President Trump, advisor @SWAtlasHoover arguing there's lot of false coding of COVID

This is junk news

Like junk food, junk news tastes good but has no nutritional value

So what are the facts?

Don't hospitals get more $ for COVID?

Thread on hospital billing, COVID, and fraud
Our payment system is insanely complex

So this is a simplification

Hospitals get paid based on what condition patient has

A patient with pneumonia?

Typical hospital might get between $8K to $11K from Medicare, depending on whether pt has major comorbid conditions or not

2/n
So what happened in COVID era?

Cares Act gives hospitals a 20% bump (to about $9600 – 13K) if pneumonia is from COVID

Additional $1600 - $2200 for a typical COVID pneumonia patient

To get this bump, hospitals must document that patient is COVID positive

3/n
Don't incentives change billing practices?

Why yes!

Hospitals famous for documenting comorbidities to get higher reimbursement

What folks DON’T do is make up false diagnoses

That'll get them fined, jailed

Most Docs, hospitals would NOT lie about a positive COVID test

4/n
But may be extra $2K might lead hospitals to test their pneumonia patients for COVID?

Actually, even without incentives, any hospitalized patient with pneumonia today will get tested for SARS-CoV2

And if positive, they have COVID

Which gets us to another trope....

5/n
Another trope is that someone died "with" COVID, not "because of" COVID.

This is clinical nonsense

If you have pneumonia and are COVID positive?

You have COVID pneumonia. You are sick from COVID

Ah, what about the stories of car accident victims who tested + for COVID?

6/n
More nonsense

There is no higher reimbursement that I can find for car accident victims who are COVID+.

And if you bill these patients as COVID pneumonia, that's fraud

This is Facebook junk

Why did Congress, President enact a law that gives hospitals extra $ for COVID?

7/n
Higher payment for COVID because policymakers knew hospitals would need extra money getting PPEs.

The federal govt wasn't going to get PPEs

This was a way to help make hospitals whole

And it hasn’t.

Most hospitals are bleeding money from COVID

8/10
What about stories of $40K for a COVID death?

That's MS-DRG 207: pneumonia patient who spends >4 days in ICU on ventilator

Without COVID, Medicare pays about $35K. With COVID, about 40K

Again, doctors aren't taking random deaths, calling them COVID deaths

That's fraud

9/10
So does COVID diagnosis get hospitals a little extra $?

Yes

Are physicians, hospitals lying about who has COVID?

No

Are people dying “with” COVID, not “because of” COVID?

Clinical nonsense

10/11
So lets ignore the noise and misinformation about COVID billing, etc.

While doctors and nurses are dying on the front lines,

our leaders aren't working to get them protective equipment

Instead, they are falsely accusing our front line providers of fraud

Its reprehensible

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More from @ashishkjha

27 Oct
President keeps saying we have more cases because we are testing more

This is not true

But wait, how do we know?

Doesn't more testing lead to identifying more cases?

Actually, it does

So we look at other data to know if its just about testing or underlying infections

Thread
Easiest is to wait 2-4 weeks

If underlying infections stable but you test more, hospitalizations and deaths will remain stable

But what if you don't want to wait?

Look at test positivity

As testing increases, becomes harder to find the next case

So test positivity drops
Best example is NY, which tests more than 100K people daily, test + of about 1.3%

So now, let's look at where we are as a nation vs 2 weeks ago

All data from @COVID19Tracking using 7d moving avg

Yesterday, did 960K tests
2 weeks ago, 898K tests

So testing is going up

3/n
Read 6 tweets
25 Oct
I tweeted data from @MWRA_update on amount of virus in wastewater in Massachusetts starting to spike

What about more traditional metrics like infections, hospitalizations and deaths in Massachusetts?

Let's compared today's number with where we were after labor day

Short thread
All data from @COVID19Tracking. 7-day moving avgs

6 weeks ago, Massachusetts had:

323 daily new infections
331 people in hospital
12 people dying every day

Today?

937 daily new infections (up nearly 3 fold)
532 folks in hospital (up 58%)
17 people dying daily (up 37%)

2/3
What's driving this?

Indoor dining recently expanded

House gatherings/parties big driver

Disinformation makes it harder for people to stay focused

And complacency settling in that we did well over summer so we're all good.

We aren't

3/4
Read 4 tweets
21 Oct
On 9/23, Indiana's @GovHolcomb lifted nearly all COVID19 restrictions

wfyi.org/news/articles/…

This struck me and other public health folks as dangerous

A month later, how's it gone?

Pretty badly. Like really badly.

Don't take my word for it.

Let's look at data!

Thread
First, let’s look at Infections over past 2 months

All numbers 7-day moving avg from @COVID19Tracking

Between August 1 and September 23, cases fluctuating between 700-900 per day

Restrictions lifted 9/23

Infections start to take off by Oct 1

By 10/19, over 1800 cases per day
Test positivity was around 9% on 9/23

Today? Around 18%

Meaning Indiana missing way more cases now than they were a month ago

So identified infections AND missed infections way up

Ah you say, but what about hospitalizations?

Isn't that what matters?

3/n
Read 7 tweets
19 Oct
You know about dramatic increases in cases, hospitalizations across US

Surge began after labor day

But one state has done well during this time

Big state that would move national numbers

And what they've done holds a lesson for all of us

Yes -- let's talk California

Thread
Walk down memory lane:

California early to act in March, preventing surge of cases that affected many others

Over April/May, CA cases were low

But California had an awful summer surge, especially in SoCal

Cases peaked in late July: over 12,000 cases, 150 deaths / day

2/6
But in August, strong leadership from @CHHSAgency Health Secretary Mark Ghaly and @GavinNewsom

What did they do? Huge increases in testing including bringing new capacity online

Created highly customized approach on a county by county level -- micro targeting policies

3/6
Read 7 tweets
12 Oct
So this tweet is getting me lots of flak

Few points

I've become more optimistic that with proper masking, some distancing, more schools can open safely

Why? Because evidence base changing

Schools open in many places and aren't generally seeing large outbreaks

Short thread
I've been particularly swayed by work of the brilliant @ProfEmilyOster.

She brings evidence, not bluster, to this topic. Its inspiring

She's actually tracking data (!!). Yup, its not perfect. But its the best we have

Read her in @TheAtlantic

theatlantic.com/ideas/archive/…
Will we see some spread in schools?

Sure

Will it be worse than spread happening outside of school?

Not that we see in the (limited) data

But isn't it just "safe" to keep kids online until some unspecified future time?

No

So let's talk costs of keeping kids remote only

3/5
Read 5 tweets
12 Oct
Cases and hospitalizations are rising across the US

And I’m getting asked repeatedly whether we're heading toward lockdowns

Short answer – no – not if we are smart

Long answer? Its complicated

So let’s talk about lockdowns – and how we get through next few months

Thread
Lockdowns – shelter in place orders – are extreme

And awful. Super costly and usually not necessary

We locked down in March/April because virus spread across US in Jan/Feb

And we were blind. We had no testing. We had little choice

Situation now different. We know more

2/n
First, let’s talk about why everyone is concerned:

Cases rising in most states

Hospitalizations rising in most states

Test + going up too

As weather gets colder, expect things to get worse in much of nation

Why?

People will spend more time indoors. But not just that

3/n
Read 11 tweets

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