The Health 202: Doctors, hospitals blast Trump’s baseless claims they inflate coronavirus deaths for money

“You know that, right?” Trump said at a Michigan rally on Friday. “I mean our doctors are very smart people. So what they do is they say, ‘I’m sorry, but everybody dies of covid.’” 

Chip Kahn, president of the Federation of American Hospitals, said “it is so offensive.” 

There is no evidence that hospitals and doctors are lying about the number of covid-19 patients. 

That would be fraud and something the Department of Justice could prosecute. “It’s unethical, it’s illegal and it’s inappropriate,” Kahn said.

Without naming the president, the American Medical Association called Trump’s statement a “malicious, outrageous and completely misguided charge” and defended front-line health care workers. “They did it because duty called and because of the sacred oath they took,” said AMA President Susan Bailey.

The pandemic has actually cost medical facilities money, although by how much is unclear. 

Elective surgical procedures, which hospitals were forced to cancel or postpone for much of the spring, generate the most revenue for them. In contrast, carrying for severely ill coronavirus patients for weeks on end consumes lots of staffing hours and bed space for hospitals.

“Frankly, these are very expensive cases on average … the hospitalizations are long and so even the reimbursement is probably way below cost,” Kahn said. 

And hospitals don’t get extra money if a coronavirus patient dies. 

Hospitals bill the government and private insurers for specific services related to specific illnesses, regardless of the outcome.

“Hospitals do not receive extra funds when patients die from covid-19,” the American Hospital Association wrote in a blog post yesterday addressing the claims. “They are not over-reporting covid-19 cases. And, they are not making money on treating covid-19.”

Ashish Jha, dean of Brown University School of Public Health:

However, there is a coronavirus “bonus” for uninsured covid-19 patients.

The coronavirus relief package passed by Congress includes money to pay hospitals for treating uninsured covid-19 patients. The package allows hospitals to be paid 120 percent of typical Medicare rates. 

Yet Kahn feels that, if anything, hospitals aren’t getting paid as much as they need for caring for coronavirus patients. Trump’s comments, he feels, reflected little-to-no understanding of how the coding system works. 

Hospitals can only submit claims for the payments that list covid-19 as a patient’s primary diagnosis. For example, a patient admitted with sepsis due to the coronavirus would be given “sepsis” as a primary diagnosis and “covid-19” as a secondary diagnosis — even though the virus caused the sepsis to begin with. 

Hospitals have asked the Department of Health and Human Services to loosen those rules, charging that the majority of claims for coronavirus testing and treatment would be rejected and ineligible for reimbursement under the program.

Trump’s claim was just the tip of the iceberg in how he talked about the pandemic.

The president switched between blaming others for focusing on the pandemic while simultaneously promising a widespread vaccine within weeks.

He offered extreme depictions of a pandemic response might look like under a Biden administration. He claimed the former vice president would delay the distribution of a vaccine. He said Biden wants to turn the United States into “a prison state.”

Trump even suggested he would fire Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases who has emerged as one of the public’s most-trusted health experts for pandemic information (it’s an empty threat, because Fauci isn’t a political appointee).

After complaining at a South Florida campaign rally that “covid, covid, covid, covid, covid” was dominating the news, Trump listened with evident delight as the crowd chanted “Fire Fauci!”

“Let me wait until a little bit after the election,” the president replied.

Biden struck back, saying at his own campaign event yesterday that the president had “the gall to suggest that America’s doctors” are falsely inflating covid-19 deaths in the interest of making more money.

“The people of this nation have suffered and sacrificed for nine months, none more so than our doctors and front-line health care workers,” Biden said. “And this president is questioning their character, their integrity, their commitment to their fellow Americans? It’s a disgrace.”

Ahh, oof and ouch

AHH: Deborah Birx warned of another deadly virus surge in an internal report.

“We are entering the most concerning and most deadly phase of this pandemic … leading to increasing mortality,” said a Nov. 2 report from Deborah Birx, coordinator of the White House coronavirus task force. “This is not about lockdowns — It hasn’t been about lockdowns since March or April. It’s about an aggressive balanced approach that is not being implemented.”

“While the president holds large campaign events with hundreds of attendees, most without masks, she explicitly warns against them. While the president blames rising cases on more testing, she says testing is ‘flat or declining’ in many areas where cases are rising. And while Trump says the country is ‘rounding the turn,’ Birx notes the country is entering its most dangerous period yet and will see more than 100,000 new cases a day this week.”

Fauci has also warned of surging cases, but Birx is a political appointee and could be fired by Trump. While she was highly visible in the early months of the pandemic, the administration is now heavily restricting her media appearances.

One administration official told The Post that Birx “feels like she’s being ignored,” even as she calls on the administration to ramp up testing and push a more forceful message on masks and social distancing – a sharp contrast to the message from Trump, who continues downplaying the virus.

But the president appears unpersuaded by such warnings: “Trump plans to hold a large indoor gathering for 300 to 400 guests at the White House on Tuesday to watch the election returns, only a few weeks after a White House event to announce his Supreme Court nominee Amy Coney Barrett became a superspreader event,” Sun and Dawsey write.

OOF: Several states including Texas, Michigan and Wisconsin aren’t requiring masks for voting.

“A voter’s personal experience casting a ballot has long been shaped by decisions of local elections officials, who control many of the ground rules and allocate resources for voting operations. Now, as historic numbers of Americans cast early ballots for the 2020 presidential election in the middle of the worst public health crisis in a century, they’re encountering disparate policies on masks, too,” The Post’s Neena Satija, Emma Brown, Michael Kranish and Beth Reinhard report.

States and local districts differ on whether poll workers are required to wear masks. Some officials said if they required masks, they wouldn’t be able to find enough workers.Several states and counties are encouraging voters to wear masks but say voters who refuse to wear one will still be allowed into polling places.

Mi Familia Vota and the Texas NAACP sued Texas Gov. Gregg Abbott (R) over an order exempting polling places from the mask mandate. The groups argued that Black and Latino voters, whose communities had been hit hard by the virus, would be disadvantaged in going to the polls if public health guidance was not enforced. While a federal judge initially sided with them, the U.S. Court of Appeals for the 5th Circuit overruled the lower court last week.

OUCH: Healthcare issues are on the ballot in a number of states.

Voters in 32 states will have the opportunity to weigh in on 120 statewide ballot measures. Some are related to medical marijuana, abortion and sex education in schools.

Here’s what to look out for:

  • Medical marijuana and other initiatives related to drug policy: South Dakota and Mississippi will vote on whether to join 33 other states in legalizing medical marijuana. Meanwhile, Oregon could become the first state to decriminalize hard drugs. If voters approve Measure 110, individuals found with small amounts of heroin, methamphetamines, cocaine or LSD would be given the option of paying a $100 fine or receiving treatment at an addiction recovery center instead of facing jail time. Oregon is also considering going a step further when it comes to psilocybin, the psychoactive compound in magic mushrooms, which has shown promising results in clinical trials for the treatment of addiction and depression. A ballot proposal in the state would legalize the growth and administration of psychedelic mushrooms in facilities regulated by the Oregon Health Authority. Mushrooms are also on the ballot in D.C., which is considering a measure to make psychedelic plants among the lowest enforcement priorities for police.
  • Abortion: Abortion is on the ballot in Colorado and Louisiana. In Colorado, voters will weigh in on a proposal to prohibit the procedure after 22 weeks, except to save the mother’s life. At least 17 states restrict abortion after 22 weeks, with several others setting deadlines of 20 or 24 weeks or limiting abortions after fetal viability. In Louisiana, an abortion referendum proposes adding a sentence to the state constitution stating, “nothing in this constitution shall be construed to secure or protect a right to abortion or require the funding of abortion.”
  • Other health measures: Oklahomans are voting on whether to direct tobacco settlement funds to pay for some of the state’s Medicaid costs. In California voters will weigh in on funding for stem cell research, as well as a measure to increase regulations on dialysis clinics, which has the backing of the Service Employees International Union but is fiercely opposed by the dialysis industry. Washington voters, meanwhile, will see a ballot initiative that would require public schools to implement comprehensive sex education. In Colorado, voters will decide whether to create a paid 12-16 week family and medical leave program.

Coronavirus latest

Hospitals are scrambling to make up for nursing shortages as coronavirus cases spike.

“Nurses are being trained to provide care in fields where they have limited experience. Hospitals are scaling back services to ensure enough staff to handle critically ill patients. And health systems are turning to short-term travel nurses to help fill the gaps,” the Associated Press’s Tammy Webber reports. 

The shortage is especially acute for rural and small hospitals. Despite a national rise in the number of nurses over the past decade, some medical facilities went into the pandemic already short-staffed. Compounding the problem is the fact that some nurses have left the profession during the pandemic. 

“[T]he departures are not surprising, according to experts, considering not only the mental toll but the fact that many nurses trained in acute care are over 50 and at increased risk of complications if they contract COVID-19, while younger nurses often have children or other family to worry about,” Webber writes.

San Diego-based Aya Healthcare, which recruits and deploys travel nurses, said that demand for their services has more than doubled since the early pandemic. Meanwhile, some state governments have stepped in to help send assistance to the most acute regions. 

“In Texas, Gov. Greg Abbott recently announced he was sending 75 nurses and respiratory therapists to El Paso to help handle the city’s surge. Wisconsin Gov. Tony Evers, meanwhile, issued emergency orders making it easier for nurses from elsewhere to practice in his state and for retired nurses to come back,” Webber writes.

Abortion in the news

The Supreme Court will consider on Friday whether to take up a Mississippi abortion ban.

The Court will decide whether it wants to review a lower-court ruling that blocked a 15-week abortion ban from going into effect. The justices were originally set to consider the case last Friday but bumped the conference to this week instead, the Mississippi Clarion Ledger reports. 

The case stems from a 2018 law that would prohibit abortions after 15 weeks, except in cases of a medical emergency or severe fetal abnormality. A federal judge ruled that the law was unconstitutional, arguing that states could not legally restrict abortion before a fetus could viably survive outside the womb.

Bloomberg News reporter Greg Stohr:

Politico’s Alice Miranda Ollstein:

A leading antiabortion group spent $52 million in the 2020 election cycle.

The Susan B. Anthony List, which seeks to elect antiabortion candidates, said it reached more than 8 million voters in 10 battleground states. Its president, Marjorie Dannenfelser, is co-chair of Trump’s “pro-life coalition” for his reelection bid.

“The 2020 election cycle marks SBA List’s biggest campaign effort yet at a time when the stakes for unborn children have never been higher,” said the group’s spokeswoman, Mallory Quigley.

Elsewhere in health care

Georgia can block its residents from shopping on Healthcare.gov.

“The Trump administration has approved a plan to scrap the website in the swing state of Georgia,” Vox’s Dylan Scott writes. “In a Sunday announcement, which is highly unusual timing, as several health care experts noted, the US Department of Health and Human Services announced it had approved a plan from Georgia Gov. Brian Kemp to close Healthcare.gov to his state’s residents. They will instead be asked to shop for health insurance through brokers or on private websites.”

Centers for Medicare and Medicaid Services Administrator Seema Verma accused the Obamacare exchanges of leaving Georgians with “fewer options and skyrocketing premiums.” But Georgia’s uninsured rate is five points lower than it was before the Affordable Care Act went into effect, and almost all of the 430,000 individuals who buy their insurance through Healthcare.gov receive premium subsidies created by the law.

The waiver could confuse some consumers who have been using Healthcare.gov for years. Meanwhile, private companies could steer some consumers towards plans that don’t cover preexisting conditions. Experts at the Brookings Institute think tank estimate that the disruption caused by the waiver could lead to tens of thousands of Georgians losing their insurance. If so, the new plan may be illegal under the ACA, since the program it was approved under requires that waivers can’t result in people losing coverage.

“The US uninsured rate was already increasing under Trump, and it could still get worse if he’s reelected. Even if Trump’s bid to get the Supreme Court to overturn Obamacare fails, he would have four more years to approve proposals like this. The only limitations would be whether states would want to take up the administration’s preferred policies — and clearly some, like Georgia, are — and whether the increasingly conservative judiciary would stop them,” Dylan writes.

Sugar rush

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