Formerly DT: COVID-19 - Featuring Lots of Politics, now CR because political talk not going away

[dcar00 14,904]

1 minute ago, Dahobbs said:

 

That didn't happen. I've responded to this claim before. The CDC has different systems for tracking mortality. The "disappeared" numbers are just from a different system that is less up-to-date.

 

 

It absolutely did happen, Mr. Claim police. they were tracking maybes separately and cleanly on the main page for deaths.  that number then disappeared and they mixed confirmed with maybes so you can't tell how many are maybes.

[sunset87 253]

53 minutes ago, JBJ said:

Origin -  The virus seemingly to went from a horseshoe bat to either a pangolin (chinese armadillo) or some kind of snake then to humans.

Thanks for that. I've been wondering, wtf is a pangolin.

[Onboard 2.0 9,083]

2 minutes ago, sunset87 said:

Thanks for that. I've been wondering, wtf is a pangolin.

African, armadillo, type creature.

[BabaYaga 15,532]

Just now, dcar00 said:

It absolutely did happen, Mr. Claim police. they were tracking maybes separately and cleanly on the main page for deaths.  that number then disappeared and they mixed confirmed with maybes so you can't tell how many are maybes.

I still am baffled that the perverse incentive of case attribution is questioned by nobody.  This is crazy.  We are talking to the tune of hundreds of millions of dollars desperately needed by hospitals teetering on the edge of insolvency.  I'm not attributing these numbers to this, but neither is this being factored into the decision making process.  EX., the UK health system is poised to lose $160M this quarter.  Be nice to see some of that $$$$ go their way, don't you think....

[BabaYaga 15,532]

3 minutes ago, sunset87 said:

Thanks for that. I've been wondering, wtf is a pangolin.

[atomheartbevo 90,548]

17 minutes ago, Armybrat said:

For some odd reason that doesn’t make me feel better about the situation. 

Theoretically, you can still procreate.  Tony Randall fathered two kids in his late 70s.  Or at least, his wife became pregnant when he was in his late 70s.

[dcar00 14,904]

3 minutes ago, sunset87 said:

Thanks for that. I've been wondering, wtf is a pangolin.

this.  also, I thought it would have to go pangolin->snake-> Tom Cruise and THEN to humans

[Cheeseweasel 26,439]

Just now, atomheartbevo said:

Theoretically, you can still procreate.  Tony Randall fathered two kids in his late 70s.  Or at least, his wife became pregnant when he was in his late 70s.

Yeah, but those kids looked like Jack Klugman. 

[Brisketexan 106,627]

1 minute ago, BabaYaga said:

I still am baffled that the perverse incentive of case attribution is questioned by nobody.  This is crazy.  We are talking to the tune of hundreds of millions of dollars desperately needed by hospitals teetering on the edge of insolvency.  I'm not attributing these numbers to this, but neither is this being factored into the decision making process.  EX., the UK health system is poised to lose $160M this quarter.  Be nice to see some of that $$$$ go their way, don't you think....

Sure, let's buy into the perverse incentive of case attribution by hospitals  Let's say that's a real temptation.

Let's also look at the other side of the scale....do you have any idea how hard CMS pops people for medicare fraud?  Including losing your credentials?  There's a reason hospitals are rarely popped for medicare fraud....it's because they do their best not to commit it, because to have CMS yank their ability to bill is a death-blow.  And if hospital X in a region is reporting materially more COVID deaths than hospital Y, CMS is very likely to scrutinize why (as just one example of how this would work).

So, there's also a REALLY strong incentive for a hospital NOT to falsely attribute a death to COVID.

Does that mean that there hasn't been a single death wrongly attributed to COVID by a hospital?  Surely not -- I'm sure there have been a handful.  But when you weigh the dueling incentives, it's most likely that it's a statistically insignificant phenomenon.

There are dozens of factors meaning that some cases are undercounted.  There are dozens of factors meaning that some cases are overcounted.  But there's no good reason to believe (in the US, at least) that there is a vast conspiracy pushing the number in either direction.  Indeed, the only factor that seems to be pushing hard in a direction is the relative scarcity of tests, which is well-documented and continues in some areas.  But even then, I think we're talking margin of error type stuff.

[dcar00 14,904]

1 minute ago, Brisketexan said:

Sure, let's buy into the perverse incentive of case attribution by hospitals  Let's say that's a real temptation.

Let's also look at the other side of the scale....do you have any idea how hard CMS pops people for medicare fraud?  Including losing your credentials?  There's a reason hospitals are rarely popped for medicare fraud....it's because they do their best not to commit it, because to have CMS yank their ability to bill is a death-blow.  And if hospital X in a region is reporting materially more COVID deaths than hospital Y, CMS is very likely to scrutinize why (as just one example of how this would work).

So, there's also a REALLY strong incentive for a hospital NOT to falsely attribute a death to COVID.

Does that mean that there hasn't been a single death wrongly attributed to COVID by a hospital?  Surely not -- I'm sure there have been a handful.  But when you weigh the dueling incentives, it's most likely that it's a statistically insignificant phenomenon.

There are dozens of factors meaning that some cases are undercounted.  There are dozens of factors meaning that some cases are overcounted.  But there's no good reason to believe (in the US, at least) that there is a vast conspiracy pushing the number in either direction.  Indeed, the only factor that seems to be pushing hard in a direction is the relative scarcity of tests, which is well-documented and continues in some areas.  But even then, I think we're talking margin of error type stuff.

how do you handle maybes in your scenario?

[Brisketexan 106,627]

3 minutes ago, dcar00 said:

how do you handle maybes in your scenario?

Gently?

[NotActuallyALonghorn 4,998]

So if you made one of these:

Out of a pangolin, what would you then call it?

[dcar00 14,904]

Just now, Brisketexan said:

Gently?

pos rep.  wonder what the legal/fraud ramification is of a maybe? 

[Brisketexan 106,627]

Just now, dcar00 said:

pos rep.  wonder what the legal/fraud ramification is of a maybe? 

Well, I don't know the CMS coding, but I doubt there's any payment code for a "maybe" COVID case.

[BabaYaga 15,532]

3 minutes ago, Brisketexan said:

Sure, let's buy into the perverse incentive of case attribution by hospitals  Let's say that's a real temptation.

Let's also look at the other side of the scale....do you have any idea how hard CMS pops people for medicare fraud?  Including losing your credentials?  There's a reason hospitals are rarely popped for medicare fraud....it's because they do their best not to commit it, because to have CMS yank their ability to bill is a death-blow.  And if hospital X in a region is reporting materially more COVID deaths than hospital Y, CMS is very likely to scrutinize why (as just one example of how this would work).

So, there's also a REALLY strong incentive for a hospital NOT to falsely attribute a death to COVID.

Does that mean that there hasn't been a single death wrongly attributed to COVID by a hospital?  Surely not -- I'm sure there have been a handful.  But when you weigh the dueling incentives, it's most likely that it's a statistically insignificant phenomenon.

There are dozens of factors meaning that some cases are undercounted.  There are dozens of factors meaning that some cases are overcounted.  But there's no good reason to believe (in the US, at least) that there is a vast conspiracy pushing the number in either direction.  Indeed, the only factor that seems to be pushing hard in a direction is the relative scarcity of tests, which is well-documented and continues in some areas.  But even then, I think we're talking margin of error type stuff.

It's not "fraud" to attribute if they do test positive for COVID.  More than 70% of the cases of asymptomatic, yet test positive.  This stat doesn't stop at the door of the hospital.  Pneumonia, cardia arrest, COPT issues, etc.  There were innumerable MEMEs about shark victims having a COD as "COVID" for this very reason.  It's not "fraud", it's examining critically the perverse incentive created by the stimulus bill and reconciling this with hospitals on the verge of insolvency.  

Economics is simply the study of how people make decisions.  It's not a complicated thought experiment.  We know, for a hard, cold fact the stimulus is keeping tens of thousands of people on the sidelines by paying them NOT to work.  This is not up for debate.  We know hospitals are floundering and furloughing thousands.  Now you have a way to receive up to $39,000 PER PERSON, that technically can, and probably does test positive, even though what is uncertain is the actual relationship to between the virus, the diagnosis, and the COD.  So you check the box, and you get what you can.  A perverse incentive creating a moral hazard.  We see them all them time.  This is no different.  To just wave you hands and dismiss this is being less than intellectually honest.  

[dcar00 14,904]

2 minutes ago, Brisketexan said:

Well, I don't know the CMS coding, but I doubt there's any payment code for a "maybe" COVID case.

What if I told you...

https://www.cdc.gov/nchs/nvss/vsrr/COVID19/index.htm

 

[Guest Lobo]

“(Chewing on bat knockwurst) Hey, Mark Wang... is that you?”

”yeah, Mike Lin Damone. You come to this wet market too?”

”all the time.  I come here for the pangolin strudel.”

then they both fucked Stacy and that’s how the virus got from Wuhan to Ridgemont. 

[C-Man 27,685]

3 hours ago, StruggleBus said:

The simplest and most obvious answer is that this virus was transmitted to humans at that lab. 

Agreed. And wasn't there a report that they hadn't been able to track any of the earliest cases to that particular wet market?

[Brisketexan 106,627]

1 minute ago, BabaYaga said:

It's not "fraud" to attribute if they do test positive for COVID.  More than 70% of the cases of asymptomatic, yet test positive.  This stat doesn't stop at the door of the hospital.  Pneumonia, cardia arrest, COPT issues, etc.  There were innumerable MEMEs about shark victims having a COD as "COVID" for this very reason.  It's not "fraud", it's examining critically the perverse incentive created by the stimulus bill and reconciling this with hospitals on the verge of insolvency.  

Economics is simply the study of how people make decisions.  It's not a complicated thought experiment.  We know, for a hard, cold fact the stimulus is keeping tens of thousands of people on the sidelines by paying them NOT to work.  This is not up for debate.  We know hospitals are floundering and furloughing thousands.  Now you have a way to receive up to $39,000 PER PERSON, that technically can, and probably does test positive, even though what is uncertain is the actual relationship to between the virus, the diagnosis, and the COD.  So you check the box, and you get what you can.  A perverse incentive creating a moral hazard.  We see them all them time.  This is no different.  To just wave you hands and dismiss this is being less than intellectually honest.  

I'm not dismissing it.

I'm just sharing with you that your refusal to consider the counter-weight of the harsh regime for CMS fraud makes your perspective wildly incomplete.  Not to mention nonsensical.  I mean, let's say that getting an extra $39k per person means that Hospital X, with 10 "iffy" cases per week, could bump its revenue up $390k per week.  Dude.  You yourself noted it -- they are losing MILLIONS per week.  Committing fraud is stupid and short-sighted -- it puts you out of business when you get caught.  To commit fraud that won't even solve your solvency problem, thus risking being closed and gaining very little for it....even more stupid and short-sighted.

So, I'm looking at it in balance.  And when you weigh the incentive (some dollars) with the problem (losses of millions of dollars), along with the risks (being killed as a billing entity), and the fact that the upside (some dollars) doesn't come close to solving the problem (lost millions), material numbers of fraudulent cases just doesn't make sense.  Again, not saying it's zero, I'm just saying that for it to be statistically significant makes no sense.

And yeah, your citation to slanted memes as support for your argument doesn't help your argument here.  I mean, that and the fact that we sure aren't seeing family after family come forward with a "WTF?  I got a hospital bill that said my dad was treated for and died of COVID....he was shot to death by his gay lover!" story (or similar stories about a shark attack, car wreck, terminal cancer, etc.).  Again, not that we can't find an anecdote here and there -- just like we find several about people dying at home, without ever being tested, but having lots of COVID symptoms.

I don't understand this whole crusade to argue that cases are being materially overcounted.  It's a fucking pandemic, and we've MORE than amply demonstrated that our systems in place to respond to it -- including the systems to test and count cases -- aren't up to the job.  Any "total" number is absolutely an estimate, with a significant margin of error in either direction.

[clapclapclap 9,000]

Observations from a curbside grocery pickup spot:

1.)  There were 7 waiting in line outside a Great Clips. 4 of them wearing masks and 2 of those looked in their 20's/30's.  All were somewhat spread out, though some looked to be only about 3 feet apart. 

2.)  In 10 minutes I saw 3 women wearing a mask but pulled below their noses.

3.)  Apparently the HEB Jalapeno Bean Dip factory has been hit hard by the Kung Flu.  Devastating outages have begun.

[Brisketexan 106,627]

12 minutes ago, dcar00 said:

What if I told you...

https://www.cdc.gov/nchs/nvss/vsrr/COVID19/index.htm

 

Those aren't CMS billing codes.  It's a totally separate reporting regime.

 

[BabaYaga 15,532]

8 minutes ago, Brisketexan said:

I'm just sharing with you that your refusal to consider the counter-weight of the harsh regime for CMS fraud makes your perspective wildly incomplete.  Not to mention nonsensical.  I mean, let's say that getting an extra $39k per person means that Hospital X, with 10 "iffy" cases per week, could bump its revenue up $390k per week.  Dude.  You yourself noted it -- they are losing MILLIONS per week.  Committing fraud is stupid and short-sighted -- it puts you out of business when you get caught.  To commit fraud that won't even solve your solvency problem, thus risking being closed and gaining very little for it....even more stupid and short-sighted.

Its.  Not.  Fraud.  If.  They.  Do.  Test.  Positive.  How are you not getting this?  With a 70% demographic that are completely asymptomatic, yet might have a litany of underlying conditions that are the true root cause, but not notated due to the financial disincentive to do so.  

Put CMS to the side.  You keep coming back to this.  Hard stop.  And if you really want to break down the numbers, you have 5,000 new cases as stated.  $39,000/pop.  Now do the math.  

Nor is this a "crusade", I've said time and time again I'm not auguring in on causality, but to summarily dismiss this is telling.  

Edited May 11, 2020 by BabaYaga

[Scary Stranger 1,722]

4 minutes ago, clapclapclap said:

Observations from a curbside grocery pickup spot:

3.)  Apparently the HEB Jalapeno Bean Dip factory has been hit hard by the Kung Flu.  Devastating outages have begun.

[Cheeseweasel 26,439]

8 minutes ago, Lobo said:

“(Chewing on bat knockwurst) Hey, Mark Wang... is that you?”

”yeah, Mike Lin Damone. You come to this wet market too?”

”all the time.  I come here for the pangolin strudel.”

then they both fucked Stacy and that’s how the virus got from Wuhan to Ridgemont. 

Please tell me Jackson Browne is playing in the background.

[dcar00 14,904]

1 minute ago, Brisketexan said:

I'm not dismissing it.

I'm just sharing with you that your refusal to consider the counter-weight of the harsh regime for CMS fraud makes your perspective wildly incomplete.  Not to mention nonsensical.  I mean, let's say that getting an extra $39k per person means that Hospital X, with 10 "iffy" cases per week, could bump its revenue up $390k per week.  Dude.  You yourself noted it -- they are losing MILLIONS per week.  Committing fraud is stupid and short-sighted -- it puts you out of business when you get caught.  To commit fraud that won't even solve your solvency problem, thus risking being closed and gaining very little for it....even more stupid and short-sighted.

So, I'm looking at it in balance.  And when you weigh the incentive (some dollars) with the problem (losses of millions of dollars), along with the risks (being killed as a billing entity), and the fact that the upside (some dollars) doesn't come close to solving the problem (lost millions), material numbers of fraudulent cases just doesn't make sense.  Again, not saying it's zero, I'm just saying that for it to be statistically significant makes no sense.

And yeah, your citation to slanted memes as support for your argument doesn't help your argument here.  I mean, that and the fact that we sure aren't seeing family after family come forward with a "WTF?  I got a hospital bill that said my dad was treated for and died of COVID....he was shot to death by his gay lover!" story (or similar stories about a shark attack, car wreck, terminal cancer, etc.).  Again, not that we can't find an anecdote here and there -- just like we find several about people dying at home, without ever being tested, but having lots of COVID symptoms.

I don't understand this whole crusade to argue that cases are being materially overcounted.  It's a fucking pandemic, and we've MORE than amply demonstrated that our systems in place to respond to it -- including the systems to test and count cases -- aren't up to the job.  Any "total" number is absolutely an estimate, with a significant margin of error in either direction.

the strange thing for me is NY saying 66% of deaths are people dying at home yet we(or at least I haven't seen) see no social media of someone trying to get help or complaints that they called 911 for their grandparent or parent and no one came so they died.  so 16K people died alone at home in NY?

[Brisketexan 106,627]

1 minute ago, BabaYaga said:

Its.  Not.  Fraud.  If.  They.  Do.  Test.  Positive.  How are you not getting this?  With a 70% demographic that are completely asymptomatic, yet might have a litany of underlying conditions that are the true root cause, but not notated due to the financial disincentive to do so.  

Put CMS to the side.  You keep coming back to this.  Hard stop.  And if you really want to break down the numbers, you have 5,000 new cases as stated.  $39,000/pop.  Now do the math.  

But the hospitals don't get a magical check for $39k if they just add in the note "positive COVID test."  The coding is for actual TREATMENT of COVID.  So, asymptomatic person with COVID comes in for a stroke....they aren't getting COVID treatment codes.

And yeah, let's go with your 5,000 cases.....spread out among even a hundred hospitals, IT DOESN'T MOVE THE NEEDLE FOR ANY ONE OF THEM.

I know that this has been a meme, and man, have I seen it amplified and echoed over and over.  But for something that  is so OBVIOUSLY happening...we're not seeing any material evidence of it actually happening.  Because to say that I treated a stroke patient as a COVID patient....would still be fraud.  The codes are TREATMENT codes.

[pacman 7,491]

3 hours ago, Lobo said:

Head of EcoHealth Alliance Laboratories, the world's foremost expert in bat-based virology in Asia (an American scientist mind you) says it was not.

Head of U.S. Director of National Intelligence (after an in depth review of HUMINT and SIGINT) says it was not.

Head of U.S. National Institutes of Health says it was not.

If these people are "so and so's" to you, I'd like to hear what you call stupid people with not business talking science.  And for the record, all three of those men have said they were/are sorely disappointed with how Wuhan Labs put the hammer down on data and intel on their government's orders.  You can distrust the Chinese and realize wildlife-based viruses jump species all the time.  There's a whole sub-field of science dedicated to it, and much of their intel is out there for peer review.  I'll take the guy who was studying and tracking bat viruses 20 years ago to me 20 years ago who was watching the bats under Congress Avenue Bridge thinking, "Wow, these are cool."  When a peer-reviewed panel of experts comes out and say "These so-and-so's" were dead wrong, here's our proof of genetic markers showing how it jumped out of a lab in China."  Until then, "That's how it may have been released" falls under a genre of "bullshit that doesn't exactly smack of logic nor reason."  

It took a decade to pinpoint the last outbreak.

Money and resources will be required to pinpoint the source of this outbreak in a quicker fashion. We will see how serious our governments are when they allocate and commit to tracking this outbreak. It's not encouraging at the moment, from all fronts to include China's secrecy and America's attempted blame game.

Agree with you. Easy to question the motives of anybody who suggests anything regarding the origin at this time, a time when we should be focused on containment and recovery.

Edited May 11, 2020 by pacman

[BabaYaga 15,532]

1 minute ago, Brisketexan said:

But the hospitals don't get a magical check for $39k if they just add in the note "positive COVID test."  The coding is for actual TREATMENT of COVID.  So, asymptomatic person with COVID comes in for a stroke....they aren't getting COVID treatment codes.

And yeah, let's go with your 5,000 cases.....spread out among even a hundred hospitals, IT DOESN'T MOVE THE NEEDLE FOR ANY ONE OF THEM.

I know that this has been a meme, and man, have I seen it amplified and echoed over and over.  But for something that  is so OBVIOUSLY happening...we're not seeing any material evidence of it actually happening.  Because to say that I treated a stroke patient as a COVID patient....would still be fraud.  The codes are TREATMENT codes.

Medicare pays $13K for patients DIAGNOSED with COVID.  $39K for ventilators.  

Nor is this hundreds of hospitals, unless you think the specific Burroughs in NY where all this happens have HUNDREDS of hospitals?  We are not talking about the entirety of the US.  This is just NY.  And when you say "NY", you really mean a small subset of the city where most of this is happening.  

[Brisketexan 106,627]

3 minutes ago, dcar00 said:

the strange thing for me is NY saying 66% of deaths are people dying at home yet we(or at least I haven't seen) see no social media of someone trying to get help or complaints that they called 911 for their grandparent or parent and no one came so they died.  so 16K people died alone at home in NY?

Yeah, man....I have no idea of all the factors that go into it.  Folks who are alone, folks who are poor, folks who don't take it seriously and die in their sleep, I don't know.  I imagine we'll learn more.  But, I mean, we're not making these up:

Quote

In recent weeks, residents outside Boston have died at home much more often than usual. In Detroit, authorities are responding to nearly four times the number of reports of dead bodies. And in New York, city officials are recording more than 200 home deaths per day — a nearly sixfold increase from recent years.

......

New York City was among the first to provide data on at-home deaths. Officials said last week that roughly 200 residents were dying each day outside of hospitals and nursing homes. That’s compared with about 35 per day on average between 2013 and 2017, according to city records.

ProPublica found similar patterns beyond America’s largest and most hard-hit city. Our review examined parts of states like Massachusetts, Michigan and Washington state, drawing upon information from vital-records departments, health agencies, 911 call centers and police departments. ProPublica then compared those findings with historical deaths provided by the federal Centers for Disease Control and Prevention.

In Middlesex, Massachusetts’s most populous county and home to Cambridge, Somerville and Lowell, officials reported 317 at-home deaths in March. That’s about a 20% increase from the same time period for the past three years, in which deaths ranged from 249 to 265. 

......

In Detroit, authorities responded to more than 150 “dead person observed” calls in the first 10 days of April. It was around 40 during the same period for the past three years, according to city 911 call data. Almost all of the incidents in this year’s period occurred in areas where the median household income was less than $45,000, census data shows. Lower-income areas have been particularly hard hit by the coronavirus.

This is fast-moving, and still developing.  Again, from the US perspective, we're around 100 days into this.  That's nothing.  Our data is shitty, and will remain shitty for some time.

[Armybrat 41,322]

Well shoot me now. Am having retina surgery tomorrow at an outpatient clinic, so I’ll get to take the virus home.

[Dahobbs 18,190]

1 minute ago, BabaYaga said:

Its.  Not.  Fraud.  If.  They.  Do.  Test.  Positive.  How are you not getting this?  With a 70% demographic that are completely asymptomatic, yet might have a litany of underlying conditions that are the true root cause, but not notated due to the financial disincentive to do so.  

Put CMS to the side.  You keep coming back to this.  Hard stop.  And if you really want to break down the numbers, you have 5,000 new cases as stated.  $39,000/pop.  Now do the math.  

Why do you think that wouldn't be fraud? And why would they be hospitalized and tested for Covid-19 if it isn't being treated? What do you think the hospitals are billing for? I really don't think you understand how of any this works. The hospitals don't just put down the Covid-19 ICD code and get cash. They have to actually do treatment related to Covid-19. And, it isn't a flat $39,000 (hell, I don't even know that $39,000 is based on anything in reality), but varies based on the type of treatment, time hospitalized, region, and, oh yeah, whether the patient is even covered by Medicare (~15% of the population). 

[Brisketexan 106,627]

Just now, BabaYaga said:

Medicare pays $13K for patients DIAGNOSED with COVID.  $39K for ventilators.  

Nor is this hundreds of hospitals, unless you think the specific Burroughs in NY where all this happens have HUNDREDS of hospitals?  We are not talking about the entirety of the US.  This is just NY.  And when you say "NY", you really mean a small subset of the city where most of this is happening.  

Yeah, I'm just not following you.  It seems you are talking about just NY hospitals.  From what I have seen and heard of how things have been operating in such hospitals, focusing on maximizing billing for ER and ICU patients hasn't been a high priority for the staff treating the patients.  Treating the patients has been.

And by the way, no....a hospital that administers a positive COVID test doesn't get a magical $13k check.  I am certain that the patient has to be admitted/treated for payment.  Which, you know, is how CMS works.

And thanks for splitting that out -- I'm sure you're not suggesting that hospitals are putting people on vents, a traumatic and dangerous procedure, to make an extra $26k, right?  So really, we're talking about the diagnosis only....So $13k.  Even multiplied by 5,000 cases, that totals up to....$65 million.  Have you seen the financial numbers for NY hospitals?  Again, hardly a dent (and again, that's presuming that every single one of those is some magically "found" case that isn't really legitimately being reported).

I'm sorry, you've extrapolated a massive scheme to rip off the system based on 1) the existence of a new CMS code and 2) hospitals having cash shortfalls.  That's at most a reason to ask the question....in light of all of the evidence (including lack thereof), it's no basis to reach your conclusion.  Again, what I don't understand is why you and others have such a hard-on for this issue....

 

[Dahobbs 18,190]

4 minutes ago, BabaYaga said:

Medicare pays $13K for patients DIAGNOSED with COVID.  $39K for ventilators.  

No, no it doesn't. You're repeating over generalized and frankly incorrect information. Medicare pays for treatments. Covid-19 related treatments received something like a 20% bump up from Medicare recently, but there is not one-size fits all number. A ton a factors go into Medicare reimbursement rates for facilities. 

[Trey3216 15,450]

25 minutes ago, Brisketexan said:

I'm not dismissing it.

I'm just sharing with you that your refusal to consider the counter-weight of the harsh regime for CMS fraud makes your perspective wildly incomplete.  Not to mention nonsensical.  I mean, let's say that getting an extra $39k per person means that Hospital X, with 10 "iffy" cases per week, could bump its revenue up $390k per week.  Dude.  You yourself noted it -- they are losing MILLIONS per week.  Committing fraud is stupid and short-sighted -- it puts you out of business when you get caught.  To commit fraud that won't even solve your solvency problem, thus risking being closed and gaining very little for it....even more stupid and short-sighted.

So, I'm looking at it in balance.  And when you weigh the incentive (some dollars) with the problem (losses of millions of dollars), along with the risks (being killed as a billing entity), and the fact that the upside (some dollars) doesn't come close to solving the problem (lost millions), material numbers of fraudulent cases just doesn't make sense.  Again, not saying it's zero, I'm just saying that for it to be statistically significant makes no sense.

And yeah, your citation to slanted memes as support for your argument doesn't help your argument here.  I mean, that and the fact that we sure aren't seeing family after family come forward with a "WTF?  I got a hospital bill that said my dad was treated for and died of COVID....he was shot to death by his gay lover!" story (or similar stories about a shark attack, car wreck, terminal cancer, etc.).  Again, not that we can't find an anecdote here and there -- just like we find several about people dying at home, without ever being tested, but having lots of COVID symptoms.

I don't understand this whole crusade to argue that cases are being materially overcounted.  It's a fucking pandemic, and we've MORE than amply demonstrated that our systems in place to respond to it -- including the systems to test and count cases -- aren't up to the job.  Any "total" number is absolutely an estimate, with a significant margin of error in either direction.

Robbing a gas station when you’re broke doesn’t make a whole lot of sense either, but it happens nonetheless 

[Cheeseweasel 26,439]

6 minutes ago, Armybrat said:

Well shoot me now. Am having retina surgery tomorrow at an outpatient clinic, so I’ll get to take the virus home.

Hard to believe you survived the Bubonic Plague just to be taken by the WuFlu. 

[Brisketexan 106,627]

5 minutes ago, Trey3216 said:

Robbing a gas station when you’re broke doesn’t make a whole lot of sense either, but it happens nonetheless 

Sure....but not much.  The vast majority of broke people DON'T rob gas stations.  So, y'all have a hypothesis that you've converted into FACT.  Sorry.  Takes a lot more than that.

[Trey3216 15,450]

3 minutes ago, Brisketexan said:

Sure....but not much.  The vast majority of broke people DON'T rob gas stations.  So, y'all have a hypothesis that you've converted into FACT.  Sorry.  Takes a lot more than that.

Don’t lump me into that shit, I was merely making a fairly simple logical fallacy out of your argument.  

[Js1 86,943]

NO POLITICS! 

*criticizes Newsom*
*spreads right wing talking points about faking cause of deaths for money*

NO POLITICS! 

[BabaYaga 15,532]

1 minute ago, Brisketexan said:

Yeah, I'm just not following you.  It seems you are talking about just NY hospitals.  From what I have seen and heard of how things have been operating in such hospitals, focusing on maximizing billing for ER and ICU patients hasn't been a high priority for the staff treating the patients.  Treating the patients has been.

And by the way, no....a hospital that administers a positive COVID test doesn't get a magical $13k check.  I am certain that the patient has to be admitted/treated for payment.  Which, you know, is how CMS works.

And thanks for splitting that out -- I'm sure you're not suggesting that hospitals are putting people on vents, a traumatic and dangerous procedure, to make an extra $26k, right?  So really, we're talking about the diagnosis only....So $13k.  Even multiplied by 5,000 cases, that totals up to....$65 million.  Have you seen the financial numbers for NY hospitals?  Again, hardly a dent (and again, that's presuming that every single one of those is some magically "found" case that isn't really legitimately being reported).

I'm sorry, you've extrapolated a massive scheme to rip off the system based on 1) the existence of a new CMS code and 2) hospitals having cash shortfalls.  That's at most a reason to ask the question....in light of all of the evidence (including lack thereof), it's no basis to reach your conclusion.  Again, what I don't understand is why you and others have such a hard-on for this issue....

 

It was spelled out from the initial article it was about NY.  You extrapolated across the entire county and immediately started dropping paragraph after paragraph.  Not me.  Not once, but twice was it brought up that this was in fact a thought experiment examining a perverse incentive easily leading to the an obvious moral hazard.  Now the question is what triggered you such that even to speculate on the incentives here is sheer dismissal.  That in itself is telling.  

Treatments?  Detail the distinct treatment differences between pneumonia, influenza, and COVID.  They are virtually the same.  Do pneumonia cases get to use ventilators?  Of course they do.  As the article stated, the most common cross-contamination is between COVID and pneumonia. 

Nor is this just conjecture.  Dr Birx of the WH Corona task force indicated early on that the federal government is classifying the deaths of patients infected with the coronavirus as COVID-19 deaths, regardless of any underlying health issues that could have contributed to the loss of someone's life.

 

Quote

"There are other countries that if you had a pre-existing condition, and let's say the virus caused you to go to the ICU [intensive care unit] and then have a heart or kidney problem," she said during a Tuesday news briefing at the White House. "Some countries are recording that as a heart issue or a kidney issue and not a COVID-19 death.

"The intent is ... if someone dies with COVID-19 we are counting that," she added.

 

[MNLonghornFUKM 8,963]

Wow..US numbers are insanely low. Hope bloody Tuesday can toss us a bait line of hope tomorrow

[BabaYaga 15,532]

NY Doc says time to reopen

Good read.  From the front lines.  Ray of sunshine...

Quote

Dr Samir Farhat's hospital in New York had been at the epicentre of the coronavirus outbreak in the US. Now, the ICU was almost back to normal and he found himself wondering when the city would be too.

"It's not often I agree with Trump, but I think that we should open up on May 15," said Dr Farhat, who runs the emergency room at New York Community Hospital as well as working as a physician at Mount Sinai Brooklyn.

The New York governor's three-phase plan to end the lockdown will see the city next week begin slowly easing restrictions that have paralysed the Big Apple for months.

But Dr Farhat and doctors at other major New York hospitals who spoke to The Telegraph said their experience on the front line of the crisis had, somewhat unexpectedly, convinced them the city should reopen without delay.

"Hospital census is right down, admissions are too," Dr Farhat said. "Opening up now is a calculated risk we need to take."

Dr Farhat, who specialises in pulmonology, worries that he has not seen the cases of severe asthma, heart attacks and strokes that usually fill his ER beds.

His concern is that the virus has stopped them from seeking medical attention, an unfortunate - and sometimes fatal - consequence of the stay-at-home strategy.

Quote

"While Covid-19 is serious, fear of it is being over-amplified. The public needs to understand that the vast majority of infected people do quite well," he said.

He said he noticed the "wave had crested" at St Barnabas on April 7 - three weeks after the statewide shutdown was ordered. "It was a discrete, noticeable event. Stretchers became available, and the number of arriving Covid-19 patients dropped below the number discharged, transferred or deceased," he said.

"This was striking, because the community I serve is poor. Most work in 'essential,' low-paying jobs where distancing isn't easy. Nevertheless, the wave passed over us, peaked and subsided.

"The way this transpired tells me the ebb and flow had more to do with the natural course of the outbreak than it did with the lockdown," he said.

His observation appeared to be supported by figures released on Wednesday by Governor Andrew Cuomo, which showed the majority of people who are still being hospitalised with the virus across the state were staying at home and not essential workers.

Quote

The data has prompted questions of how effective the lockdown has been and for how much longer it will be necessary.

"Covid-19 is also more prevalent than we think. Many New Yorkers already have the infection, whether they are aware of it or not," Dr Murphy said, referring to a recent antibody sample study which showed that one-in-five residents of New York City had likely already had the virus.

"As of today, over 43 per cent of those tested are positive in The Bronx. We are developing a significant degree of natural herd immunity," he said. "Distancing works, but I am skeptical that it is playing as predominant a role as many think."

 

[Brisketexan 106,627]

Just now, BabaYaga said:

It was spelled out from the initial article it was about NY.  You extrapolated across the entire county and immediately started dropping paragraph after paragraph.  Not me.  Not once, but twice was it brought up that this was in fact a thought experiment examining a perverse incentive easily leading to the an obvious moral hazard.  Now the question is what triggered you such that even to speculate on the incentives here is sheer dismissal.  That in itself is telling.  

Treatments?  Detail the distinct treatment differences between pneumonia, influenza, and COVID.  They are virtually the same.  Do pneumonia cases get to use ventilators?  Of course they do.  As the article stated, the most common cross-contamination is between COVID and pneumonia. 

Nor is this just conjecture.  Dr Birx of the WH Corona task force indicated early on that the federal government is classifying the deaths of patients infected with the coronavirus as COVID-19 deaths, regardless of any underlying health issues that could have contributed to the loss of someone's life.

 

 

That's not what Birx meant with that clause -- even the context that you quoted, for crying out loud.  It's an argument that was had and was over weeks ago.  If you have high blood pressure, but were not heading towards any imminent death, but now you get COVID, and that kills you because you're a weaker patient (because of your HBP), then it's counted as a COVID death.  Which is literally how the law treats such things

The phenomenon is "eggshell skull" plaintiff.  If I hit 5 guys on the head with a baseball bat, and 4 of them are fine because I'm not that strong, but the 5th guy dies because he has a really thin skull, he didn't die of "thin skull." He died from a baseball bat to the head -- he was more SUSCEPTIBLE to death because the thin skull, but the cause of death was the baseball bat.  so, what Birx said was actually in line with exactly how causes of death have been recorded under US law, historically.

[BabaYaga 15,532]

Just now, Brisketexan said:

That's not what Birx meant with that clause -- even the context that you quoted, for crying out loud.  It's an argument that was had and was over weeks ago.  If you have high blood pressure, but were not heading towards any imminent death, but now you get COVID, and that kills you because you're a weaker patient (because of your HBP), then it's counted as a COVID death.  Which is literally how the law treats such things

The phenomenon is "eggshell skull" plaintiff.  If I hit 5 guys on the head with a baseball bat, and 4 of them are fine because I'm not that strong, but the 5th guy dies because he has a really thin skull, he didn't die of "thin skull." He died from a baseball bat to the head -- he was more SUSCEPTIBLE to death because the thin skull, but the cause of death was the baseball bat.  so, what Birx said was actually in line with exactly how causes of death have been recorded under US law, historically.

Which has been my point this entire time - except now they tied a financial incentive to it.  It both over inflates the true case count and creates a perverse incentive, leading to the stark possibility of moral hazard.  We all know the overwhelming majority of cases are conjoined with underlying factors, but correlation is not causation.  It's amazing the mental gymnastics for perverse incentives with CEOs, corporate boards, etc most here are so quick to sentence to the gallows...but when applied to medical scenarios, it's like they don't exist.  Again, if you are being intellectually honest, and can see how these incentives impact other corporate actions, but somehow think the tens of billions YOY in medical fraud are just superfluous....then what stance do you really have? 

[washparkhorn 9,967]

40 minutes ago, Armybrat said:

Well shoot me now. Am having retina surgery tomorrow at an outpatient clinic, so I’ll get to take the virus home.

Good luck AB. FYI - if they offer you anti-nausea medicine, don't be a hero and take it.  Most don't get nausea, but vomiting (with your eye recently flayed open and your retina welded back on with a laser) is no-bueno. 

[atomheartbevo 90,548]

1 hour ago, Cheeseweasel said:

Yeah, but those kids looked like Jack Klugman. 

[atomheartbevo 90,548]

44 minutes ago, Armybrat said:

Well shoot me now. Am having retina surgery tomorrow at an outpatient clinic, so I’ll get to take the virus home.

Your grandkids survived the Spanish Flu, don't be a wussy about this.

[atomheartbevo 90,548]

1 hour ago, NotActuallyALonghorn said:

So if you made one of these:

Out of a pangolin, what would you then call it?

I'm sorry, can you post a better photo, zoomed in on the neck, because I'm unable to read the words "Romeo Rose" on it.

[Brisketexan 106,627]

4 minutes ago, BabaYaga said:

Which has been my point this entire time - except now they tied a financial incentive to it.  It both over inflates the true case count and creates a perverse incentive, leading to the stark possibility of moral hazard.  We all know the overwhelming majority of cases are conjoined with underlying factors, but correlation is not causation.  It's amazing the mental gymnastics for perverse incentives with CEOs, corporate boards, etc most here are so quick to sentence to the gallows...but when applied to medical scenarios, it's like they don't exist.  Again, if you are being intellectually honest, and can see how these incentives impact other corporate actions, but somehow think the tens of billions YOY in medical fraud are just superfluous....then what stance do you really have? 

"except now they tied a financial incentive to it.  It both over inflates the true case count and creates a perverse incentive, leading to the stark possibility of moral hazard."

There is a financial incentive to a jillion codes.  There always has been.  And how does that "overinflate the true case count?"  Come on, there's no evidence that someone coming in for a hangnail is being reported as a COVID case.  There's ALWAYS a possibility of this "moral hazard."  And I am NOT arguing that there is zero instances of that happening - imagine any bad act, and someone has probably committed it.  The issue is whether the phenomenon that you FEAR is statistically meaningful.

" It's amazing the mental gymnastics for perverse incentives with CEOs, corporate boards, etc most here are so quick to sentence to the gallows"

Well, where we've seen the evidence of ACTIONS driven by those incentives (e.g, shitty long-term planning driven by quarterly reporting trumping all else), then yes.  The existence of the incentive alone....particularly in a complex mix of factors...doesn't give us the basis to conclude that there is some wrongful action.

And if you want to look into the medicare fraud issue, give it a look.  It's rather rare that a HOSPITAL is popped for any meaningful fraud.  Almost all of it is by individual doctors and practices (the direct providers).  I have plenty of issues with how hospitals are run, but what you are postulating is just not how they operate.  I know and have worked with several hospital CEOs, and that's just not in play.  Again, not saying there are no bad actors in the world, but it's not a systemic issue.

[dcar00 14,904]

39 minutes ago, Brisketexan said:

Yeah, man....I have no idea of all the factors that go into it.  Folks who are alone, folks who are poor, folks who don't take it seriously and die in their sleep, I don't know.  I imagine we'll learn more.  But, I mean, we're not making these up:

This is fast-moving, and still developing.  Again, from the US perspective, we're around 100 days into this.  That's nothing.  Our data is shitty, and will remain shitty for some time.

OK, I'm correcting myself here.  It was 66% of hospitalizations that were at home.  apparently this means they had not left their home at all but got it and were hospitalized.  It was called shocking by NY because it was said that these people did not take public transportation, and were sheltering at home, which surprised them that they got it.  I guess you have to go under the assumption these people are being truthful and truly did not leave home ever or have guests come to their home.

 

[JBJ 3,780]

My understanding of the data:

1) CDC is tracking both separately (tested and suspected deaths) and requested states/hospitals to report both as well.  The published numbers are a combination of both.

2) Attribution doesn't matter right now.  Years down the road someome will parse the coroner reports for causes and co-morbidities and do an attribution study.  Right now the qualifications are (1) testing positive or suspected and (2) dying.

3) Various places are reporting deaths differently than the CDC guidelines.  They aren't compelled to be standardized.

4) Dead people probably wouldn't test positive even if you tested them.  Viral shed would be low if it exists at all.  This also goes back to my previous post where viral shed has usually already peaked before you hit peak symptoms.  If you are on the tail end of the disease, you might not get an accurate result.  If you are discovered a day later, even more so.  Viruses aren't going to last long without a host.

5) The scarcity of tests or difficulty getting tested was vastly overstated.  You'd expect a surge in cases with equal drop in rates if this was an impactful problem.  It'd also show up in random population studies in the areas testing was reported to be a problem.

6) False positive rates are known and low.  This is easy to know by testing aged blood from blood banks. 

False negatives are less certain and may be high.  The most certain way to figure false negatives is testing against a different test.  This is where the three-prong test comes in.  Two of the prongs are specific to SARS-COV-2.  When these produce different results, the sample goes to CDC for deeper analysis and confirmation.  If they confirm, then you know one leg failed.  You do this enough and you can determine the rate both will fail.  I'm not sure where on the curve we currently are.  It would take longer to nail down numbers the smaller they are.

The bigger problem with false negatives is the sampling.  If you don't get a good sample you'll get a false negative regardless of the test.  This could be double-digit %s for the nasal swab method that has to go deep into your brain.

7) There's zero incentive for hospitals to lie about test results.  They aren't going to be turned down for a COVID treatment for a patient if it is uncertain exactly which ILI disease they have.  The tests are better at confirming a treatment than ruling it out.