Claim: U.S. Covid-19 Deaths are being Artificially Inflated

[Dingo]

Hello all,

A current claim circulating heavily in right-wing circles on Twitter and frequently in the comments of tweets made by the President, is that Covid-19 deaths are being artificially inflated in the U.S. This inflation is described as all deaths in hospitals being attributed to Covid-19, even traumatic injury deaths (e.g. car crash, murder etc.) The reason for this inflation is given as either financial, as Covid-19 deaths are paid more highly for the hospital than any other; or political in order to extend the lockdown. Obviously the political motivation cannot be debunked, however possibly the financial could be. I will however be focusing on the factual accuracy of the number inflation claims.


Covid-19 Deaths With Underlying Causes/not confirmed by testing

This portion of the claim attests that doctors are being improperly instructed to fill out death certificates as being Covid-19 when underlying or pre-existing conditions are present in a patient. Some statements from doctors are being used to back this claim. For instance, on April 8 2020, Chris Berg of West Dakota Fox posted this interview with Senator Dr. Scott Jensen (R. Minnesota):
Source: https://twitter.com/chrisbergpov/status/1247680994821509121?lang=en

Senator Dr. Scott Jenson: Well last Friday I received a seven-page document that told me that if I had an 86-year-old patient with pneumonia but was never tested for Covid-19; but some time after she came down with pneumonia we found that she had been exposed to her son, who had no symptoms but later on was diagnosed with Covid-19, that it would be appropriate to diagnose Covid-19 on the death certificate.
Now we don't do that in the middle of an influenza epidemic if someone has pneumonia and I do not have a test for influenza, I do not diagnose influenza on the death certificate, I will say this elderly patient died of pneumonia.

Now the document that he was referring to is the CDC guidelines for certifying deaths due to COVID-19, which was linked in a comment by Chris Berg, and is available from the CDC here. Reading through the CDC guidelines, the scenario talked about by Senator Dr. Jensen is given as scenario III, on page 6 of the document.

The description given by Sen. Dr. Jensen is inaccurate as to the actual content of the document.

The instructions given are for two portions of the death certificate. Part I is:

This section on the death certificate is for reporting the sequence of conditions that led directly to death. The immediate cause of death, which is the disease or condition that directly preceded death and is not necessarily the underlying cause of death (UCOD), should be reported on line a. The conditions that led to the immediate cause of death should be reported in a logical sequence in terms of time and etiology below it.

The UCOD, which is “(a) the disease or injury which initiated the train of morbid events leading directly to death or (b) the circumstances of the accident or violence which produced the fatal injury” (7), should be reported on the lowest line used in Part I.

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For Part II:

Other significant conditions that contributed to the death, but are not a part of the sequence in Part I, should be reported in Part II. Not all conditions present at the time of death have to be reported—only those conditions that actually contributed to death.

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It also notes that:

In cases where a definite diagnosis of COVID–19 cannot be made, but it is suspected or likely (e.g., the circumstances are compelling within a reasonable degree of certainty), it is acceptable to report COVID–19 on a death certificate as “probable” or “presumed.” In these instances, certifiers should use their best clinical judgement in determining if a COVID–19 infection was likely. However, please note that testing for COVID–19 should be conducted whenever possible.

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So, it is up to the attending physician, coroner, or medical examiner to determine whether or not the case was probable Covid-19, and this is a valid entry on a death certificate.

Here is a screen cap of the example that Sen. Dr. Jensen was referring to:



Now, the claim given by Sen. Dr. Jensen is that this is unprecedented and unusual for determining cause of death and filling out certificates. This is not in line with the Physician's Handbook on Medical Certification of Death, 2003 revision. This states on page 19 that:

The cause-of-death information should be the physician’s best medical OPINION. Report each disease, abnormality, injury, or poisoning that the physician believes adversely affected the decedent. A condition can be listed as ‘‘probable’’ if it has not been definitively diagnosed.

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A diagnosis of probable Covid-19 based off of the patient's symptoms and case history is completely appropriate, in line with existing policy, and not an example of artificial inflation of numbers. Snopes.com also provided their own rundown of this claim here and reached much the same conclusion.



Traumatic Deaths Misreported as COVID-19

As for traumatic deaths being misreported, per twitter rumours such as the following:

As far as covid patients dying I will bet the 65,000 Cuomo says their were in New York is probably only 20,000. Remember people die of natural cause and cancer car accidents murder gunshots but by some miracle no one died of anything but covid! Why money each covid worth money

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or

Yes there is a awakening. Covid death numbers are inflated. I had a friend whose son committed suicide and death certificate said cause by covid. She has tried to get it changed but hospital says they were ordered to put all deaths as covid that is fraud. Hoax? Yes!!

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(Tweets not linked directly as these people are not public figures and were found via twitter search)

The common thread in all of these is a lack of verifiable details. All claims are made of 'things that they heard' etc. without names. I have been unable to find any evidence of a traumatic death being misreported. Any assistance in research for this one would be appreciated, but until a specific claim and not just rumours on Twitter are seen, this one can be discarded as simple hearsay and the internet at work.


The first person quoted also claimed the 'Covid deaths get more money' story. I'd appreciate some help if someone wants to give a rundown of how true that claim is.
As this is the first thread I've created here on Metabunk, feedback is of course appreciated.

 

[Mendel]

As far as covid patients dying I will bet the 65,000 Cuomo says their were in New York is probably only 20,000. Remember people die of natural cause and cancer car accidents murder gunshots but by some miracle no one died of anything but covid! Why money each covid worth money

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This seems confused about the numbers, I believe the US total was 65000 whily NY was 20000 at the time (US 72275, NY 25205 via https://www.worldometers.info/coronavirus/country/us/ today), I can't imagine Gov. Cuomo saying otherwise.

The National Center for Health Statistics (NCHS) is monitoring deaths in the US. You can figure out how many people died of Covid-19 by comparing it to how many people would normally have died ("of natural cause and cancer car accidents murder gunshots"), and the excess is quite noticeable:

Article:

Source: https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/05012020/nchs-mortality-report.html

The data for week 17 is still incomplete, and week 16 may be only partially complete as well, due to reporting delays.
But we can see that there is a spike of total deaths in the left column that is akin to a small war that tracks with a spike in the next column showing respiratory deaths including Covid-19 at a time when the flu wave had died down.

For comparison, week 16 ended on April 18th:

Article:

Source: https://www.worldometers.info/coronavirus/country/us/

There's not much room for overinflation in that number, certainly not three-fold.

The NCHS mortality data by state or region is available at https://gis.cdc.gov/grasp/fluview/mortality.html , mortality data for 24 European countries is collected at https://www.euromomo.eu/graphs-and-maps/ .

 

[Z.W. Wolf]

Possible confounds, that will need to be sorted out in time; just off the top of my fallible head:

-fewer than average traffic, industrial and recreational accidents
-fewer flu deaths
but
-more than average non-Covid deaths due to people hesitating to get needed medical care; e.g. heartattack
- or not getting medical care due to system overload

Question:
-Have there been more... or fewer... deaths due to crime?
-What's the suicide rate looking like?

 

[deirdre]

You can figure out how many people died of Covid-19 by comparing it to how many people would normally have died ("of natural cause and cancer car accidents murder gunshots"), and the excess is quite noticeable

that's not what the methods says.

The national overall percentage of patient visits to health care providers for ILI reported each week is calculated by combining state-specific data weighted by state population. This percentage is compared each week with the national baseline of 2.4% for the 2019-2020 influenza season. The baseline is developed by calculating the mean percentage of patient visits for ILI during non-influenza weeks for the previous three seasons and adding two standard deviations. A non-influenza week is defined as periods of two or more consecutive weeks in which each week accounted for less than 2% of the season’s total number of specimens that tested positive for influenza in public health laboratories. Due to wide variability in regional level data, it is not appropriate to apply the national baseline to regional data; therefore, region-specific baselines are calculated using the same methodology.

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https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/purpose-methods.html


2016 is the latest year we have full data
New York state population:
2020 19.45 million
2016 19.63 million
March 14,2020 1st NY covid death. age 82 preexisting conditions.

https://www.health.ny.gov/statistics/vital_statistics/2016/table33a.htm

Table 33 a : Deaths and Death Rates* by Selected Causes and Race New York State - 2016

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total deaths in 2016 153,674 divided by 12 months is 12,806. Granted winter months might see higher rates due to flu etc and I don't find a breakdown by month https://www.health.ny.gov/statistics/vital_statistics/2016/#mort

*note 'snowbirds' may not yet be counted in New York totals. snowbirds are people who either winter in other states or have dual residences ex: when Trump still lived in NY he might have died at Mar a Lago, and my guess is it might take a while for NY to register that..

*I highly doubt even disreputable hospitals would put covid for a suicide (or car accident, gunshot) as there would be no supporting medical documentation.

For instance, on April 8 2020, Chris Berg of West Dakota Fox posted this interview with Senator Dr. Scott Jensen (R. Minnesota):

In an interview with FactCheck.org, however, Jensen said
he did not think that hospitals were intentionally misclassifying cases for financial reasons.

….

An analysis by the Kaiser Family Foundation looked at average Medicare payments for hospital admissions for the existing diagnosis-related groups and noted that the “average Medicare payment for respiratory infections and inflammations with major comorbidities or complications in 2017 … was $13,297. For more severe hospitalizations, we use the average Medicare payment for a respiratory system diagnosis with ventilator support for greater than 96 hours, which was $40,218.”

It is true, however, that the government will pay more to hospitals for COVID-19 cases in two senses: By paying an additional 20% on top of traditional Medicare rates for COVID-19 patients during the public health emergency, and by reimbursing hospitals for treating the uninsured patients with the disease (at that enhanced Medicare rate).

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https://www.factcheck.org/2020/04/hospital-payments-and-the-covid-19-death-count/

 

[deirdre]

-fewer flu deaths

the flu season was really in wind down mode (at least in America) so I think any mislabeled flu deaths would be minimal. for instance in Connecticut looking at past flu seasons i'd say AT MOST maybe 10-15 flu deaths might have gotten labeled as COVID. We have 2,500 covid deaths since early March.

https://portal.ct.gov/DPH/Epidemiology-and-Emerging-Infections/Influenza-Surveillance-and-Statistics

 

[Mendel]

that's not what the methods says.

Quite so, because you are quoting the method for "Outpatient and Emergency Department Illness Surveillance" while I'm using the Mortality Surveillance data.
The "Total Deaths" column is the all-causes mortality, regardless of how those deaths were labeled.You don't need a "method" to see these numbers start to rise from week 13 (March 23) at a time when they should be falling.

Article:

Numbers released Thursday from the Centers for Disease Control and Prevention show 48,344 people died by suicide in 2018, up from 47,173 the year before.

Source: https://eu.usatoday.com/story/news/nation/2020/01/30/u-s-suicide-rate-rose-again-2018-how-can-suicide-prevention-save-lives/4616479002/

 

[deirdre]

Quite so, because you are quoting the method for "Outpatient and Emergency Department Illness Surveillance" while I'm using the Mortality Surveillance data.
The "Total Deaths" column is the all-causes mortality, regardless of how those deaths were labeled.You don't need a "method" to see these numbers start to rise from week 13 (March 23) at a time when they should be falling.

Article:

Numbers released Thursday from the Centers for Disease Control and Prevention show 48,344 people died by suicide in 2018, up from 47,173 the year before.

Source: https://eu.usatoday.com/story/news/nation/2020/01/30/u-s-suicide-rate-rose-again-2018-how-can-suicide-prevention-save-lives/4616479002/

the chart with the big red bump is misleading. the baseline on that chart is not car accidents, gunshots etc.

 

[Mendel]

the chart with the big red bump is misleading. the baseline on that chart is not car accidents, gunshots etc.

Of course. Let me show you one that's not misleading. It looks basically the same, though, and my original point remains that the excess deaths are very noticeable.

Article:

Source: https://www.nytimes.com/interactive/2020/04/21/world/coronavirus-missing-deaths.html

I'm also judging you because your reply "not what the methods says" was very misleading, and you've neither acknowledged it, apologized, nor corrected your post.

 

[deirdre]

I'm also judging you because your reply "not what the methods says" was very misleading, and you've neither acknowledged it, apologized, nor corrected your post.

I clicked the methods button from your link and just saying what it says. I think the issue is that YOU know what you are talking about, but [me and] the people who are claiming the numbers for covid are exaggerated, are thinking of this info from a different perspective. for ex: showing that the numbers of influenza have increased "noticeably" doesn't prove squat. they know the numbers are high. Their claim is that heart attacks, cancer etc deaths might be being thrown in with covid numbers.

so showing people there are MORE influenza like deaths compared to normal is just quoting the people they don't trust. (hospitals, cdc, etc)

and the individual week list only shows this year. up until april 18th. now I see (considering real flu cases decrease this time of year) about 10,000 more deaths per week for 2 weeks there (14 and 15).. and a 5,000 increase for week 13...but we have no other years to compare it to. and we don't know if suicides have increased or drug overdoses or stress heart attacks etc.



you said:

by comparing it to how many people would normally have died ("of natural cause and cancer car accidents murder gunshots"), and the excess is quite noticeable:

playing devil's advocate for the target audience (peopel who believe numbers are inflated for covid) ..you are assuming the covid cases are actual covid cases. The naysayers disagree with this assumption.
and it's not "quite noticeable" really because the numbers so far only go to April 18th. and America has like 330 million people. so i'm not sure 25,000 in 3 weeks is super odd or not because i dont have an in depth knowledge of how many people die every week in America.

 

[Mendel]

Their claim is that heart attacks, cancer etc deaths might be being thrown in with covid numbers.

And why do they think we have thousands of heart attack, cancer etc. deaths all of a sudden?
What is causing that?

You do know that rejecting the obvious evidence and instead going with assumptions contrary to existing evidence that have absolutely no factual support is the way down the rabbit hole. You're playing the rabbit's advocate here. Have fun!

(the way to more mortality data is the link at the bottom of my original post)

 

[deirdre]

And why do they think we have thousands of heart attack, cancer etc. deaths all of a sudden?

my guess is what zw said.. because people are afraid to go to the doctors or hospital now.

You're playing the rabbit's advocate here. Have fun!

this is a debunking site. not a "sing to the choir" site. Metabunk's goals are to reach people on-the-fence of issues.

(the way to more mortality data is the link at the bottom of my original post)

if it contained data that would further prove your point, i'm going to guess that you would have provided it.

 

[vooke]

I am hearing and reading less and less of this claim as deaths and infections keep rising.

 

[Rory]

The first person quoted also claimed the 'Covid deaths get more money' story. I'd appreciate some help if someone wants to give a rundown of how true that claim is.

I heard this irl from someone today; some of the mainstream debunking websites have written articles about it, such as:

https://www.factcheck.org/2020/04/hospital-payments-and-the-covid-19-death-count/
https://www.snopes.com/fact-check/medicare-hospitals-covid-patients/

Snopes judges it partly true, saying: "it is plausible that Medicare is paying hospital fees for some COVID-19 cases in the range of the figures given by Dr. Scott Jensen [...] however, Medicare says it does not make standard, one-size-fits-all payments to hospitals for patients admitted with COVID-19 diagnoses and placed on ventilators."

 

[Mendel]

Medicare says it does not make standard, one-size-fits-all payments to hospitals for patients admitted with COVID-19 diagnoses and placed on ventilators

I've heard the opposite here, on a video by Youtuber Doctor Mike, whose channel I recommend, debunking Plandemic:
Source: https://www.youtube.com/watch?v=TWpjc1QZg84&t=10m35s

10:35 WOMAN IN VIDEO: If my husband were to die, who has COPD, his lungs have fibrosis, his lungs would look exactly like somebody with COVID-19 theoretically, but he has no evidence of infection. So if you're not testing and you don't have evidence of infection, and if you walked in there today, you know, they'd call it COVID-19.

DOCTOR MIKE: If you're coming in for a broken leg, and your leg gets infected, and you end up dying from that infection, we won't just put COVID-19 on your death certificate. If you had COVID-19, you were screened and tested for it, and you came positive, we would. That would be counted in the death toll. And you may think that's unfair, that's inaccurate, it may increase the numbers. All we have to do is look at overall mortality for the last few years in a place like New York City, and you'll see that every wintertime mortality spikes, but if you look at the spike for 2020, it's outrageous how many more people have died.

You may be upset about the way we're categorizing them, COVID related, not COVID related, COVID presumed, but more people are dying, and the only thing that changed is COVID-19. In fact, more people are staying home now because of social distancing, meaning that less trauma, less car accidents, but the deaths skyrocketed.

11:50 DOCTOR IN VIDEO: When I'm writing up my death report, I'm being pressured to add COVID, why is that? Why are we being pressured to add COVID to maybe increase the numbers and make it look a little bit worse than it is?

DOCTOR MIKE: No one's being pressured, the CDC puts out recommendations of how you decide what someone has passed from. And you're free to follow those recommendations or not. As a practicing physician, I've filled out death certificates. When I was a resident, I would do death pronouncements all the time and there are things that you write that contributed to a person's demise.
For example, if someone had kidney cancer, and it was an end-stage kidney cancer, and while they were dying from kidney cancer, they got a pneumonia on top of that, I would put both on the death certificate. I can't say exactly which one is the reason they died, 'cause you can't just say one thing.
So yes, if someone has a heart attack, but they're also having a COVID infection, it's very reasonable to put both on the death certificate and count it towards the COVID death toll. Now, whether or not you think this would create misinformation, that's your choice.
But again, look at the amount of people that have died in comparison to the last 10 years. The numbers have skyrocketed, and it's simply because of this COVID outbreak.


13:02 MAN IN VIDEO: I've talked with doctors who have admitted that they are being incentivized to list patients that are sick or have died with COVID-19.
WOMAN IN VIDEO Yeah, $13,000 from Medicare, if you call it COVID-19.
REPORTER IN VIDEO: Right now, Medicare has determined that if you have a COVID-19 admission to the hospital, you'll get paid $13,000. If that COVID-19 patient goes on a ventilator, you get $39,000, three times as much.

DOCTOR MIKE: The $13,000 and the $39,000 figure are accurate. This is how hospitals are reimbursed for COVID-19 patients. Now, while it sounds like they're getting paid more to diagnose more, the reality of the fact is these types of bundled payments actually save us money. Let me explain.

Before these types of bundled payments, the way hospitals would bill insurance companies for treatment would be to say, we did this, we gave these medications, the patient stayed this long, these are the doctors they saw, these are the skilled technicians that took care of them, and they would bill for all these services. And what we found was, they were just wasting a lot of money and not delivering great care. So what CMS did was, they said: Let's take an average in an area, of how much hospitals are spending on a typical pneumonia case, on a heart attack case, and make it a standardized payment that then the hospital has to make do with in treating the patient.
And what came out of that?
Well, the hospitals became more effective. They said, we need to be more cost effective, and we need to deliver better quality care to get patients better sooner, so they can leave and we can save some of that extra money for ourselves as a profit.

The reason why we're paid $13,000 is 'cause we're spending time, resources, medications, on that patient. And on average, it costs $13,000 to deliver that care. In some areas, maybe it will cost less than that, and therefore you're left with more profit. In other cases, it gets really complicated and it costs a lot more than that and you lose money. But on average, it should cost around $13,000, that's the fair rate set by CMS. Again, this is very effective both in terms of cost-saving measures and patient outcomes.

Now the $39,000 figure for ventilators. It's not like hospitals are getting a three times bonus by putting someone on a ventilator. Ventilators cost money, respiratory therapists need to get billed for their time. If a patient is put on a ventilator, they need to be sedated with expensive medications. They need to be put into the ICU. The reason hospitals are being paid $39,000 is because it costs more to deliver that level of care. It's not 'cause now the hospitals getting rich by putting someone on a ventilator. The hospital's actually incentivized to deliver just enough care in order to get the most money out of it, but at the same time, get the patient better as soon as possible.

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P.S. I downloaded the subtitles with downsub.com.
P.P.S.: Fun fact: in Germany, hospitals bill for empty ICU beds that they're providing as part of the government-mandated Covid-19 reserve, as compensation for lost profits.

 

[deirdre]

I've heard the opposite here, on a video by Youtuber Doctor Mike,

and how does he says he knows what hospitals are doing as far as death certificates, or how they are getting reimbursed? (aside from his fun stethoscope font or the fact that he is "the sexiest doctor alive" according to People magazine).

Mikhail Varshavski - Wikipedia
en.wikipedia.org › wiki › Mikhail_Varshavski
Mikhail Varshavski, D.O. commonly known as Doctor Mike, is a Russian–American internet celebrity doctor. His Instagram account went "viral" after he was featured in Buzzfeed and in People magazine's 2015 issue of The Sexiest Doctor Alive.

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[Rory]

DOCTOR MIKE: The $13,000 and the $39,000 figure are accurate [...] that's the fair rate set by CMS.

What he says seems reasonable and sensible, but I would question whether he would be the best person to confirm this, compared with, say, someone working in the finance or insurance departments. Or maybe the Centers for Medicare & Medicaid Services (CMS) would be the place to confirm it.

In the Snopes article they said they communicated with a spokesperson for the CMS and were told:

"there is no set or predetermined amount paid to hospitals for diagnosing and treating COVID-19 patients, and the amounts would depend on a variety of factors driven by the needs of each patient. Pay-outs would also depend on the variance of the costs of medical care in different regions."

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Likewise, the factcheck.org article states:

A CMS spokesperson told us exact payments vary, depending on a patient’s principal diagnosis and severity, as well as treatments and procedures. There are also geographic variations.

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The figures quoted may end up reflecting something close to the 'average' payment for each Covid-19 case, but unless the information from the two fact-checking articles is incorrect, it seems that Doctor Mike may be overreaching here a little, and that the idea the CMS set a "fair rate" isn't factual.

 

[Mendel]

and how does he says he knows what hospitals are doing as far as death certificates, or how they are getting reimbursed? (aside from his fun stethoscope font or the fact that he is "the sexiest doctor alive" according to People magazine).

The wikipedia article you're quoting mentions that Doctor Mike worked as a resident physician at Overlook Hospital, a 504-bed non-profit teaching hospital located in Summit, New Jersey, from 2014 to 2017. As he says in the video, part of his job duties there would include issuing death certificates, and presumably billing as well (and he definitely does billing now that he's in private practice). Covid-19 hasn't changed any of that fundamentally.

His celebrity status allows Doctor Mike to talk to a lot of other physicians on the subject of Covid-19 (see spoiler below), so I'd say he's not only in the profession, he's probably also better informed than most on what actually goes on.

Spoiler: Doctor Mike did a video with 100+ doctors

Source: https://youtu.be/WhHfjsOl8Tc

 

[Mendel]

The figures quoted may end up reflecting something close to the 'average' payment for each Covid-19 case, but unless the information from the two fact-checking articles is incorrect, it seems that Doctor Mike may be overreaching here a little, and that the idea the CMS set a "fair rate" isn't factual.

Your factcheck.org source confirms Doctor Mike:

Article:

The figures cited by Jensen generally square with estimated Medicare payments for COVID-19 hospitalizations, based on average Medicare payments for patients with similar diagnoses.

Medicare — the federal health insurance program for Americans 65 and older, a central at-risk population when it comes to COVID-19 — pays hospitals in part using fixed rates at discharge based off a grouping system known as diagnosis-related groups.

The Centers for Medicare & Medicaid Services has classified COVID-19 cases with existing groups for respiratory infections and inflammations. A CMS spokesperson told us exact payments vary, depending on a patient’s principal diagnosis and severity, as well as treatments and procedures. There are also geographic variations.

An analysis by the Kaiser Family Foundation looked at average Medicare payments for hospital admissions for the existing diagnosis-related groups and noted that the “average Medicare payment for respiratory infections and inflammations with major comorbidities or complications in 2017 … was $13,297. For more severe hospitalizations, we use the average Medicare payment for a respiratory system diagnosis with ventilator support for greater than 96 hours, which was $40,218.”

Source: https://www.factcheck.org/2020/04/hospital-payments-and-the-covid-19-death-count/

Doctor Mike did mention the geographic variations.

And the point is that the hospital does get a predetermined rate based on the diagnosis (in this case, Covid-19) and some other factors. That is true.

But it's also true that this is a fair rate, it is an effective system, and falsifying diagnoses for billing is criminal fraud. So the argument comes down to "hospitals commit fraud to get more money", which is a tall and slanderous accusation to make with no evidence to back it up. I tend to suspect the morals of the person who makes such a suggestion, not the morals of the person whom they're pointing the finger at.

 

[Rory]

So perhaps we should be interpreting him saying "the $13,000 and the $39,000 figure are accurate [...] that's the set rate" as something like "those figures are ball-park accurate and close to the 2017 average ($13.2k and $40.2k) for similar diagnosis-related groups. The exact amount is calculated partly using a fixed rate system and partly using other factors, and will vary depending on specific conditions such as principal diagnosis, severity of illness, treatments, procedures, and geographic location"?

 

[deirdre]

Covid-19 hasn't changed any of that fundamentally.

I highly doubt in 2017 if someone with a positive flu test died of an infection from a broken leg, they would put cause of death "flu" down.

 

[Mendel]

I highly doubt in 2017 if someone with a positive flu test died of an infection from a broken leg, they would put cause of death "flu" down.

What is your medical qualification, Deirdre? You've been questioning Doctor Mike's qualification by quoting the part of his wikipedia entry that does not relate to his qualification, which I find in bad faith, and now you're contradicting him without any evidence.

If someone comes to a hospital with a broken leg and acquired a pneumonia in the hospital and then dies, why wouldn't they list that as cause of death? Hospital-acquired infections are a big problem, and you can't get a handle on them if you close your eyes to them. People generally don't die of broken legs.

 

[Mendel]

So perhaps we should be interpreting him saying "the $13,000 and the $39,000 figure are accurate [...] that's the set rate" as something like "those figures are ball-park accurate and close to the 2017 average ($13.2k and $40.2k) for similar diagnosis-related groups. The exact amount is calculated partly using a fixed rate system and partly using other factors, and will vary depending on specific conditions such as principal diagnosis, severity of illness, treatments, procedures, and geographic location"?

Doctor Mike and the factcheck.org source confirms several things:
-- hospitals are reimbursed for certain types of services by blanket, pre-determined fair rates that mainly depend on the diagnosis
-- these fair rates also take into account regional variations
-- these fair rates can get extended if the patient requires additional services (e.g. if a pneumonia patient requires a ventilator, another rate (or combination of rates) applies)
-- based on a particular geographic location and typical cases, these fair rates could be $13000 and $39000; they could be different in other locations.
-- these fair rates cover the services that the hospital needs to provide for a typical patient without having to bill for each individual item (group rates)
-- so the moment a patient gets diagnosed with Covid-19, there's a rate that the hospital can bill Medicare for (if that patient is on medicare), but they also have to treat the patient for that amount. It's not a bonus.

And my obvious addition is that billing based on a knowingly incorrect diagnosis would be fraud. Doctors sometimes do that. Hospitals sometimes do that. But it's the exception, not the norm, and it's punishable by law.

The effect of this is that with individual billing, the hospital can say "would this procedure be medically benmeficial? let's do it and make a profit! Can we keep the patient a day longer for observation! Great, we can bill another day and make a profit!" and with the flat rate, it's "do we have to do that? or can we get the patient treated without it and make a profit? Can we send the patient home now so we have the bed available and can makle a profit from that bed by admitting another patient?" This pre-determined rate system makes billing more effective and it makes hospitals more effective. It's not an incentive to diagnose more patients with Covid-19 that may not actually suffer from it.

 

[deirdre]

and now you're contradicting him without any evidence.

you can provide evidence that I am wrong.

acquired a pneumonia in the hospital and then dies, why wouldn't they list that as cause of death?

if he died of pneumonia then it would make sense to put pneumonia down as the cause of death.

People generally don't die of broken legs.

Dr. Mike didnt say he died of a broken leg. He said he died of an infected leg.

What is your medical qualification, Deirdre?

I'm not the one appealing to authority. and i'm not the one using the word "we" throughout my influencer video, when there is no "we" in this case.

we won't just put COVID-19 on your death certificate.

If you want to believe every 'expert' on Youtube without question, knock yourself out. a 2 year residency, 3.5 years ago, is more experience then i have, but it doesn't equate to having knowledge about what is happening today in hospitals in regards to covid. and Dr. Oz has alot more experience than i have too, but you shouldn't believe outright everything he says either.

 

[Rory]

Doctor Mike and the factcheck.org source confirms several things:
-- hospitals are reimbursed for certain types of services by blanket, pre-determined fair rates [...]

Not quite. The factcheck articles says:

1. "Medicare — the federal health insurance program for Americans 65 and older, a central at-risk population when it comes to COVID-19 — pays hospitals in part using fixed rates."

2. "A CMS spokesperson [said] exact payments vary, depending on a patient’s principal diagnosis and severity, as well as treatments and procedures. There are also geographic variations."

This seems the difference: that there is no "set rate", as Doctor Mike suggests. But I think we're really talking nuances and interpretations, and the interpretation I suggested above may very well be what he meant when he said there was a set rate.

You've been questioning Doctor Mike's qualification by quoting the part of his wikipedia entry that does not relate to his qualification, which I find in bad faith.

I can agree with this, in part. Not sure what the font he uses or a People Magazine article calling him sexy has to do with the facts here.

If someone comes to a hospital with a broken leg and acquired a pneumonia in the hospital and then dies, why wouldn't they list that as cause of death?

I think one thing to remember is there's a lot of bandying around of this statement "cause of death", when the reality seems to be they list secondary factors, contributory factors, suspected additional factors, etc. This seems to be something the conspiracy theorists ignore too.

 

[Z.W. Wolf]

A nitpick. I'm in general agreement with the point being argued, but I'm not a fan of using graphs that don't start at zero to make a point about how much things have changed. It's misleading at best..

This could be interpreted by the naive reader as "deaths have quintupled."

 

[Mendel]

1. "Medicare — the federal health insurance program for Americans 65 and older, a central at-risk population when it comes to COVID-19 — pays hospitals in part using fixed rates."

2. "A CMS spokesperson [said] exact payments vary, depending on a patient’s principal diagnosis and severity, as well as treatments and procedures. There are also geographic variations."

This seems the difference: that there is no "set rate", as Doctor Mike suggests. But I think we're really talking nuances and interpretations, and the interpretation I suggested above may very well be what he meant when he said there was a set rate.

My understanding is that the "in part" means that not all medicare billing is done using fixed rates, but for many common diagnoses, it is, and that Covid-19 is a diagnosis for which such a fixed rate exists. This rate may only be a base rate, i.e. if the patient develops a kidney failure, they may be able to bill extra for that, etc.

And I agree that Doctor Mike is trying to simplify here for a general audience: that these "flatrates" are a part of the billing, but that it's actually a good thing that we have them, and not a conspiracy specific to Covid-19.

 

[Mendel]

and Dr. Oz has alot more experience than i have too, but you shouldn't believe outright everything he says either.

Article:

He is a proponent of alternative medicine, and has been criticized by physicians, government officials, and publications, including Popular Science and The New Yorker, for endorsing unproven products and non-scientific advice.

Source: https://en.wikipedia.org/wiki/Mehmet_Oz

Apples and oranges.

you can provide evidence that I am wrong.

I did. I provided expert testimony of a practicing physician with recent hospital experience (and 2014-2017 is not "two years").
You're rejecting it from incredulity.

 

[Rory]

I provided expert testimony of a practicing physician with recent hospital experience. [Deirdre is] rejecting it from incredulity.

Or because it doesn't tally with the statements from the relevant authorities.

And - wait: he's not currently working in a hospital? So how would he have access to billing information regarding Covid-19 treatment?

My understanding is that the "in part" means that not all medicare billing is done using fixed rates, but for many common diagnoses, it is.

Perhaps it's time to update your understanding? According to both Factcheck and Snopes, CMS and Medicare spokespeople have stated explicitly that there is no fixed rate payment for Covid-19.

I'm not a fan of using graphs that don't start at zero.

Agree with that. I think most of the ones I've looked at started at zero, like this one (covering 7 Italian regions, or about 25% of the country's population). Still plenty striking:


Source: https://voxeu.org/article/covid-19-italy-analysis-death-registry-data

That's from what seems a well-researched and balanced article, which again supports the notion I'm finding pretty much everywhere: that coronavirus deaths are underreported, rather than inflated.

It's interesting that the CT narrative isn't pushing this - especially in the US, where there's a strong political motivation for underreporting the true figures.

 

[deirdre]

You're rejecting it from incredulity.

actually i'm rejecting you. Dr. Mike didn't say that. you did. I quoted YOU.

 

[Dingo]

I think one thing to remember is there's a lot of bandying around of this statement "cause of death", when the reality seems to be they list secondary factors, contributory factors, suspected additional factors, etc. This seems to be something the conspiracy theorists ignore too.

Yup that's what I touched upon in the OP.

There's two main listings - one is 'factors directly leading to death'. This is given in order of how the situation developed to the best of the doctor's knowledge.

So someone with covid-19 is admitted to hospital and develops pneumonia, and subsequently dies of respiratory failure, this primary section would look something like:
1)respiratory failure
2) [due to] pneumonia
3) [due to] covid-19

(In the actual certificate the 'due to' is implied by order it's written, written here for clarity)
In this example covid is the Underlying Cause of Death because it started the chain of events leading to death.

Other factors in the case would be listed in a second section. These are factors that did NOT contribute to the immediate chain of events, but WOULD have had a substantial impact on the patient's survival. For example in this case it may list "Obesity, Diabetes". Both of these conditions substantially affect a patient's general health, but are not directly linked to the causal chain. They're listed in the second section because they're substantial. You would not for instance list 'papercut on index finger' here because it would not have a substantive impact on patient health.


Where it gets complicated is in more nuanced cases. Like for instance the example of leg break->infection->death. Presumably by infection he means the usual bacterial infections that you see with trauma.
In this case the primary listing should be:
1) [whatever organ failure directly caused death]
2) [due to] bacterial infection
3) [due to] broken leg

If that patient was also positive for covid-19, it would be at the -physician's discretion- whether that should be listed in contributing factors. Given the wider systematic effects with blood clotting and the like that's now being seen with covid, it's in my non-medical opinion that it could easily be considered a contributing factor.

A lot of leeway is given to the physician in determining cause of death and contributing factors. As I said in the OP, a positive test is not even needed - if you have a patient with severe respiratory issues who has been in contact with positive individuals, then a diagnosis of 'probable covid-19' is perfectly acceptable, because the diagnosis is being performed off of epidemiological factors as well as patient symptoms.

 

[Agent K]

"Trump Suggests Virus Death Count Is Inflated. Most Experts Doubt It."

Article:

Last Friday, Trump told reporters that he accepted the current death toll, but that the figures could be “lower than” the official count, which now totals nearly 95,000.
Most statisticians and public health experts say he is wrong; the death toll is probably far higher than what is publicly known. People are dying at their houses and nursing homes without ever being tested, and deaths early this year were likely misidentified as influenza or described only as pneumonia.
Dr. Anthony Fauci, the nation’s top infectious disease expert, told lawmakers this month that the overall toll was likely an undercount. “I don’t know exactly what percent higher but almost certainly it is higher,” he said at a Senate health committee hearing.
Jennifer Nuzzo, a senior scholar at the Johns Hopkins Center for Health Security, which is closely tracking the coronavirus pandemic, said that “the officially reported numbers don’t reflect the true level of illness and death that have occurred.”
“We very much feel the reported numbers reflect an undercount,” she said.
...
Robert Anderson, who runs the mortality statistics branch of the CDC’s National Center for Health Statistics, said the federal government deployed two parallel, related systems to tally deaths, one based on case reports and one on death certificates. He said it was unlikely that there was any kind of overcount.
“The case reporting system asks: Did the patient die from this illness?” he said. “It’s not asking if the patient with COVID-19 died. It’s asking if they died from COVID-19.”
A death certificate, Anderson said, clearly establishes a cause of death or a contributing factor.
...
White House officials say skepticism in the Trump administration over CDC data, including for opioid use, long predates the coronavirus outbreak. But new reasons have cropped up.
At least one senior White House official has mentioned that hospitals could be inflating their coronavirus patient counts, responding to financial incentives — Medicare offers higher payments to providers for treating coronavirus patients. Several senior officials said they were unaware of such talk.
An official with the American Hospital Association disputed that idea. “There’s guidance around what you have to do, and the clinician has to say, ‘This is the diagnosis,’” said Nancy Foster, the association’s vice president for quality and patient safety policy. “They’re putting their professional reputation on the line to say that.”
...
Trying to separate the cause of death in coronavirus-infected patients is “ludicrous,” said Dr. Alicia Skarimbas, a physician in Bergen County, New Jersey, who has treated around 75 COVID-19 patients.
“I have yet to have anyone infected with COVID die from anything else,” she said.

Source: https://www.nytimes.com/2020/05/22/us/politics/coronavirus-trump-death-toll.html

 

[Jeff Semenak]

Trying to separate the cause of death in coronavirus-infected patients is “ludicrous,” said Dr. Alicia Skarimbas, a physician in Bergen County, New Jersey, who has treated around 75 COVID-19 patients.
“I have yet to have anyone infected with COVID die from anything else,” she said.

Since many are asymptomatic, how could you possibly make such a blanket statement? Has every patient you've seen been tested?

 

[Mendel]

Since many are asymptomatic, how could you possibly make such a blanket statement? Has every patient you've seen been tested?

You forget the context: the CT is that the Covid-19 death count is overinflated because there are deaths counted for Covid-19 that weren't caused by Covid-19.
If someone dies from a non-Covid cause, and they haven't been tested, then they won't be counted for the Covid-19 statistic, either. When we're adressing the Covid-19 mortality figures, we're looking at dead people who were determined to have Covid-19. From that group, within Dr Skarimba's experience, which presumably includes mostly hospitalized people, those who died did die of Covid-19. That's what her statement means in context.

 

[deirdre]

When we're adressing the Covid-19 mortality figures, we're looking at dead people who were determined to have Covid-19

your wording might mean this, but just to clarify.-- determined to have covid-19 or determined to probably have had covid-19.




----------------------------------------------------------------------

It seems reporting of "probably covid-19" is still (June 8th) all across the board in America (this article goes into more detail), which surprises me since testing has expanded greatly. Certainly early in the pandemic when we had very limited tests, people weren't always tested. But this was already covered in the OP

june 8 Washington Post

The CSTE recommended reporting probable and confirmed cases and deaths on April 5. The CDC’s written response to the recommendations, which was shared with The Post, said the agency “concurs” and that adoption by states is “very important” for covid-19 record-keeping.
On April 14, the CDC noted on its website that the national tally includes probables, although the agency did not at that time provide a state-by state breakdown.
The CDC also modified the form states use for coronavirus reports, adding boxes that can be checked to indicate a “lab-confirmed” case or “probable” case.
Probable cases were defined as showing symptoms and having contact with an infected person, or meeting one of those criteria and testing positive for coronavirus antibodies, rather than for the virus itself. Probable deaths meant those who were never tested for the virus but whose death certificates listed covid-19 as the cause of death or a significant condition contributing to death.

Content from external source

Since many are asymptomatic, how could you possibly make such a blanket statement? Has every patient you've seen been tested?

I dont know if everyone of her patients were tested (or how many of the 75 actually died), but if they were asymptomatic she would have no reason to assume they might have Covid. And flu testing is pervasive in America. so if they couldn't breathe due to pneumonia (how most covid people die) and they tested negative for flu (and I cant imagine a state not testing for flu), it is likely they had Covid. It is -of course-possible they died from another respiratory virus or bacteria that led to their pneumonia but those mistaken accounts would be rather small in number i'm sure.

Unfortunately i dont have a NYTimes subscription so i dont know what information was in the article before her quote above.

of course, now im wondering if in the early days before wide spread testing was available, if the patient tested positive for flu.. did they just put influenza as the cause of death? can you have simultaneous influenza and covid? if so maybe some covid cases were put down as flu deaths.

According to Dr. Neisheiwat, co-infection is possible, but extremely bad luck. She would differentiate between the two with a nose swab test.

"And, it takes about 10 minutes for the results to come back to tell me if they have influenza A or B," she explained. "If they're positive for Influenza A, we stop -- or B. We stop. We do not proceed to testing them for COVID-19."

Content from external source

https://www.foxnews.com/media/coronavirus-questions-answers-flu-covid-same-time

 

[Jeff Semenak]

So, since most, over 99% survive testing positive, do they stop dying from other causes? Or, is testing Positive a Death sentence. I was arguing against the quote proffered, and high-lighted by me.
“I have yet to have anyone infected with COVID die from anything else,” she said.
Yes, that's completely relevant to this thread. If she hasn't seen it, how many others signing Death Certificates feel, the same way?

 

[deirdre]

So, since most, over 99% survive testing positive, do they stop dying from other causes? Or, is testing Positive a Death sentence. I was arguing against the quote proffered, and high-lighted by me.
“I have yet to have anyone infected with COVID die from anything else,” she said.
Yes, that's completely relevant to this thread. If she hasn't seen it, how many others signing Death Certificates feel, the same way?

I haven't found anything really that says she volunteered to work in a hospital, but maybe your primary physician signs the death certificate and not hospital staff in New Jersey?

Dr. Alicia Skarimbas, who practices in New Jersey, said, “We signed so many death certificates, we would get behind and take turns doing them.”

Skarimbas said that she would list Covid-19 as the cause of death when that seemed obvious, but her partners might simply list “respiratory failure” unless there had been a positive test for the virus. Thus it was often random whether Covid-19 was listed as the cause of death

Content from external source

https://twnews.us/us-news/america-s-true-covid-toll-already-exceeds-100-000

 

[deirdre]

So, since most, over 99% survive testing positive, do they stop dying from other causes?

but no, im sure they don't stop dying from accidents or gun shots or spousal abuse.

but it's only 75 people. i'm sure in an apartment building with 75 people you can have many 3 month periods where noone dies from "something else".

 

[Mendel]

So, since most, over 99% survive testing positive, do they stop dying from other causes? Or, is testing Positive a Death sentence. I was arguing against the quote proffered, and high-lighted by me.
“I have yet to have anyone infected with COVID die from anything else,” she said.
Yes, that's completely relevant to this thread. If she hasn't seen it, how many others signing Death Certificates feel, the same way?

George Floyd tested positive for Coronavirus, and his death was unrelated.
I really don't follow your line of argument.
Nobody claims that a virus infection confers eternal life, and we know that the infection fatality rate (IFR, or how many infected die from the infection) for SARS-CoV-2 ("coronavirus") is somewhere around 1%.

The yearly mortality rate in the US is 863.8 deaths per 100,000 population (2017 data, via https://www.cdc.gov/nchs/fastats/deaths.htm ). That means if you randomly pick 75 people from the US population, you're expecting 0.65 of them to die over the course of a year, or 0.15 over the course of 3 months (March, April, May). So you'd need on average 6 physicians like Dr Skarimbas to have just one of them see a Covid-diagnosed patient die from a cause different than Covid-19.

That said, the case fatality rate (deaths/cases) is ~5% in the US right now, so only 4 of 75 Covid-19 patients would be expected to have died if Dr Skarimbas does not work in a hospital. The death rate is higher for hospitalized patients, e.g. ~27 of 75 in New York state, using data from the infobox in https://en.m.wikipedia.org/wiki/COVID-19_pandemic_in_New_York_(state) : Hospitalized cases 89,995 (total), Deaths 24,551.

 

[Mendel]

your wording might mean this, but just to clarify.-- determined to have covid-19 or determined to probably have had covid

The determination of cause of death is made by the physician who signs the death certificate. Dingo posted at length in post #1 above on how that determination may be made.