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The Man in Blue

The COVID-19 Thread - Discussion & Cancellations

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8 minutes ago, JonnyCat said:

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.

You will get those patients if Covid didn't exist or was much smaller than it is, thus a hospital is reducing its potential margin by prolonging it if it were to code everyone as infected.

Profits are the important thing--not revenue. Because of the margin curve, the more revenue you make after a certain point, the more money you lose.

None of what you cited referred to hospital coding, but UCOD reporting, which is a separate issue, and used for epidemiological purposes, not billing.

I do financial reporting, analysis, budgeting, and forecasting; but most importantly for this conversation, I do pricing for procedures (the area I support is provider consults and pharmaceuticals.) So, when it comes to how procedures are priced and reimbursed, that's what I do on a daily basis, and why I can tell you that the idea of doing what people are claiming is being done is not feasible from an economic perspective. My largest client is a Medicare-funded PBM, and (from a purely financial standpoint) I want to drop them like a bad habit because their amounts they are willing to pay are far less than other plans and they're taking up capacity that we could be using for higher-margin business.

Again, to reiterate, it's not revenue that's important--it's margin. You cannot make up margin from higher-margin procedures through lower-margin procedures, no matter the volume. 

Also keep in mind, it's impossible to prove a negative. I've provided my analysis on to why it wouldn't happen and commented on the lack of evidence that it is happening insofar as it is related to reimbursement, so that's all I really have to say about that. In short, there's no benefit for someone to be miscoded in the manner asserted, so to assume that it is occurring (especially with a less-than-full understanding of what documentation means what) is to deny the financial reality of the situation.

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8 minutes ago, Matt said:

You will get those patients if Covid didn't exist or was much smaller than it is, thus a hospital is reducing its potential margin by prolonging it if it were to code everyone as infected.

Profits are the important thing--not revenue. Because of the margin curve, the more revenue you make after a certain point, the more money you lose.

None of what you cited referred to hospital coding, but UCOD reporting, which is a separate issue, and used for epidemiological purposes, not billing.

I do financial reporting, analysis, budgeting, and forecasting; but most importantly for this conversation, I do pricing for procedures (the area I support is provider consults and pharmaceuticals.) So, when it comes to how procedures are priced and reimbursed, that's what I do on a daily basis, and why I can tell you that the idea of doing what people are claiming is being done is not feasible from an economic perspective. My largest client is a Medicare-funded PBM, and (from a purely financial standpoint) I want to drop them like a bad habit because their amounts they are willing to pay are far less than other plans and they're taking up capacity that we could be using for higher-margin business.

Again, to reiterate, it's not revenue that's important--it's margin. You cannot make up margin from higher-margin procedures through lower-margin procedures, no matter the volume. 

Also keep in mind, it's impossible to prove a negative. I've provided my analysis on to why it wouldn't happen and commented on the lack of evidence that it is happening insofar as it is related to reimbursement, so that's all I really have to say about that. In short, there's no benefit for someone to be miscoded in the manner asserted, so to assume that it is occurring (especially with a less-than-full understanding of what documentation means what) is to deny the financial reality of the situation.

Excellent, thank you for the info. I think we were largely understanding each other and mostly in agreement, just that we may have been arguing different points. Often happens in online discussions.

I think one of the problems here is perception and the lack of in-depth and accurate reporting on the subject.

When people hear that Medicare pays more for covid 19 patients, many just jump to conclusions that hospitals can charge more for covid 19 and would assume they would want to bill as much as they can, going so far as to falsify claims, without understanding the totality of the situation.

While it is true that Medicare pays more for covid 19, it may not be the cash cow many people believe it to be.

Thanks for the discussion and input!

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@JonnyCat ... glad to see you are coming around on some of this and @Matt thank you for the direct information.

Not from a finance standpoint, but from a labor and resource standpoint ... my wife is working on a COVID-19 floor.  COVID-19 patients are very labor and resource intensive.  Her floor is normally labor and resource intensive due to their specialty plus they are an ICU overflow.  Their capacity has been reduced to a fraction of what they would normally have yet they are burning through more far resources (PPE, billable care items, labor, etc.) than they normally do. 

From a hospital standpoint, you have also lost a major percentage of your business from elective and even necessary-but-lesser surgeries, treatments, etc.  They aren't making up for losing vasectomies, wart removals, and knee scopes by charging more for COVID-19 patients.  This is further evidenced by hospitals that are furloughing and laying off staff from these other areas.

A flawed analogy: you were hired to work six 10u games with 75-minute time limits at $40/game as part of a two-man crew.  You arrive at the tournament and find out the 10u bracket was canceled, but you are going to work 14u games instead.  However, you are only going to get 4 games with 120-minute time limits ... and you are working solo ... and you are still only getting $40/game ... and all your games ran over, plus there was a rain delay so you lost another game.  You went from $240 for a pretty easy 9- or 10-hour day to $120 for a 12-hour+ day.  The TD feels sorry for you, so they give you an extra $5/game or $15 ... OH THE OUTRAGE!!  You made more per game!!!!  :hopmad:  ;)

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1 minute ago, The Man in Blue said:

@JonnyCat ... glad to see you are coming around on some of this and @Matt thank you for the direct information.

Not from a finance standpoint, but from a labor and resource standpoint ... my wife is working on a COVID-19 floor.  COVID-19 patients are very labor and resource intensive.  Her floor is normally a labor and resource intensive care floor and an ICU overflow.  Their capacity has been reduced to a fraction of what they would normally have yet they are burning through more far resources (PPE, billable care items, labor, etc.) than they normally do. 

From a hospital standpoint, you have also lost a major percentage of your business from elective and even necessary-but-lesser surgeries, treatments, etc.  They aren't making up for losing vasectomies, wart removals, and knee scopes by charging more for COVID-19 patients.

A flawed analogy: you were hired to work six 10u games with 75-minute time limits at $40/game as part of a two-man crew.  You arrive at the tournament and find out the 10u bracket was canceled, but you are going to work 14u games instead.  However, you are only going to get 4 games with 120-minute time limits ... and you are working solo ... and you are still only getting $40/game ... and all your games ran over, plus there was a rain delay so you lost another game.  You went from $240 for a pretty easy 9- or 10-hour day to $120 for a 12-hour+ day.  The TD feels sorry for you, so they give you an extra $5/game or $15 ... OH THE OUTRAGE!!  You made more per game!!!!  :hopmad:  ;)

Not coming around on anything, thank you.

Matt hasn't changed my mind nor did he need to, that wasn't the point, he provided us more information and clarification on the subject at hand. It was never my position that hospitals are making money hand over fist on covid 19. Aging_Arbiter brought up in his post that hospitals get more money for covid 19 and that hospitals are classifying deaths as covid when they are not. I provided evidence that backed up Aging_Arbiters claim. A claim that many are making. Matt and I just provided clarity. Do whatever you want with that information.

The rest of the discussion with regards to increasing revenue was just that, a civil discussion. Medical billing and hospital finances are far more complex than most can imagine. I appreciate Matt providing insight.

And your analogy is not flawed. From a strict revenue standpoint. Did you increase your revenues that day? Yes. Did they offset your costs? Who knows. But you did increase your revenue, $120.00 is more than zero. You would list that figure on any financial form as revenue. Whether you made a profit or not at the end of the day/month/year, that would remain to be seen due to many other factors.

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Just like I would counsel umpires to wear the Muchlinski helmet wth the regular mask for concussion protection, I would counsel those going back to work to wear a face shield with their home made mask or surgical mask if you have one. Double up on as much facial protection as you can for incoming or outgoing.

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On 5/14/2020 at 3:17 PM, 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.

The numbers aren't going to be perfect, regardless, but I think in the end everything will be within a reasonable margin of error.

Yes, there is likely some overcounting going on...but those bodies that are piling up in empty offices, closets and mass graves aren't imaginary.   And Italy, Spain and UK aren't inflating numbers for medicare.    If there is overcounting, it's not by an order of magnitude.    There is certainly a mass influx of deaths that are outside the norm in the US - and they aren't all due to an sudden increase of cancer, heart attacks, aneurysms, bee stings, etc.   Whether it's really 75k or 90k, or 110k to this point, those are COVID deaths

There is also undercounting...whether it be malice, incompetence, apathy or ignorance.   Probably more early on, but it's happening.  Both in the US and everywhere else - some countries far worse than others.  

I suspect worldwide the numbers we see are low - both cases and deaths...including the US....Frankly, even if we're off by 50% in either direction, worldwide or the US, those numbers would tell the same story.

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I just got an invitation to Umpire a Tournament in Palm Beach June 5th.

Director thinks its a 95% chance it will happen.

Assignor says it's 50/50

 

So we will see!

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This Palm Beach?

"On May 11, Palm Beach County registered a weekly increase in cases of the deadly respiratory disease of 17 percent, the inverse of the rapid rise that alarmed federal officials, Florida Department of Health figures show.

On that day, the county recorded 3,889 cases, a 17 percent increase over a week earlier, when cases stood at 3,311, DOH figures maintained by The Palm Beach Post show."

from The Palm Beach Post, 5/16/20

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17 pages in... what's the score anyways? Who's winning?  Any minds been changed yet?

disappear GIF

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1 hour ago, beerguy55 said:

 Whether it's really 75k or 90k, or 110k to this point, those are COVID deaths

We all understand that folks are going to die from this. That sucks and we all hate it. That being said we know that as of this morning about 5% of CONFIRMED cases result in death. I would say that in real numbers of folks that have had it (asymptomatic) and were never tested, or had minor symptoms and were never tested, is about 2-4% result in death. And again, that's terrible. We also know from the CDC that MOST deaths (as much as 3/4 of all deaths) are in folks over age 75--so now we are down to about 1/2%, or less, if your under 75.

The problem (as I see it) is we cannot continue to shutter in the 97% to protect the 3%. The 3% should be protecting themselves, with all of us following the rules set forth.  We don't do this in any other situation or circumstance. We don't shut down high school football because 3% of the players will sustain injury (yes I know thats not death). We don't take all cars off the roads because 3% of drivers will be injured or killed by accident. We don't outlaw alcohol because 3% of the folks that drink will become alcoholics and die from complications therefrom.

We know that masks, gloves and hygiene are a complete defense to this C19. We know this because we have healthcare workers treating positive folks and testing negative. We know this because we have folks working on/with the live virus testing negative. We also know that if your under 75 you'll probably (yes probably, not for sure) be just fine.

We need to get out of the mindset "it's not about you, its about EVERYONE else". No, its about 3%, that's not everyone else. We need to get into the mindset that "if you are over 75, or have an underlying condition you need to be extra cautious".  

On a final note. I was in my workshop all weekend listening to the radio--couple of different stations. Every other commercial was a PSA on suicide prevention. We have to focus on the 97%, not the 3% (or more accurately 1/2%). The 3% will be just fine if they adhere to the precautions. Video the baseball game and email it to grandma.

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1 hour ago, aaluck said:

We all understand that folks are going to die from this. That sucks and we all hate it. That being said we know that as of this morning about 5% of CONFIRMED cases result in death. I would say that in real numbers of folks that have had it (asymptomatic) and were never tested, or had minor symptoms and were never tested, is about 2-4% result in death. And again, that's terrible. We also know from the CDC that MOST deaths (as much as 3/4 of all deaths) are in folks over age 75--so now we are down to about 1/2%, or less, if your under 75.

The problem (as I see it) is we cannot continue to shutter in the 97% to protect the 3%. The 3% should be protecting themselves, with all of us following the rules set forth.  We don't do this in any other situation or circumstance. We don't shut down high school football because 3% of the players will sustain injury (yes I know thats not death). We don't take all cars off the roads because 3% of drivers will be injured or killed by accident. We don't outlaw alcohol because 3% of the folks that drink will become alcoholics and die from complications therefrom.

We know that masks, gloves and hygiene are a complete defense to this C19. We know this because we have healthcare workers treating positive folks and testing negative. We know this because we have folks working on/with the live virus testing negative. We also know that if your under 75 you'll probably (yes probably, not for sure) be just fine.

We need to get out of the mindset "it's not about you, its about EVERYONE else". No, its about 3%, that's not everyone else. We need to get into the mindset that "if you are over 75, or have an underlying condition you need to be extra cautious".  

On a final note. I was in my workshop all weekend listening to the radio--couple of different stations. Every other commercial was a PSA on suicide prevention. We have to focus on the 97%, not the 3% (or more accurately 1/2%). The 3% will be just fine if they adhere to the precautions. Video the baseball game and email it to grandma.

If anything else had a mortality rate such as this, everything for damn sure would be shut down. I don't think you get how big of a deal even a 0.5% mortality rate is in a virus that has R0 as high as this. 

As for your laughable comment about PPE being a complete defense, well...that's where I'll leave it.

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27 minutes ago, Mussgrass said:

Sounds like more trouble than it's worth. These are young, healthy athletes.

Yeah, but with how much their contracts are worth, it behooves the teams to keep them that way. 

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8 hours ago, aaluck said:

We don't shut down high school football because 3% of the players will sustain injury (yes I know thats not death). We don't take all cars off the roads because 3% of drivers will be injured or killed by accident. We don't outlaw alcohol because 3% of the folks that drink will become alcoholics and die from complications therefrom.

You don't really believe this do you?  If high school football killed 0.1% of everyone who played it the sport would never be played again.  If one in 33 licensed drivers died every year you would see a seismic cultural shift in driving - be it bans, higher qualification standards, higher safety standards, and the likelihood that people just wouldn't drive.

 

And the thing about car accidents and football injuries...people who get in a car accident don't cause six other car accidents.  Football injuries, and deaths, aren't passed on to other football players.

 

8 hours ago, aaluck said:

We know that masks, gloves and hygiene are a complete defense to this C19. We know this because we have healthcare workers treating positive folks and testing negative

HAHAHAHA!   What?!?!?!?!  Healthcare workers are dying, let alone testing positive .  Should we stop thanking them since it's obviously so safe for them?  I have yet to meet an ER nurse who doesn't dread their next shift...and doesn't fear their personal safety.  jfc I can't believe you just said that.

 

8 hours ago, aaluck said:

No, its about 3%, that's not everyone else. We need to get into the mindset that "if you are over 75, or have an underlying condition you need to be extra cautious".  

UK tried this - look where it got them.  In fact...they only tried that for THREE WEEKS!!!

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1 hour ago, beerguy55 said:

You don't really believe this do you?  If high school football killed 0.1% of everyone who played it the sport would never be played again.  If one in 33 licensed drivers died every year you would see a seismic cultural shift in driving - be it bans, higher qualification standards, higher safety standards, and the likelihood that people just wouldn't drive.

 

And the thing about car accidents and football injuries...people who get in a car accident don't cause six other car accidents.  Football injuries, and deaths, aren't passed on to other football players.

 

HAHAHAHA!   What?!?!?!?!  Healthcare workers are dying, let alone testing positive .  Should we stop thanking them since it's obviously so safe for them?  I have yet to meet an ER nurse who doesn't dread their next shift...and doesn't fear their personal safety.  jfc I can't believe you just said that.

 

UK tried this - look where it got them.  In fact...they only tried that for THREE WEEKS!!!

Don’t know where to start...so I won’t.  We have to agree to disagree. The difference is you insist that the 97% accommodate the 3%. I say the 3% accommodate the 97%. It’s like arguing the ‘rules’ with a coach that hasn’t read them. 

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3 hours ago, aaluck said:

It’s like arguing the ‘rules’ with a coach that hasn’t read them. 

Oh, the irony...

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Without trying to be political, I just wish that for every worker they had the exact same level/risk of exposure to the virus as Smithfiel, Tyson, Amazon, police fire hospital that has the greatest exposure risk, we would all have that amount of risk for at least 8 hours everyday. Then I wish we all had the same amount of supplies to help us everyday once we figured out the type of supplies needed everyday.supplies

Then the "exact level" of care public or private if you got it. It would be nice if only 4 things could be used with the ventalator being the last chance. There would be no shortages of anything needed, and then it is what it is for everybody till that vaccine. If there are ways to help mitigate, everybody gets to use the same mitigation in equal proportions to everyone else. Nobody could run to an island or glass house and hide and wait till it is over, or we all get to go to an island and wait it out.

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21 hours ago, aaluck said:

Don’t know where to start...so I won’t.  We have to agree to disagree. The difference is you insist that the 97% accommodate the 3%. I say the 3% accommodate the 97%. It’s like arguing the ‘rules’ with a coach that hasn’t read them. 

I am accommodating the 97%...I'm trying to keep it to 97% and not drop it to 90% and lower.

The UK tried to do exactly what you're proposing and it blew up in their face.

Slow and steady wins the race.   If this was less contagious it wouldn't be a problem.   An r0 of 1-2 would be manageable...an r0 of 6 makes this a disaster...it's one thing to accept the risk for yourself, and lock up all the old and sick people...the problem is most people don't understand the risk they think they're signing up for.

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The risk to reasonably healthy people is not what the MSM is making it out to be. I get it that we need to protect the frail elderly people. Maybe 3% of people even get serious symptoms. 80% of people have no or slight symptoms. The death rate will end up being about 0.2% when all is said and done. That is just a bad flu year. It has all been blown way out of proportion.

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13 minutes ago, Mussgrass said:

The risk to reasonably healthy people is not what the MSM is making it out to be. I get it that we need to protect the frail elderly people. Maybe 3% of people even get serious symptoms. 80% of people have no or slight symptoms. The death rate will end up being about 0.2% when all is said and done. That is just a bad flu year. It has all been blown way out of proportion.

The evidence isn't supporting that. We are continuously discovering both serious chronic and acute conditions that are being caused by this. Plus, as mentioned repeatedly, that death rate (which is lower than factual) is horrific when you take into account an R0 of 5.7.

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There’s been a lot that I’ve wanted to respond to, but I haven’t because at this time it’s pointless. Obviously no one is going to change their minds, and states are reopening regardless of what we put on this forum... just saying... 

The great thing is, we have 50 different states reopening in 50 different ways. Doing it this way will allow us to figure out what works and what doesn’t. 

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1 hour ago, Mussgrass said:

The risk to reasonably healthy people is not what the MSM is making it out to be. I get it that we need to protect the frail elderly people. Maybe 3% of people even get serious symptoms. 80% of people have no or slight symptoms. The death rate will end up being about 0.2% when all is said and done. That is just a bad flu year. It has all been blown way out of proportion.

Understanding that "data" is not the plural of "anecdote"...

I have a cousin who is a nurse in CO that caught this. Right around 50 years old, and no other high-risk factors. This was her last Facebook post on the matter a couple of days ago:

(Link to this article about long-lasting symptoms) "It’s good to know that I’m not alone and not totally losing it! Week 8 brought extreme joint pain, even more fatigue, high blood pressure, the ever present shortness of breath and lots of tears because it seems like I should be feeling better by now."

Personally, I just find all this data fascinating. I work with people doing "deep learning" (where you put in LOTS of different factors) and the computer chews on it for awhile and figures out strange and unexpected "clusters" of things that coincide.

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3 hours ago, Mussgrass said:

The risk to reasonably healthy people is not what the MSM is making it out to be. I get it that we need to protect the frail elderly people. Maybe 3% of people even get serious symptoms. 80% of people have no or slight symptoms. The death rate will end up being about 0.2% when all is said and done. That is just a bad flu year. It has all been blown way out of proportion.

First - it's already gone beyond a bad flu year - the worst seasonal flu  in the US, in the past 50 years, was at 80 thousand deaths, over six months - and that was mostly because that year's vaccine wasn't as effective as other years - a "bad" US flu year typically comes in about 50000 deaths....COVID blew past that 80k in three months.   And that's with social distancing measures in place.  Even when you take the novel flu pandemics, like Hong Kong, H1N1, Spanish Flu, etc, the comparisons become apparent.   H1N1 killed about 100000 Americans over 12-18 months...with no social distance measures in place.   The lock down rules around the world are the only reason the COVID death count isn't ten time higher, to this point.    Even with lockdown measures, worldwide the COVID-19 death count, through four months, is not far from the number of a bad worldwide 12 month flu death count.

The difference is those pandemics (not even Spanish Flu) didn't have the contagiousness COVID-19 does.

The r0 for H1N1 was 1.3...right in line with a seasonal flu.  The r0 for COVID-19 is 5.7.  That's the difference, and that is the driving force behind all these measures.

So, even if the death rate comes in at 0.2% (which is still twice that of a seasonal flu), the elevated r0 throws that out the window.

The death rate, whatever it ends up being, is dependent on the capabilities of the health care system.  So, if we say COVID kills 1% of anyone who gets it, that assumes the health care system can treat EVERYONE who gets it with the same level of care.  We know that many of the people who have survived COVID have only done so because they've been able to get the medical attention and/or ventilator service they needed.   If at any point capacity is overwhelmed, that 1% goes up...exponentially.   And because the r0 is so high, more people get the disease at once...greatly increasing the chances of the system being overwhelmed.  Italy lost more people in a few weeks than they'd typically lose over the course of an entire bad flu season.

So, just stop with the "it's just a flu" line.  Dismissing it in January as "just another flu" was understandable...now it's just stubbornness.  

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