northernraider Posted April 13, 2020 Share Posted April 13, 2020 9 minutes ago, keikla said: I do take serious exception to the implication that hospitals are coding inappropriately in order to get more money right now. Hospitals in NY are hemorrhaging money just like hospitals elsewhere because the revenue generating items are all canceled while expenses for staffing and supplies have skyrocketed. But 80% of our census is covid, and every single suspected covid patient gets tested, even if they had a known contact. Patients get billed as covid only if they are actually covid. Thank you for pointing this out, the conspiracy theorists are really driving that drivel. 3 Link to comment Share on other sites More sharing options...
Oxbow6 Posted April 13, 2020 Share Posted April 13, 2020 Online Fargo Forum breaking news headline states ND sees biggest single day of new cases today.....23. That's correct but fails to mention in same article ND had new case numbers of 22 on 3/31 and 21 on 4/4. Link to comment Share on other sites More sharing options...
LH Golfer Posted April 13, 2020 Share Posted April 13, 2020 1 hour ago, UND1983 said: If NYC is effectively shutdown and everyone is staying home, why are they getting 8,000 new cases a day? Ever been in their subway system? It is a petri dish of everything imaginable. Link to comment Share on other sites More sharing options...
yzerman19 Posted April 13, 2020 Share Posted April 13, 2020 20 minutes ago, keikla said: I think overall census and covid numbers have been fairly stable (+/- 10%) for the past several days. Vents are going down slightly - partially because I think the movements in anticoag treatment are making a difference and also because families are coming to terms with the odds of recovery and deciding to terminally extubate loved ones. At no point have I seen or heard of the triaging of patients (i.e deciding who gets access to a ventilator and who doesn't) other than many hospitals have a DNR convo with the patient and family as soon as they come in with suspected covid. With a survival rate of vented patients currently around 20%, I certainly don't blame any hospital that chooses to do this. I do take serious exception to the implication that hospitals are coding inappropriately in order to get more money right now. Hospitals in NY are hemorrhaging money just like hospitals elsewhere because the revenue generating items are all canceled while expenses for staffing and supplies have skyrocketed. But 80% of our census is covid, and every single suspected covid patient gets tested, even if they had a known contact. Patients get billed as covid only if they are actually covid. 80% is covid? wow. Is the overall census down or is it fairly consistent. We are seeing nothing of the sort out in CA...low census and low covid Link to comment Share on other sites More sharing options...
UND1983 Posted April 13, 2020 Share Posted April 13, 2020 27 minutes ago, northernraider said: Thank you for pointing this out, the conspiracy theorists are really driving that drivel. Yah cause it's totally beneath the hospitals to code it that way to get more money in a dire time. How does anybody not in accounting know what is actually being billed to the government? 1 Link to comment Share on other sites More sharing options...
SIOUXFAN97 Posted April 13, 2020 Share Posted April 13, 2020 would be interesting to see how much more quicker we could have a vaccine if we did what dr.shiva says should happen..... universitys and research facilities that take government money have to upload their vaccine research to the cloud instead of hoarding their data so your school/ firm finds the cure and takes all the credit. shiva>fauci Link to comment Share on other sites More sharing options...
UND1983 Posted April 13, 2020 Share Posted April 13, 2020 21 minutes ago, keikla said: Billing is based on ICD10 codes. The ICD10 codes for any given patient are easily visible to anyone accessing the chart for medical purposes, since it's kind of important to know why the patient is there and/or what other chronic diseases the patient has. But when 80%+ of the patients have lab confirmed covid (outsourced, so get rid of that conspiracy theory too), there is minimal room for manipulation even if a hospital were to attempt it. Are hospitals getting paid more to treat Covid cases? Link to comment Share on other sites More sharing options...
yzerman19 Posted April 13, 2020 Share Posted April 13, 2020 17 minutes ago, keikla said: Billing is based on ICD10 codes. The ICD10 codes for any given patient are easily visible to anyone accessing the chart for medical purposes, since it's kind of important to know why the patient is there and/or what other chronic diseases the patient has. But when 80%+ of the patients have lab confirmed covid (outsourced, so get rid of that conspiracy theory too), there is minimal room for manipulation even if a hospital were to attempt it. yeah- they are not falsifying coding. Maximizing net revenue within the gray area is certainly happening though and is no different than pre-covid. I do understand that people unfamiliar find the esoteric ICD-10 to DRG grouper incomprehensible, sane with CPT, throw in a side of coding and payment edits and most people outside the industry are lost. 1 Link to comment Share on other sites More sharing options...
yzerman19 Posted April 13, 2020 Share Posted April 13, 2020 1 minute ago, UND1983 said: Are hospitals getting paid more to treat Covid cases? Define paid more? There aren’t specific covid kickers in the fee for service system that I’m aware of. Although in many cases subscriber liability is being waived and becoming payer responsibility. covid specific codes are new to the party, and I haven’t seen the numbers in terms of RVUs or DRG weight for the new codes. many providers have been asking payers for advances, and the government is promising financial support. Link to comment Share on other sites More sharing options...
Kab Posted April 13, 2020 Share Posted April 13, 2020 5 minutes ago, yzerman19 said: yeah- they are not falsifying coding. Maximizing net revenue within the gray area is certainly happening though and is no different than pre-covid. I do understand that people unfamiliar find the esoteric ICD-10 to DRG grouper incomprehensible, sane with CPT, throw in a side of coding and payment edits and most people outside the industry are lost. Does anyone know what the DRG payment for this is, do they even have it in the system yet? Link to comment Share on other sites More sharing options...
yzerman19 Posted April 13, 2020 Share Posted April 13, 2020 1 hour ago, Kab said: Does anyone know what the DRG payment for this is, do they even have it in the system yet? My understanding is it’s being treated as an MCC, the groupers will still follow the MDC....likely respiratory diseases.. Payment of course will vary based on State for Medicare and Medicaid and will be dependent upon contract for private commercial coverage. Two weeks in an ICU with a vent likely will trip payment to outlier status in commercial contracts paying off DRG or per diem. Capitation wouldn’t consider it prospectively in a DOFR. Link to comment Share on other sites More sharing options...
Hammersmith Posted April 13, 2020 Share Posted April 13, 2020 6 hours ago, keikla said: I remember standing at an intersection in Germany, waiting for the crosswalk light to signal it was ok to walk. There were no cars in sight, and yet the large number of pedestrians patiently waited for that light to turn. I remember being absolutely flabbergasted at the adherence to the rules. It seems to have served them quite well. Reminds me of a story James May told during an episode of The Grand Tour being filmed in Stuttgart. He said he was having a conversation about losing your driver's license with a friend from California and a friend from Germany, and it went something like this: California Friend(CF): In Germany what would happen if you lost your license and then drove your car? German Friend(GF): No, you cannot do this. CF: Well, yeah, I know you're not supposed to, but what if you did? GF: No, you cannot drive, you have no license. CF: Yeah man, but late one night you just go for a drive... GF: IT IS IMPOSSIBLE TO DRIVE WITHOUT A LICENSE!!! 1 1 Link to comment Share on other sites More sharing options...
geaux_sioux Posted April 13, 2020 Share Posted April 13, 2020 2 hours ago, Oxbow6 said: Online Fargo Forum breaking news headline states ND sees biggest single day of new cases today.....23. That's correct but fails to mention in same article ND had new case numbers of 22 on 3/31 and 21 on 4/4. [George Constanze voice] So it’s going up? The curve? THE CURVE IS GOING UP! 1 Link to comment Share on other sites More sharing options...
BarnWinterSportsEngelstad Posted April 13, 2020 Share Posted April 13, 2020 Excellent posts in this thread today. Link to comment Share on other sites More sharing options...
Nodak78 Posted April 13, 2020 Share Posted April 13, 2020 I'm in my upper 60's. grew up in small town ND. So the summer before I start 1st grade My mother takes me to our town doctor. A tall 6' 3" hunched over and about 70 years old at the time. He share a building with the town dentist. One lobby open area with about 6 to 8 chairs and usually filled with older men catching up on gossip with the Doc. My mother and I waiting in the lobby with the Men while Doc is attending to someone in his office. Soon he appears and asking my mother what does she want. My son needs a physical for school. Doc looks at me and asks me to stand up. I look up at this towering Man with a gruff voice smoking a cigar. He says hop on one foot so I do. He says hop on the other foot. I do now he checks my heart rate and listens to my lungs. Next he says pull your pants down. Mind you we are in the lobby, I look at my mother never cracked a smile so I look at the other Men no expression. Damn I better pull down my pants. So I start to unbuckle and zip my jeans and start to pull them down. In a loud quick voice the Doc says what is the matter you pulling down your pants in front of everyone. Pull your pants up. So now I'm embarrassed and quickly pull my pants up. Of course I never had the pants down just getting ready to. Next he says I thought I told you to pull down your pants. Now I'm totally confused and still no expression from anyone in the room except for Doc who seems to be impatient with me. So I repeat the process and start to pull down my pants again. Again he scolds me to pull up my pants. Finally remarks I'm a pretty good boy and the Men chuckles and my mother smiles. Doc takes us in the office and completes the form for school. Small town Doc's. On a side note he always gave us a nickel to squeeze while he gave us a shot. If we didn't cry we could keep it. Quick a bedside manner. He always had a cigar. 1 2 Link to comment Share on other sites More sharing options...
Nodak78 Posted April 13, 2020 Share Posted April 13, 2020 IHME updated their projections. For ND the death totals through August 4 was lower from 369 to 32. the model was garbage. We may end up with about 32 but not convinced yet. Link to comment Share on other sites More sharing options...
Oxbow6 Posted April 13, 2020 Share Posted April 13, 2020 12 minutes ago, Nodak78 said: IHME updated their projections. For ND the death totals through August 4 was lower from 369 to 32. the model was garbage. We may end up with about 32 but not convinced yet. So Walz can use these beds at the Fargodome? IHME projects 656 in MN........is he still clinging to 20K? Overall deaths projected up to just under 69K. Link to comment Share on other sites More sharing options...
dynato Posted April 13, 2020 Share Posted April 13, 2020 9 minutes ago, Nodak78 said: IHME updated their projections. For ND the death totals through August 4 was lower from 369 to 32. the model was garbage. We may end up with about 32 but not convinced yet. Worth noting, nationwide, IHME projected total deaths increased by 13% from 60k to 68k. Most of the increases are in states with major cities/urban areas that are currently being impacted. 1 Link to comment Share on other sites More sharing options...
Nodak78 Posted April 13, 2020 Share Posted April 13, 2020 14 minutes ago, dynato said: Worth noting, nationwide, IHME projected total deaths increased by 13% from 60k to 68k. Most of the increases are in states with major cities/urban areas that are currently being impacted. That would make more sense. Link to comment Share on other sites More sharing options...
Nodak78 Posted April 13, 2020 Share Posted April 13, 2020 20 minutes ago, Oxbow6 said: So Walz can use these beds at the Fargodome? IHME projects 656 in MN........is he still clinging to 20K? Overall deaths projected up to just under 69K. I saw IHME increased MN from 442 to 656. To date MN has 70. IHME probably needed to stick with 442. Link to comment Share on other sites More sharing options...
Oxbow6 Posted April 14, 2020 Share Posted April 14, 2020 3 minutes ago, Nodak78 said: I saw IHME increased MN from 442 to 656. To date MN has 70. IHME probably needed to stick with 442. Osterholm is waiting for you on line 3....... Link to comment Share on other sites More sharing options...
Nodak78 Posted April 14, 2020 Share Posted April 14, 2020 2 minutes ago, Oxbow6 said: Osterholm is waiting for you on line 3....... Keep himon hold I'm enjoying a glass of Merlot Link to comment Share on other sites More sharing options...
yzerman19 Posted April 14, 2020 Share Posted April 14, 2020 45 minutes ago, Nodak78 said: Keep himon hold I'm enjoying a glass of Merlot Ya Know, I didn't drink merlot for a long time...I've cycled it back into rotation and I'm enjoying it. Still can't beat a punch you in the face Cab from Cali...Cakebread, Caymus, Silver Oak...but the Merlots aint shabby these days. 1 Link to comment Share on other sites More sharing options...
Kab Posted April 14, 2020 Share Posted April 14, 2020 4 hours ago, yzerman19 said: My understanding is it’s being treated as an MCC, the groupers will still follow the MDC....likely respiratory diseases.. Payment of course will vary based on State for Medicare and Medicaid and will be dependent upon contract for private commercial coverage. Two weeks in an ICU with a vent likely will trip payment to outlier status in commercial contracts paying off DRG or per diem. Capitation wouldn’t consider it prospectively in a DOFR. Will be interesting to see how a hospital comes out on this with reimbursement and what their costs are. Any CAH being reimbursed on cost will still lose money since reimbursement is being paid at 99% of cost and being on sequestration reduction for Medicare patients. CAHS with clinics have lost 60% or more of their volume since this took place, cash flow is terrible. Link to comment Share on other sites More sharing options...
Oxbow6 Posted April 14, 2020 Share Posted April 14, 2020 28 minutes ago, Kab said: Will be interesting to see how a hospital comes out on this with reimbursement and what their costs are. Any CAH being reimbursed on cost will still lose money since reimbursement is being paid at 99% of cost and being on sequestration reduction for Medicare patients. CAHS with clinics have lost 60% or more of their volume since this took place, cash flow is terrible. In many of these systems for every $3M lost in revenue they are spending $1M in preparing for their surge. Link to comment Share on other sites More sharing options...
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