Viewing post #2624508 by flaflwrgrl

This is in no way prompted by Donald's post but I thought it was time to repost a post that @MISSINGROSIE made perhaps a month ago since there seem to be so many who STILL believe in the conspiracy theories & misinformation & disinformation that is & has been put out there about WHY hospitals code deaths as covid or not. It's not as simple as:
'hospitals get more money for covid deaths than for other deaths so they are putting covid as the cause of death just so they can get more money even if the person died in a car accident.'

MISSINGROSIE said:Apologizing ahead of time for the length ..several topics.

Joanna .. I don't have any experience with coding on death certificates .. I have experience coding and billing for patients that survive — and some of that relates.. especially where it concerns the hospital getting a higher reimbursement rate for COVID patients .. there is a good reason for that ..

But first let me say that I would welcome Oregon's senators or any interested party asking for an exploration of the CDC practices on collection and reporting data. We the taxpayers are entitled to know all about that and so why not examine it? I would especially be interested in the information coming from year 2020.. when for the first time ever I had significant anxiety about the CDC ..the FDA.. Homeland Security and many other agencies directly or indirectly responsible for reporting data or establishing policy on a catastrophic public health crisis. I am no spring chicken, and I cannot remember a time when politics played such a role in or when a presidential administration got in the middle of the work done by these once-esteemed agencies …or when division or agency heads were assigned that did not have the qualifications necessary to handle necessary aspects of a national pandemic —- and when all of the interference seemed designed to effect change in the perception of its citizenry. And so I am glad if Oregon's senators are raising these issues ..however, I would not rely on the the reporting of Mr. Kyle Becker —author of many conspiracy articles and one of the prime writers for Mr. Sean Hannity's show. Even their employer (FOX) in court briefs filed by FOX lawyers warns that the content coming from the shows of its anchors is not reliable and is not believed by reasonably minded people. It was a defense that satisfied the court and saved FOX and Mr. Tucker Carlson - both named in a recent lawsuit - a great deal of money.

Back to the coding on death certificates.. this does not specifically apply to COVID..but it's a long standing practice / process/ algorithm - for DECADES - to code for the " proximal " cause of death.. meaning the reason that directly results in death at the time of its occurrence. Ex. Susie has advanced brain cancer ..she is in hospice ..her death is imminent …. Days away…from brain cancer.. Nurse Mary reports to work .. she has infectious meningitis .. she infects three other nurses and the janitor and Susie. Susie develops meningitis and succumbs to it… her proximal cause of death is meningitis ..secondary may be respiratory failure and somewhere down the line is the brain cancer ..once the top contender for cause of death …. because while it was slowly taking her life — it did not cause her death.. perhaps it contributed to the ability to fight the meningitis successfully and so it will be listed.

And so, if a patient comes in with COVID and a co-morbidity —which greatly impacts the success of treatment of infection.. like diabetes..like obesity… like immunosuppression or drug addiction … all conditions that can individually can cause death.. if that person dies from the COVID infection directly — would not be dead at that particular time if not for that infection-- then the proximal cause of death is (and should be) coded as COVID..primarily… and the rest whether it was kidney failure.. or respiratory failure ..or circulatory collapse or clotting would follow in the order of significance ..

With regard to the payments .. there has been made much about hospitals getting higher reimbursement ( although greatly inflated numbers ) for a COVID infected patient as opposed to another with similar diagnoses without COVID.. and there is very good reason for that .. and I relied on it when I billed.. patients with infectious disease just cost more .. they cost more to staff.. they cost more in similar tests .. not just the supplies and personnel dedicated to the patient but sometimes in the frequency of the labs. If two people have pneumonia ..bad pneumonia …. They both may need similar numbers of X-rays .. and antibiotic titers ..but the patient with COVID will require frequent monitoring of clotting factors .. and kidney function.. the patient will require many more changes of staff protective equipment .. one on one staffing.. isolation rooms.. sterilizing of equipment ..all generating higher costs. Our payers ..like Medicare and private insurers… take all this into account ..and pay higher reimbursement.. when I treated two equally recovering patients after coronary bypass surgery .. let's call them identical in every way.. except one had diabetes.. well I had to measure the diabetics glucose three times during the single hour of rehab therapy .. three separate sticks.. three uses of the lab equipment .. three regents..
three one on one staff attendance .three times the documentation time, reporting to the physician and securing of the record strips— as compared to the non diabetic that got none of that .. and the reimbursement for that patient visit was much higher.. and I had to code for that otherwise the charge "scrubber" would have tossed my charges out.. questioning why three glucose monitoring tests and associated costs were done when there was no code ( for diabetes ) to support it.

The bean counters in our unplanned and unprepared pandemic may have decided a diagnosis of COVID was an automatic higher reimbursement and set that reimbursement by region..( costs more to treat a person in NYC as compared perhaps to Missouri.. electric is higher, salaries higher, real estate is higher .. ( as an aside- I was charged rental on my in -hospital space by the square foot.. my electric costs were higher than the smaller city hospital 70 miles away.. and so I can comfortably say my reimbursement was likely higher say for a breathing nebulizer treatment than that hospital 70 miles away in a smaller town )

BUT there had to be a lab test SUPPORTING the diagnosis. .. that is why it is thought COVID deaths were very likely underreported .. our doctors supported that too..not the ONLY reason ..but supplies were so woefully and so shamefully short .. that as patients were brought in dead or dying —and there were a lot of them especially in the beginning— the docs did not ..could not .. afford to test them.. or they knew that they could not get the results in time for it to matter ..back at the beginning, it was a good MANY DAYS -sometimes weeks - to get a COVID test back.. there were little to no testing machines nor supplies to run the machines.... and so without that test ON RECORD.... COVID could NOT be listed as a cause of death. It may not be remembered now.. but there was a shortage of all testing supplies and the machines to run the test. ..no process.. no cohesiveness.