our governor has postponed opening by another two weeks.

...and there's not much doubt about this. ;)

 

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1 minute ago, kylehutson said:

I think I've already gone through this in great detail, and I don't care to do so again.

Turns out it's all moot in my case, because our governor has postponed opening by another two weeks.

...and there's not much doubt about this. ;)

 

I was visiting family last weekend in Missouri and my brother and I drove by a field he used to be the groundskeeper for.  One of the tourneys was using the fields as a satellite  field and although they might have said they were conducting safe practices on the news, they weren't.  The dugouts were full of kids, in between innings umpires were standing next to each other and parents were huddled together in the bleachers.  Bunch of hard headed stubborn stupid people.

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Here is Ohio Department of Health updated return to play for baseball/softball:

“Umpires calling balls and strikes should allow
adequate distance behind the catcher while still able to perform their duty.“

LOL

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19 hours ago, Matt said:

They aren't. It's funny how these FOAF stories keep coming up, yet no one has provided evidence. It's simple, really--it isn't happening. 

Hospitals are not making money off of this. They make more money off of other things they could be doing. So for this to be occurring, providers would be gouging so they can make less money.

Hospitals do make more off covid 19 patients from Medicare. Not saying that this is being abused, but they do get more money, especially if they are on a ventilator.

https://www.usatoday.com/story/news/factcheck/2020/04/24/fact-check-medicare-hospitals-paid-more-covid-19-patients-coronavirus/3000638001/

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9 minutes ago, JonnyCat said:

Hospitals do make more off covid 19 patients from Medicare. Not saying that this is being abused, but they do get more money, especially if they are on a ventilator.

https://www.usatoday.com/story/news/factcheck/2020/04/24/fact-check-medicare-hospitals-paid-more-covid-19-patients-coronavirus/3000638001/

No, they don't. They get reimbursed more to offset the extra expense, but they do not make more money. 

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52 minutes ago, Matt said:

No, they don't. They get reimbursed more to offset the extra expense, but they do not make more money. 

Okay, but they do get more per patient, we agree on that. 

But how do you know for certain that the hospital does not make more money on the covid patients? You're assuming that their expenditures equal the increase in caring for covid19 patients. That may not necessarily be the case.

Assuming the hospitals make money on medicare patients anyway, (I don't know how lucrative medicare is for hospitals), but assuming they do, it's entirely possible that the "markup" on covid patients nets them more money.

Unless you're a hospital executive directly involved with accounting, how do you know they don't make more money? Can you cite some figures?

I understand that they might not make more money, but I also understand that they could, as well.

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Just now, JonnyCat said:

Okay, but they do get more per patient, we agree on that. 

But how do you know for certain that the hospital does not make more money on the covid patients? You're assuming that their expenditures equal the increase in caring for covid19 patients. That may not necessarily be the case.

Assuming the hospitals make money on medicare patients anyway, (I don't know how lucrative medicare is for hospitals), but assuming they do, it's entirely possible that the "markup" on covid patients nets them more money.

Unless you're a hospital executive directly involved with accounting, how do you know they don't make more money? Can you cite some figures?

I understand that they might not make more money, but I also understand that they could, as well.

In my professional assessment (being in healthcare finance,) hospitals are not making more in reimbursements than they are in additional expense. I know what the coding is, I know what the pre- and post-CARES Act reimbursement is, and I know what they make for other procedures, which is the salient issue--even if they were making more in reimbursements, it still would not make up for lost GP on other patients, so it would behoove them not to categorize them as such--the juice isn't worth the squeeze.

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2 minutes ago, Matt said:

In my professional assessment (being in healthcare finance,) hospitals are not making more in reimbursements than they are in additional expense. I know what the coding is, I know what the pre- and post-CARES Act reimbursement is, and I know what they make for other procedures, which is the salient issue--even if they were making more in reimbursements, it still would not make up for lost GP on other patients, so it would behoove them not to categorize them as such--the juice isn't worth the squeeze.

Understood and fair enough.

However, if the hospitals as you say are not making the same revenue because they are seeing less patients, wouldn't the increased revenue from covid 19 help offset the decreased revenue from less patients?

If a hospital is seeing less patients, it's entirely possible that they will help their bottom line by the increased revenue with covid 19. That is assuming their profit margin is greater on covid 19 patients, which is entirely possible.

Your last statement doesn't make sense to me. If a hospital is losing revenue, it makes perfect sense to me they will try to increase revenue where ever they can. Why wouldn't they try to help their bottom line by increasing revenue with covid 19 if possible?

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47 minutes ago, JonnyCat said:

Understood and fair enough.

However, if the hospitals as you say are not making the same revenue because they are seeing less patients, wouldn't the increased revenue from covid 19 help offset the decreased revenue from less patients?

If a hospital is seeing less patients, it's entirely possible that they will help their bottom line by the increased revenue with covid 19. That is assuming their profit margin is greater on covid 19 patients, which is entirely possible.

Your last statement doesn't make sense to me. If a hospital is losing revenue, it makes perfect sense to me they will try to increase revenue where ever they can. Why wouldn't they try to help their bottom line by increasing revenue with covid 19 if possible?

Because by doing so, they prolong the time they go with fewer higher-margin patients. 

I will say this again...a Covid-19 patient is going to be low-margin compared to just about everything else. Without the 20% incremental reimbursement, they would be negative.

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12 minutes ago, Matt said:

Because by doing so, they prolong the time they go with fewer higher-margin patients. 

I will say this again...a Covid-19 patient is going to be low-margin compared to just about everything else. Without the 20% incremental reimbursement, they would be negative.

How so? It would be one thing if you had high margin patients, but if you don't, why wouldn't you try to increase those margins on the patients you do have?

Just because in your estimation, covid 19 patients are low margin, if they're all you have, of course any business would be trying increase the margins on the business they do have. If you see enough covid 19 patients, then you could increase your revenue on volume even though the margins are low. Many business' operate on that principle and do very well.

Honestly, it is entirely possible hospitals somewhere in the US are increasing their revenues through covid 19. Even if their revenues are not what they used to be, they can see an increase with covid 19 patients. 

A hospital could definitely make more money seeing covid 19 patients than one that didn't see any covid patients.

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2 hours ago, JonnyCat said:

How so? It would be one thing if you had high margin patients, but if you don't, why wouldn't you try to increase those margins on the patients you do have?

Just because in your estimation, covid 19 patients are low margin, if they're all you have, of course any business would be trying increase the margins on the business they do have. If you see enough covid 19 patients, then you could increase your revenue on volume even though the margins are low. Many business' operate on that principle and do very well.

Honestly, it is entirely possible hospitals somewhere in the US are increasing their revenues through covid 19. Even if their revenues are not what they used to be, they can see an increase with covid 19 patients. 

A hospital could definitely make more money seeing covid 19 patients than one that didn't see any covid patients.

Because by doing so, you're perpetuating a leftward shift in the demand curve and lowering your revenues, because this action prolongs the time that other patients are not getting in.

Not really--volume only works up to the point where your marginal cost is equal to your marginal revenue. Beyond that, profits decrease. Volume-based businesses succeed by lowering marginal costs, which really isn't feasible here.

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1 hour ago, Matt said:

Because by doing so, you're perpetuating a leftward shift in the demand curve and lowering your revenues, because this action prolongs the time that other patients are not getting in.

Not really--volume only works up to the point where your marginal cost is equal to your marginal revenue. Beyond that, profits decrease. Volume-based businesses succeed by lowering marginal costs, which really isn't feasible here.

You don't have those patients anyway, so that doesn't matter. It's not business as usual as hospitals are not seeing many patients they would normally see. If covid 19 is all you have, then you to try to maximze your revenues as much as possible. Sure it wouldn't be the same as a normal period for a hospital, but you don't have the normal patients you would see.

Never said anything about profits, only revenue. 

Regardless, it is entirely possible that a hospital could increase their revenues with the additional funds Medicare pays out for covid 19. 

The fact remains that hospitals do in fact receive more money for covid 19 patients. There is at least one incident of abuse with falsely reporting a covid 19 death. There are probably more.  Dr. Birx has clarified how covid 19 deaths are recorded. Aging_Arbiter was at least partially correct in his post, and I have provided some citations as evidence.

Is there any direct evidence you have come across that disputes this? If there is, I would be interested in studying it further. 

Out of curiosity, what is healthcare finance and what role do you play in that industry? I've never heard of it and am genuinely interested in what it is.

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1 hour ago, Lou B said:

Sorry, I must have messed up, I thought I was logging in to an Umpire Forum!

Umpire forum? Is anyone umpiring these days? :lol:

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