It Looks Like the Death Numbers are Being Inflated

[fatmanatee]

My mom grew up in Jersey City, her grandparents came over from Ireland and landed there, my dad had to teach her to drive because they didn’t have a car, very few had cars.

I live in JC now, don't have a car. Would guess that the percentage of public transit riders is even higher now.

 

[Deano45m]

um, no, not a Disney bus driver. I have no idea why you would even think that. Idiotic thread? Wow. Do you honestly think it’s okay to falsify death certificates?

They are not falsifying them they are checking everyone that passes away to see if they had the virus at time of death. If they died at the hospital and the test showed that they tested positive then the hospital is receiving more money.

 

[pahoben]

My mom grew up in Jersey City, her grandparents came over from Ireland and landed there, my dad had to teach her to drive because they didn’t have a car, very few had cars.

If you look at Houston-Harris County has suffered about 100 deaths versus population of 4,000,000. Houston is one of the most diverse cities in the US and large international airport with constant international traffic associated with oil and gas industry. The style of living though much different though than NJ with very low use of public transportation. Coronavirus has been a non event in Houston except going forward very hard times because the oil and gas industry has been absolutely decimated by the quarantine. They built a $16MM temporary hospital that hasn’t treated a single patient. People in Houston view this very differently than people in NJ.

 

[Pea-n-Me]

Please explain. Does it cost more to put (and keep) a vent in a Covid patient than another patient? Don't the procedures and medicines cost the same regardless of what the diagnosis is?

There are a lot of variables including a large increase in staffing and supplies. Working in the Covid ICUs I am experiencing this firsthand.

They're not the same as regular patients. More staff are required to assist in the time consuming process of donning and doffing PPE (gloves, masks, shields, body cover) each and every time you go in and out of a patient's room, which is constantly. Just finish up caring for a patient for an hour in the room, trying to dot all your i's and cross all your t's while in there, sweating and steaming up under all the protective gear, coming out, doffing, washing up, breathing fresh air again for a couple of minutes, when one of the many pumps inexplicably starts beeping again. In you go again, but first donning all your gear all over again and doffing and cleaning when you come out, etc. It's constant, and takes away time the nurse needs to do other things including primarily critical documentation, which is very involved, so more staff are needed to assist in this process. This is what caring for people with Covid during a pandemic necessitates, and Medicare understands that. As a result, there are more staff assigned to these units.

Now don't get me wrong, normally there will be some patients who are on contact precautions. But this isn't even in the same league as that. Every. single. patient. has a potentially deadly disease.

Where I am, only RNs go in Covid rooms, with few exceptions, hence higher costs of care. Additional RNs on units will be assigned in many ways besides caring for patients, they may be "runners" or "circulators" or "code nurses" or charge nurses trying to manage all the chaos. All necessary for the daunting task of caring for these patients. Patients who deteriorate in other areas of the hospital are admitted to the ICUs with great needs and an admitting ICU nurse may not be able to get out of their room(s) for many hours if the patient is unstable. Anyone on a vent requires a respiratory therapist's frequent care, as well. Doctors on medical teams in the ICU remain right on the units, and there are lots of them. They round frequently and have to do things like insert new arterial lines and be present to troubleshoot if and when things become problematic, etc. There are far more people than normal working in Covid ICUs - and non-ICUs for many of the same reasons.

Some of the unlicensed staff are observers for helping direct caregivers don and doff, as because we don't wear fresh N95 masks and shields due to the shortages, great care has to be taken in taking these off, cleaning them and putting them back on again, so a second person is there to help oversee and support that, if possible. (I have had many shifts without one.) Last week we had a priest come in to see a patient, arriving with his own mask and shield, but he was a little unsure of how and in what order to put everything on so I watched him and directed him for his safety. Not everyone who goes in rooms is totally adept at donning and doffing (there are more tricky steps than I've outlined here), so it's always a safety issue. Many staff have become sick with Covid everywhere. Some have died. It's overwhelming at times. Patients are extremely sick.

Supplies are another big issue. A Covid ICU patient uses a lot of supplies. Most are on feeding tubes, are vented, have arterial lines, etc. Depending on their individual diagnoses, there may be additional complex therapies involved as well, like CVVH for patients with renal failure, or ECMO for the sickest, etc. Too many possibilities to list. It's not uncommon to see six or eight different drips running. Many are expensive. One bag or bottle runs dry and another goes up, over and over. Same with tube feeds, whose administration sets for pumps have to be changed daily as germs can grow pretty fast in the feeding solutions. Many Covid patients have diarrhea so they have rectal tubes and urinary catheters. (Sorry if TMI.) Supplies inside the room, if not used, all have to be thrown away during cleaning when the room becomes empty, so nurses have to be judicious about what supplies they take in. If something's not there, someone needs to get it for you while you're in there. A variety of communication devices are used, including electronics like iPads and other cameras. We can't touch phones due to contamination. During one shift I had a small white board to write things down on (feeling like Anthony Hopkins in Legends of the Fall), holding up to the door and trying to catch the attention of someone outside to bring me what I needed. In 12 hrs there were about forty different items that I needed, including medication drips, gowns and linens, needles and tubing, cups, blood drawing supplies, etc. Hundreds of items are needed in care.

There are also a lot of extra supportive personnel on hand like IT people, housekeeping, administrators, biomedical engineers, to help keep things running smoothly during the crisis.

We've became a well-oiled machine but it takes a lot; unlike anything most of us have ever seen. And with that comes extra costs. I'm sure someone else may have another perspective, as well.

* BTW I was going to try to make this more concise but decided it's probably better to give a glimpse of what it's like so people can feel it along with us.

 

[mjkacmom]

There are a lot of variables including a large increase in staffing and supplies. Working in the Covid ICUs I am experiencing this firsthand.

They're not the same as regular patients. More staff are required to assist in the time consuming process of donning and doffing PPE (gloves, masks, shields, body cover) each and every time you go in and out of a patient's room, which is constantly. Just finish up caring for a patient for an hour in the room, trying to dot all your i's and cross all your t's while in there, sweating and steaming up under all the protective gear, coming out, doffing, washing up, breathing fresh air again for a couple of minutes, when one of the many pumps inexplicably starts beeping again. In you go again, but first donning all your gear all over again and doffing and cleaning when you come out, etc. It's constant, and takes away time the nurse needs to do other things including primarily critical documentation, which is very involved, so more staff are needed to assist in this process. This is what caring for people with Covid during a pandemic necessitates, and Medicare understands that. As a result, there are more staff assigned to these units.

Now don't get me wrong, normally there will be some patients who are on contact precautions. But this isn't even in the same league as that. Every. single. patient. has a potentially deadly disease.

Where I am, only RNs go in Covid rooms, with few exceptions, hence higher costs of care. Additional RNs on units will be assigned in many ways besides caring for patients, they may be "runners" or "circulators" or "code nurses" or charge nurses trying to manage all the chaos. All necessary for the daunting task of caring for these patients. Patients who deteriorate in other areas of the hospital are admitted to the ICUs with great needs and an admitting ICU nurse may not be able to get out of their room(s) for many hours if the patient is unstable. Anyone on a vent requires a respiratory therapist's frequent care, as well. Doctors on medical teams in the ICU remain right on the units, and there are lots of them. They round frequently and have to do things like insert new arterial lines and be present to troubleshoot if and when things become problematic, etc. There are far more people than normal working in Covid ICUs - and non-ICUs for many of the same reasons.

Some of the unlicensed staff are observers for helping direct caregivers don and doff, as because we don't wear fresh N95 masks and shields due to the shortages, great care has to be taken in taking these off, cleaning them and putting them back on again, so a second person is there to help oversee and support that, if possible. (I have had many shifts without one.) Last week we had a priest come in to see a patient, arriving with his own mask and shield, but he was a little unsure of how and in what order to put everything on so I watched him and directed him for his safety. Not everyone who goes in rooms is totally adept at donning and doffing (there are more tricky steps than I've outlined here), so it's always a safety issue. Many staff have become sick with Covid everywhere. Some have died. It's overwhelming at times. Patients are extremely sick.

Supplies are another big issue. A Covid ICU patient uses a lot of supplies. Most are on feeding tubes, are vented, have arterial lines, etc. Depending on their individual diagnoses, there may be additional complex therapies involved as well, like CVVH for patients with renal failure, or ECMO for the sickest, etc. Too many possibilities to list. It's not uncommon to see six or eight different drips running. Many are expensive. One bag or bottle runs dry and another goes up, over and over. Same with tube feeds, whose administration sets for pumps have to be changed daily as germs can grow pretty fast in the feeding solutions. Many Covid patients have diarrhea so they have rectal tubes and urinary catheters. (Sorry if TMI.) Supplies inside the room, if not used, all have to be thrown away during cleaning when the room becomes empty, so nurses have to be judicious about what supplies they take in. If something's not there, someone needs to get it for you while you're in there. A variety of communication devices are used, including electronics like iPads and other cameras. We can't touch phones due to contamination. During one shift I had a small white board to write things down on (feeling like Anthony Hopkins in Legends of the Fall), holding up to the door and trying to catch the attention of someone outside to bring me what I needed. In 12 hrs there were about forty different items that I needed, including medication drips, gowns and linens, needles and tubing, cups, blood drawing supplies, etc. Hundreds of items are needed in care.

There are also a lot of extra supportive personnel on hand like IT people, housekeeping, administrators, biomedical engineers, to help keep things running smoothly during the crisis.

We've became a well-oiled machine but it takes a lot; unlike anything most of us have ever seen. And with that comes extra costs. I'm sure someone else may have another perspective, as well.

* BTW I was going to try to make this more concise but decided it's probably better to give a glimpse of what it's like so people can feel it along with us.

I feel like so many healthcare workers are going to need some counseling after this, everyone I know in the crowded hospitals says pretty much the same thing, it’s like nothing they’ve experienced. Stay safe.

 

[BuckeyeBama]

I feel like so many healthcare workers are going to need some counseling after this, everyone I know in the crowded hospitals says pretty much the same thing, it’s like nothing they’ve experienced. Stay safe.

PTSD is real and these folks have witnessed some very devastating carnage.

 

[shelemm]

I think this is a sly way for some folks to turn this into a political football.

If anyone is truly concerned about this issue (incorrect counting) my question is: what is your posting history on the disboard when home deaths were not being counted? Or is your fixation on this issue only with over-counting and not under-counting?

 

[3threebabies]

That's not entirely true now. If a person is uninsured and hospitalized, the hospital can apply for reimbursement of costs from the federal govt if the person has tested positive for COVID.



The CARES ACT states that Medicare will pay an additional 20% on top of contracted rates for in-patient bills of Medicare recipients who test positive for COVID. Of course, not everyone has Medicare, but for those that do, hospitals will receive more money for a COVID patient than for a patient without COVID (if using a scenario where treatment costs/bills would have otherwise been the same). In that sense, it is financially beneficial for the hospital to ensure that if a Medicare patient has a positive test, even if done post-mortem, that it's recorded since they can receive more money that way. Same for an uninsured patient as they can then apply for reimbursement.

The Cares Act also provides hospitals financial protection for patients with private insurance and covers balance billing. The financial benefit does not require a positive Covid test. It is the same for presumed positives who present with symptoms of Covid.

As @Pea-n-Me describes, care is very intricate and expensive. It would be reasonable to assume politicians were trying to minimize treatment discrimination no matter a patient’s insurance status—thus ensuring patients receive the best care possible. It would then also be reasonable to assume the Cares Act hoped to save hospitals from financial ruin and eliminating/furloughing jobs during the crisis.

 

[LongLiveRafiki]

The Cares Act also provides hospitals financial protection for patients with private insurance and covers balance billing. The financial benefit does not require a positive Covid test. It is the same for presumed positives who present with symptoms of Covid.

As @Pea-n-Me describes, care is very intricate and expensive. It would be reasonable to assume politicians were trying to minimize treatment discrimination no matter a patient’s insurance status—thus ensuring patients receive the best care possible. It would then also be reasonable to assume the Cares Act hoped to save hospitals from financial ruin and eliminating/furloughing jobs during the crisis.

Oh, absolutely. I wasn't trying to indicate that I disagreed with the protections from the CARES ACT for the hospitals. I was simply explaining to a previous poster that the money hospitals received for COVID patients is generally more than for a non-COVID patient. I totally understand why that would be (and @Pea-n-Me gave some wonderful insight into that), and think it's wonderful that those protections are in place. I wasn't sure how it applied for presumed positives so thanks for that info.

My only concern with it is not from the hospitals as they should absolutely be getting whatever they can to help reimburse their additional costs in these times, but rather with how those positive tests when a patient dies are being reported by each county. I can see the benefits of having a record of every person that dies WITH COVID, but I do think there should be a distinction in reporting from those who die OF COVID.

And yes, for the record, I would like to see better reporting of home deaths as well to get more accurate numbers. The point is when there's no consistency in how areas are reporting deaths, you can't have accurate numbers and it becomes more difficult to glean true information about this illness and what steps to take.

 

[3threebabies]

Oh, absolutely. I wasn't trying to indicate that I disagreed with the protections from the CARES ACT for the hospitals. I was simply explaining to a previous poster that the money hospitals received for COVID patients is generally more than for a non-COVID patient. I totally understand why that would be (and @Pea-n-Me gave some wonderful insight into that), and think it's wonderful that those protections are in place. I wasn't sure how it applied for presumed positives so thanks for that info.

My only concern with it is not from the hospitals as they should absolutely be getting whatever they can to help reimburse their additional costs in these times, but rather with how those positive tests when a patient dies are being reported by each county. I can see the benefits of having a record of every person that dies WITH COVID, but I do think there should be a distinction in reporting from those who die OF COVID.

And yes, for the record, I would like to see better reporting of home deaths as well to get more accurate numbers. The point is when there's no consistency in how areas are reporting deaths, you can't have accurate numbers and it becomes more difficult to glean true information about this illness and what steps to take.

I had a multi quote thing going and may not have used best comment for my reply. I think both your comments were well thought out. I just wanted to make sure people realize that private insurance payments are included in Cares Act as well. Cares Act was very well intentioned...

 

[johnsontrio]

There are a lot of variables including a large increase in staffing and supplies. Working in the Covid ICUs I am experiencing this firsthand.

They're not the same as regular patients. More staff are required to assist in the time consuming process of donning and doffing PPE (gloves, masks, shields, body cover) each and every time you go in and out of a patient's room, which is constantly. Just finish up caring for a patient for an hour in the room, trying to dot all your i's and cross all your t's while in there, sweating and steaming up under all the protective gear, coming out, doffing, washing up, breathing fresh air again for a couple of minutes, when one of the many pumps inexplicably starts beeping again. In you go again, but first donning all your gear all over again and doffing and cleaning when you come out, etc. It's constant, and takes away time the nurse needs to do other things including primarily critical documentation, which is very involved, so more staff are needed to assist in this process. This is what caring for people with Covid during a pandemic necessitates, and Medicare understands that. As a result, there are more staff assigned to these units.

Now don't get me wrong, normally there will be some patients who are on contact precautions. But this isn't even in the same league as that. Every. single. patient. has a potentially deadly disease.

Where I am, only RNs go in Covid rooms, with few exceptions, hence higher costs of care. Additional RNs on units will be assigned in many ways besides caring for patients, they may be "runners" or "circulators" or "code nurses" or charge nurses trying to manage all the chaos. All necessary for the daunting task of caring for these patients. Patients who deteriorate in other areas of the hospital are admitted to the ICUs with great needs and an admitting ICU nurse may not be able to get out of their room(s) for many hours if the patient is unstable. Anyone on a vent requires a respiratory therapist's frequent care, as well. Doctors on medical teams in the ICU remain right on the units, and there are lots of them. They round frequently and have to do things like insert new arterial lines and be present to troubleshoot if and when things become problematic, etc. There are far more people than normal working in Covid ICUs - and non-ICUs for many of the same reasons.

Some of the unlicensed staff are observers for helping direct caregivers don and doff, as because we don't wear fresh N95 masks and shields due to the shortages, great care has to be taken in taking these off, cleaning them and putting them back on again, so a second person is there to help oversee and support that, if possible. (I have had many shifts without one.) Last week we had a priest come in to see a patient, arriving with his own mask and shield, but he was a little unsure of how and in what order to put everything on so I watched him and directed him for his safety. Not everyone who goes in rooms is totally adept at donning and doffing (there are more tricky steps than I've outlined here), so it's always a safety issue. Many staff have become sick with Covid everywhere. Some have died. It's overwhelming at times. Patients are extremely sick.

Supplies are another big issue. A Covid ICU patient uses a lot of supplies. Most are on feeding tubes, are vented, have arterial lines, etc. Depending on their individual diagnoses, there may be additional complex therapies involved as well, like CVVH for patients with renal failure, or ECMO for the sickest, etc. Too many possibilities to list. It's not uncommon to see six or eight different drips running. Many are expensive. One bag or bottle runs dry and another goes up, over and over. Same with tube feeds, whose administration sets for pumps have to be changed daily as germs can grow pretty fast in the feeding solutions. Many Covid patients have diarrhea so they have rectal tubes and urinary catheters. (Sorry if TMI.) Supplies inside the room, if not used, all have to be thrown away during cleaning when the room becomes empty, so nurses have to be judicious about what supplies they take in. If something's not there, someone needs to get it for you while you're in there. A variety of communication devices are used, including electronics like iPads and other cameras. We can't touch phones due to contamination. During one shift I had a small white board to write things down on (feeling like Anthony Hopkins in Legends of the Fall), holding up to the door and trying to catch the attention of someone outside to bring me what I needed. In 12 hrs there were about forty different items that I needed, including medication drips, gowns and linens, needles and tubing, cups, blood drawing supplies, etc. Hundreds of items are needed in care.

There are also a lot of extra supportive personnel on hand like IT people, housekeeping, administrators, biomedical engineers, to help keep things running smoothly during the crisis.

We've became a well-oiled machine but it takes a lot; unlike anything most of us have ever seen. And with that comes extra costs. I'm sure someone else may have another perspective, as well.

* BTW I was going to try to make this more concise but decided it's probably better to give a glimpse of what it's like so people can feel it along with us.

Just want to add my experience. The hospitals here have had to open overflow ICUs to provide care for the large number of patients in areas that do not have isolation rooms or capability, ORs, recovery areas, endoscopy areas etc.. Engineering has retrofitted the entire unit with proper air management but the entire area is considered contaminated, a Red Zone. We have to wear all our PPE, including N95, the entire shift, except if we are off the unit for our meal break, so not one sip of water in a 12 hour shift except for our break. Housekeeping is not allowed in this area so those tasks have been take over by the nursing staff as well. We have runners so that those RNs within 6 feet of the pts are not running to lab and pharmacy and spreading Covid throughout the hospital. We also have runners to retrieve medications out of the Pyxis or Omnicell machines so that they are not contaminated. Running these Covid ICUs requires an immense number of staff.

 

[Notrealname]

Please explain. Does it cost more to put (and keep) a vent in a Covid patient than another patient? Don't the procedures and medicines cost the same regardless of what the diagnosis is?

Yes, procedures and medications cost the same, but Medicare and Medicaid don’t reimburse based on itemized bills. The same can be said for many private insurance companies.
The pay either a set or a negotiated rate for services. In many cases the payment may be for a bundled set of services and also include medications.

 

[Cogswel_Cogs]

Yes, procedures and medications cost the same, but Medicare and Medicaid don’t reimburse based on itemized bills. The same can be said for many private insurance companies.
The pay either a set or a negotiated rate for services. In many cases the payment may be for a bundled set of services and also include medications. Not sure about covid issues.

Medicaid/Medicare pays roughly half what insurance companies pay.

 

[Notrealname]

Medicaid/Medicare pays roughly half what insurance companies pay.

Yep. We could quibble, but that’s close enough.

This might be worth a look for anyone really into reimbursement rates.
https://www.kff.org/medicare/issue-...vate-insurers-pay-a-review-of-the-literature/

 

[Disneychick75]

From Dr. Ezike's own mouth:

 

[Cannot_Wait_4Disney]

From Dr. Ezike's own mouth:

https://www.nbcchicago.com/news/cor...ois-is-over-counting-covid-19-deaths/2270810/
Dr. Ngozi Ezike, director of the Illinois Department of Public Health, dismissed claims that the state is overstating the number of coronavirus-related deaths amid the ongoing pandemic, saying that only deaths of patients with laboratory-confirmed cases of the virus are being counted in the official tally.

"Ezike said that the state is being careful to make sure to weed out deaths where the patient had COVID-19, but died in a manner completely detached from the virus, such as gunshot wounds or motor vehicle crashes."

“There are also some additional deaths that happen in someone who happened to be COVID positive, but where the COVID infection had nothing to do with the deaths,” she said. “So we are at IDPH trying to remove those obvious cases where the COVID diagnosis was not the reason for the death. If there was a gunshot wound, if there was a motor vehicle accident, we know that that was not related to the COVID positive status.

“We are trying to make sure that things that aren’t related at all to the COVID diagnosis are removed, but if someone has another illness, like heart disease, and then had a stroke or other event, it’s not as easy to separate that and say COVID didn’t exacerbate that existing illness. That would not be removed from the count,” she added.
Above all else, Ezike said that the state is striving for as much accuracy as possible, presenting a true picture of what is going on statewide when reporting on the number of cases and fatalities related to the virus.