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  • Originally posted by K82 View Post

    There certainly are financial incentives for coding Covid, here is a reference to that in USA Today:

    https://www.usatoday.com/story/news/...us/3000638001/

    That article doesn't address coding deaths as related to Covid but there is additional Medicare reimbursement for Covid. If there is no financial incentive, why would a hospital system code a death as Covid when it was not the primary cause of the death?

    Anyway, sorry to offend you, certainly not intended. I didn't think it was a controversial post. There have been a ton of patients that have sadly died as a result of this miserable disease. As to how many, I don't think we will ever really know. Does it really make any difference if its 800K, 1 million or 500K? It's too many.
    The hospital death certificates are the flash reporting system to CDC. There is a check and balance. Each county coroner reviews and makes the official determination.
    Yes, originally there was some documented what I call confusion. Did the motorcycle accident victim have Covid. Yes. Data accuracy is always subject to error. I am pretty certain some “natural causes” were accelerated by Covid and unreported and not tested. Imperfect data, use what we have. Any individual has zero incentive to falsify data.
    Ridiculous to claim financial incentives.
    Physicians, hospitals, states and CDC have only made changes intended to improve consistency and accuracy.
    Data from South Africa? We are speculating on their process. I accept it as best available. Zero evidence of manipulating data with one political exception.

    Comment


    • Originally posted by MaxPower View Post

      Say “I’ve never filled out a death certificate” without saying “I’ve never filled out a death certificate.”

      This preposterous line of thought was touted by Covid deniers basically since the beginning of the pandemic, and as the excess death numbers will easily show, we actually probably underestimated the number of covid deaths.
      You are absolutely correct, I don't fill out death certificates in my specialty of practice. I am in leadership roles at one of the facilities my group covers. I know what I have been told regarding this issue from administration. How widespread this practice is I have no idea.

      I am certainly not a Covid denier, I see the havoc its causing in my practice daily. I am saying that the Covid death data is inaccurate. I am not suggesting that physicians are falsifying data for personal financial gain, I think the data is getting muddled further up the chain. My assumption that there must be money involved somewhere is only a logical guess, that part I don't have direct knowledge of.

      Again, I'm sorry to have touched off a firestorm, not my intent. I honestly didn't think that post would be controversial, I assumed more of you would be aware of this.

      Comment


      • Originally posted by Tim View Post

        The hospital death certificates are the flash reporting system to CDC. There is a check and balance. Each county coroner reviews and makes the official determination.
        Yes, originally there was some documented what I call confusion. Did the motorcycle accident victim have Covid. Yes. Data accuracy is always subject to error. I am pretty certain some “natural causes” were accelerated by Covid and unreported and not tested. Imperfect data, use what we have. Any individual has zero incentive to falsify data.
        Ridiculous to claim financial incentives.
        Physicians, hospitals, states and CDC have only made changes intended to improve consistency and accuracy.
        Data from South Africa? We are speculating on their process. I accept it as best available. Zero evidence of manipulating data with one political exception.
        I agree with you Tim, I don't think individual physicians are doing anything nefarious. I apologize to the forum if that's what was thought, I can understand why people would be upset with that. This is being done at an administrative level.

        Comment


        • People that are saying less severe? I don’t know. What I do know is I work in rural/college town Indiana at two hospitals. The one is critical access and we are willing to take 7 Covid patients.

          I am flying one of those out every other day. The main hospital, we have roughly 142 beds and have 175 patients.

          I am flying patients to ERs from inpatient because there is not beds in Indiana at all. My hospital is the only one where we hospitalists manage optiflow and Bipap w/o a pulm consult obligatory or outside icu proper

          We use to have 8 Hospitalist teams of 15 now we have 11 with 14-16 patients each …
          Last edited by Ekanive23; 12-17-2021, 12:35 PM.

          Comment


          • Originally posted by Ekanive23 View Post
            People that are saying less severe? I don’t know. What I do know is I work in rural/college town Indiana at two hospitals. The one is critical access and we are willing to take 7 Covid patients.

            I am flying one of those out every other day. The main hospital, we have roughly 142 beds and have 175 patients.

            I am flying patients to ERs from inpatient because there is not beds in Indiana at all. My hospital is the only one where we hospitals manage optiflow and Bipap.

            We use to have 8 Hospitalist teams of 15 now we have 11 with 14-16 patients each …
            I think I'm most impressed that you have more patient than beds unless you're boarding 33 patients in the ED. I don't think I know of a local hospital that can staff all their beds.

            Comment


            • Originally posted by CordMcNally View Post

              I think I'm most impressed that you have more patient than beds unless you're boarding 33 patients in the ED. I don't think I know of a local hospital that can staff all their beds.
              We staff more than we are capable. 32 boarded in ER at worst. We have PACU as ICU, we have cath lab beds, interventional rads beds, post op, no elective surgeries.

              all nurses have been diverted so save lives. I can’t even bill properly because patients are falling off of billing because they aren’t in proper spots.

              we are now making my critical access hospital that I go to part time flex to 25 beds. It is the only physical space in our entire region.


              we are using the ambulance bay for beds and a conference room for beds as well

              Comment


              • They are paying rn 88/hr roughly, any hospital employee gets full pay to be a sitter if needed… doctor included…

                In December they are paying out roughly 150 k based on the extra shifts I see people signing up for , not including the rvu part even.

                the terrifying thought is only 1/3 are Covid. We aren’t even at last years peak. We were shipping 5 patients every day to the Indianapolis mother hospital to start every day then… except now they can’t do that . They are full too.

                I’m doing my part and printing money as a Hospitalist. It’s a lot of work but rewarding emotionally and financially.

                Comment


                • Originally posted by Ekanive23 View Post
                  I’m doing my part and printing money as a Hospitalist. It’s a lot of work but rewarding emotionally and financially.
                  Hang in there and remember to give yourself a break as we're just beginning the winter surge with influenza and dual infections that we saw early on in March 2020 that will cause a lot more issues with LOS IMHO.

                  I truly hope omicron is less lethal as it theoretically should be as evolution of a virus over time that becomes endemic. While the breakthroughs are happening, the severity remains the same with delta for the most part so far...bit most in the healthy folk. The elderly is more import and majority out 9-10 months now if not boosted.

                  Too early to tell on pact of elderly as tended to run later on the surge


                  That's going to start showing up in hospitalizations from omicron probably three weeks from our modeling with the winter surge.
                  ..right around new years

                  Comment


                  • Originally posted by CordMcNally View Post

                    The good news is that South African deaths and hospitalizations are incredibly low compared to their other waves so we'll see. One would have thought we would already be seeing large increases there at this point if it was going to get a lot worse with respect to those outcomes.
                    I have convinced myself that confirmation bias led me also to the conclusion that Omicron is less severe. The S African population is much younger on average, and the data is hard to interpret and preliminary. But I hope you are right. At this point I am not convinced that it is less severe, but hoping so.
                    My Youtube channel: https://www.youtube.com/channel/UCFF...MwBiAAKd5N8qPg

                    Comment


                    • Originally posted by StarTrekDoc View Post

                      Hang in there and remember to give yourself a break as we're just beginning the winter surge with influenza and dual infections that we saw early on in March 2020 that will cause a lot more issues with LOS IMHO.

                      I truly hope omicron is less lethal as it theoretically should be as evolution of a virus over time that becomes endemic. While the breakthroughs are happening, the severity remains the same with delta for the most part so far...bit most in the healthy folk. The elderly is more import and majority out 9-10 months now if not boosted.

                      Too early to tell on pact of elderly as tended to run later on the surge


                      That's going to start showing up in hospitalizations from omicron probably three weeks from our modeling with the winter surge.
                      ..right around new years
                      Just pointing out that there is no guarantee that viruses evolve only in less lethal or less severe direction over time. Sometimes that happens. Many of the diseases we immunize against remain as pathogenic as always. What this wave will do is add to population immunity due to infections, which could move us in the direction of herd immunity eventually. It will probably be a combination of vaccines and infection-based immunity that gets us there in the long run. We will be lucky if viral mutation helps also.
                      My Youtube channel: https://www.youtube.com/channel/UCFF...MwBiAAKd5N8qPg

                      Comment


                      • This coronavirus where you become infectious then become symptomatic and then roughly a week later become seriously ill is not facing the kind of evolutionary pressure towards being less severe that is faced by microbes that stop spreading because you're too ill to go out and see people.

                        Comment


                        • Originally posted by Antares View Post

                          I have convinced myself that confirmation bias led me also to the conclusion that Omicron is less severe. The S African population is much younger on average, and the data is hard to interpret and preliminary. But I hope you are right. At this point I am not convinced that it is less severe, but hoping so.
                          Comparing waves between the South African population seems reasonable and so far it’s promising.

                          Regardless, less and less people are more inclined to not go out of their way as time goes on.

                          Comment


                          • Originally posted by Antares View Post

                            Just pointing out that there is no guarantee that viruses evolve only in less lethal or less severe direction over time. Sometimes that happens. Many of the diseases we immunize against remain as pathogenic as always. What this wave will do is add to population immunity due to infections, which could move us in the direction of herd immunity eventually. It will probably be a combination of vaccines and infection-based immunity that gets us there in the long run. We will be lucky if viral mutation helps also.
                            True. There are other coronaviruses out there competing against each other compared to the stable viruses like measles. That is where the evolutionary pressures are for virility and fatality

                            Comment


                            • Discussion overheard in physician's lounge today went something like this:
                              Hospital isn't willing to attempt to mandate boosters. There are three RNs admitted to ICU right now, young, otherwise healthy. Hopefully it sends a message.

                              Comment


                              • Originally posted by StateOfMyHead View Post
                                Discussion overheard in physician's lounge today went something like this:
                                Hospital isn't willing to attempt to mandate boosters. There are three RNs admitted to ICU right now, young, otherwise healthy. Hopefully it sends a message.
                                It's really tough for businesses to mandate something that will likely make more of their already short staff quit. While I agree that those in healthcare should do what they can to protect themselves and their patients, hospitals also need all the people they can to come into work to care for patients.

                                Comment

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