Maybe coronavirus deaths really are being overcounted…

Changed counting rules and an unintended consequence of hospital reimbursements?

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Early on, we concluded that coronavirus statistics are generally problematic and that “cutting to the chase, the most reliable number being reported is the number of COVID-19 related “Daily New Deaths”.

For details, see: How will we know when we’ve turned the COVID-19 corner?

I argued that if anything is discrete and countable, it’s a death (versus, say, a “confirmed case”).

I acknowledged the problem posed by the difference between “dies with” and “died because of”.

But, I assumed that the counting rules would stay the same and that there wouldn’t be incentives (intentional or unintended) to either over- or under-report.

Silly, me.

A couple of weeks ago, the CDC changed a counting rule.

The original rule: If a patient tests positive for the coronavirus and dies, put COVID on the death certificate.

The change: Doctors should also record “presumed” coronavirus deaths even if they aren’t “confirmed cases”.

In NYC alone, that change boosted the death total by almost 5,000.

That might be the right way to do it, but it did screw up the data series.

So be it.

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A second counting issue has to do with economic incentives…

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Last week, a couple of California doctors caused a bit of a stir and had their press conference video blocked by YouTube for “violating community standards”.

See: The contrarian California docs who are challenging the scientific consensus.
YouTube blocked the video, but …  we’ve got it here!

Among the docs’ controversial content was an anecdote from another doctor who said:

When I’m writing up a death report I’m being pressured to add COVID (as a cause).

Why is that? Why are we being pressured to add COVID?

We’re being pressured in-house (by our hospital administration) to add COVID to the diagnostic list.

Preposterous, right?

Not so fast.

The doc (Scott Jensen, a physician and state senator in Minnesota) clarified the assertion on his Facebook page:

Hospital administrators might well want to see COVID-19 attached to a discharge summary or a death certificate.

Why?

Because if it’s a straightforward, garden-variety pneumonia that a person is admitted to the hospital for – if they’re Medicare – typically, the diagnosis-related group lump sum payment would be $5,000.

But if it’s COVID-19 pneumonia, then it’s $13,000, and if that COVID-19 pneumonia patient ends up on a ventilator, it goes up to $39,000.

Ah-ha.

With the stroke of a pen — and a plausible, legit rationale under the “presumed cause” rule — a hospital’s reimbursement can be more than doubled … or, maybe even octupled.

Think about it.

If you were a hospital administrator might you be inclined to encourage docs to break ties in favor of adding a “presumed” COVID diagnosis to death certificates?

It’s nothing illegal (I don’t think) … it’s playing by the CDC and Medicare rules.

And, at a time that highly profitable elective surgeries are banned, the economics are compelling.

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USA Today did a very thorough fact-check on the above … and, verified that the details were true. The article is worth reading.

I don’t think that either the CDC’s redefinition of a COVID death … or the unintended consequence of the quirky Medicare rates … materially change a basic conclusion: the death toll from the coronavirus is very, very high.

But, the follow-up fact-checking does vindicate the contrarian California doctors … at least on this issue.

One Response to “Maybe coronavirus deaths really are being overcounted…”

  1. Except for timing, the new IHME forecast isn’t as shocking as it seems… | The Homa Files Says:

    […] For more details, see:  Maybe coronavirus deaths really are being overcounted… […]

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