COVID-19 ongoing thread part 2

[Tribble]

David Pakman brought up a good point. With Americans barred from entry to other countries, those who rely on drugs from Canada and Mexico are no longer able to do so.
https://www.youtube.com/watch?v=Hblc81UzyhE

If you don't want to watch a youtube video, a quick google search shows CNN wrote a piece on this issue.

https://edition.cnn.com/2020/08/31/amer ... index.html

Only 1.5% of American adults who take prescription medications buy their drugs abroad, according to a June analysis by researchers at the University of Florida Gainesville, based on a 2015-2017 National Health Interview Survey.
But that's still an estimated 2.3 million people.
Many medicines and medical services are cheaper in neighboring Canada and Mexico, thanks to price controls and the power of the US dollar. The difference is great enough that US insurer PEHP, which covers Utah's state employees, offers partially paid trips to Vancouver and Tijuana "to help you save money on your prescriptions." In popular Mexican resort towns like Cabo San Lucas on the West Coast, or Tulum on the East Coast, pharmacies, doctors and dentists targeting US clientele dot the main drag, their prices on bright display. And the difference between those prices and the costs of the same drugs at US pharmacies can mean life or death.

Maybe instead of trying to poach cheaper drugs from other countries (which could potentially drive up costs in those countries depending on the degree) Americans should regulate their pharmaceutical sector better?

[Batman]

Yeah. That'll happen.
The purpose of the US medical and pharmaceutical sector isn't to help people get better. It's to make rich people get richer.

[Tribble]

Yeah. That'll happen.
The purpose of the US medical and pharmaceutical sector isn't to help people get better. It's to make rich people get richer.

And the purpose of the Canadian medical and pharmaceutical sector... should be to provide medical and pharmaceutical care to Canadians first. So long as Americans aren’t straining our capacity and/or causing large price increases that’s fine, but I am concerned of the long term implications.

[mr friendly guy]

Maybe instead of trying to poach cheaper drugs from other countries (which could potentially drive up costs in those countries depending on the degree) Americans should regulate their pharmaceutical sector better?

That would first require Americans to understand the flaws of their health system and not be bamboozled by weasel words from politicians. Remember the guy celebrating the passing of anti Obama care legislation on facebook while proudly saying he was on the Affordable Care act without realising they were the same thing?

[Tribble]

Maybe instead of trying to poach cheaper drugs from other countries (which could potentially drive up costs in those countries depending on the degree) Americans should regulate their pharmaceutical sector better?

That would first require Americans to understand the flaws of their health system and not be bamboozled by weasel words from politicians. Remember the guy celebrating the passing of anti Obama care legislation on facebook while proudly saying he was on the Affordable Care act without realising they were the same thing?

Ya I remember.

However, the solution should not be, in essence “raid other countries’ stockpiles of drugs”.

I mean, I know that’s a typical American style solution to a problem but still.

Problem for us is that if there is enough demand from
Americans doing that it could end up heavily increasing prices and/or causing shortages over here.

Assuming we remain a quasi-independent vassal state of course. The odds of a total US takeover are increasing, particularly if the current fascists remain in power.

More on topic, I wonder if/when America Is going to force Canada to open up its border? It’s kinda hard to tell cause Trump likes to keep American borders closed anyways, but I can see business lobbyists demanding something at some point.

[madd0ct0r]

Nice introductory article on Berkson's paradox paradox or collidor bias, explaining the strange result that smoking more protects you from covid: https://rss.onlinelibrary.wiley.com/doi ... 9713.01413

But basically the population being tested were people hospitalised. You are more likely to be hospitalised if you have bad covid or if you are a heavy smoker. So testing that group finds people with covid are less likely to smokers and smokers are less likely to have covid. It's an artifact of the non random sampling.

[FireNexus]

I got tested this morning. I have been careful. Social distancing, not socializing, basically only leaving the house to grocery shop and masking up the whole time. But all those measures are to restrict the virus. And without the proper controls from the top, they are not super effective. So here I am.

I have to say, though, the emotion of almost hoping, in a deep dark part of myself, that it turns out to be COVID so I can either die or get on with my life... It gives me a newfound sympathy for gay guys who got so stressed over HIV they went out trying to be infected. I don’t agree with them, and I think it’s an extreme and wrong reaction. But I get where they are emotionally in a way I never thought I would.

It’s not COVID, which is a relief. But tbh, it would have also been a relief if it was.

[mr friendly guy]

Just saw this in my subscription, apparently there was a conspiracy theory by the QAnon guys with Trump retweeting the claim that the CDC updated its figures to say only 9000 died from COVID.

https://www.snopes.com/fact-check/cdc-m ... tatistics/

Snopes goes to debunk the claim, but this is what I found interesting and quite telling about some Right Wingers.

Many believers, including conspiracy theorist Jeff Berwick, dubbed the alleged change by the CDC evidence that people other than his followers were exaggerating the seriousness of the pandemic, and that everyone should be skeptical of rules on social distancing that halt the economy. In a Sept. 1 video, for example, he said: “It’s been proven by the CDC — [the pandemic] is nothing, it was absolutely nothing. Zero. 9,000 people? That’s nothing.”

9000 deaths is "nothing." Um, that's three 9/11s. America went to war with two countries over 9/11 including one which had nothing to do with it, and now 9000 deaths is nothing. I am pretty sure the FBI aren't going to ignore serial killers until they have over 9000 victims.

[mr friendly guy]

This is breaking, but the Oxford vaccine with Astrazeneca has its trial put on hold after adverse reaction.
https://www.abc.net.au/news/2020-09-09/ ... a/12643812

Oxford coronavirus vaccine trial on hold over 'potentially unexplained illness', AstraZeneca says
Posted 53mminutes ago, updated 5mminutes ago

The Oxford University coronavirus vaccine trial has been halted in what drug maker AstraZeneca described as a "routine" action taken when there is a potentially unexplained illness among participants.

The Federal Government last month signed an agreement with the UK-based company to secure the potential COVID-19 vaccine developed by Oxford University, if its trials prove successful.

In a statement, AstraZeneca said it "voluntarily paused" the trial to allow a review of the "single event" by an independent committee.

"This is a routine action which has to happen whenever there is a potentially unexplained illness in one of the trials, while it is investigated, ensuring we maintain the integrity of the trials," the statement said.

"In large trials illnesses will happen by chance but must be independently reviewed to check this carefully."

50,000 participating in trials
The Oxford vaccine produced an immune response in its first human trials, underlining its position as one of the leading candidates in the race to combat a virus that has led to hundreds of thousands of deaths and crippled the global economy.

The trial's lead scientist, Andrew Pollard, said last month Oxford had enrolled about 20,000 people in trials across Britain, Brazil and South Africa, with AstraZeneca leading a US trial of 30,000 people.

Professor Pollard had said trial data for the possible vaccine could potentially be given to regulators this year.

It is not known how the latest development will affect the timeline.

Australia’s Deputy Chief Medical Officer Nick Coatsworth said the move "by no means puts that vaccine completely off the table".

"It would be fairly standard process if there's a very severe reaction and they are not sure whether it's attributable to the vaccine or not, to gather the information and holding the trial for the moment," he said on Seven’s Sunrise program.

"We've got to keep in mind the tens of thousands of people have now received this vaccine, so this is a testimony to the rigor and the safety focus that people are putting on vaccine development."

He said the Government was investing in "multiple technologies, multiple potential vaccines" to offset setbacks encountered by any single vaccine.

There are more than 160 vaccine candidates in various stages of development around the world.

This could be purely by chance, but it will likely delay roll out of this vaccine even if it eventually turns out to be successful.

[MKSheppard]

David Pakman brought up a good point. With Americans barred from entry to other countries, those who rely on drugs from Canada and Mexico are no longer able to do so.
https://www.youtube.com/watch?v=Hblc81UzyhE

Trump EO 13938 of July 24, 2020 titled Executive Order on Increasing Drug Importation to Lower Prices for American Patients

https://www.whitehouse.gov/presidential ... -patients/

[mr friendly guy]

David Pakman brought up a good point. With Americans barred from entry to other countries, those who rely on drugs from Canada and Mexico are no longer able to do so.
https://www.youtube.com/watch?v=Hblc81UzyhE

Trump EO 13938 of July 24, 2020 titled Executive Order on Increasing Drug Importation to Lower Prices for American Patients

https://www.whitehouse.gov/presidential ... -patients/

Thanks for letting me know. I wasn't aware of this. It would be interesting to see in a few months just how much prices, particularly insulin drops.

---------------------
In other COVID related news.

England bans gatherings of more than six as coronavirus cases spike

It just seems to be in England and not the rest of the UK AFAIK. It seems like Europe is having issues dealing with the second wave, especially when Coronavirus fatigue sets in. We are already seeing protests against restrictions.

[mr friendly guy]

More on that European second wave
https://people.com/health/record-breaki ... cond-wave/

Record-Breaking Coronavirus Cases in France and Spain Raise Concerns of a Second Wave in Europe
Both countries have seen their highest rates of daily infections over the last week — but without spikes in hospitalizations or deaths

By Julie Mazziotta September 08, 2020 02:03 PM

France and Spain are experiencing record-breaking numbers of new COVID-19 cases, raising concerns that Europe is now seeing a second wave of infections.

Both countries have recorded their highest rates of daily infections in the last week, topping their caseloads from March, when they went into full lockdowns. For now, though, there has not been a spike in hospitalizations or deaths.

On Friday, France had 8,975 new COVID-19 cases, nearly 1,500 more than their record of 7,578 from March 31, according to The New York Times. Spain, meanwhile, reported 10,476 new cases that day, surpassing its high from April 1 of 9,701.

Italy and the United Kingdom are also trending upwards again, with 1,150 and 2,948 cases, respectively, on Monday. However, they are both still far below their pre-lockdown numbers.

The rise in cases have European officials worried about a second wave of COVID-19 as citizens return from August vacations and kids head back to school. Though the virus was still circulating around Europe over the summer, springtime lockdowns lowered case levels and Europeans were able to travel during the warmer months.

But while case numbers jumped in Spain and France, hospitalizations and deaths are still down, and the new infections are primarily in younger people. Currently, less than 500 people are in France’s intensive care wards for COVID-19, well below the 8,000 hospitalized at the peak of the pandemic, NBC News reported. Some experts speculate that robust testing programs are helping to identify cases in asymptomatic young people before they spread it to more vulnerable populations.

“For the moment, the important number is the number of sick persons, and the number of sick people is not increasing,” Laurent Toubiana, a leading epidemiologist at the French Institute of Health and Medical Research, told NBC News. “The number of deaths are not increasing. So, we shouldn’t be getting worked up.”

Infections are rising, though, in older people, Ammon, from the ECDC, said.

"In August ... we are seeing more that also [an] older population is affected, indicating that it's really a true increase in transmission," she said, according to CNN.

In response, Italy and Spain have closed nightclubs and mandated masks in public — a requirement that France put in place in July. The countries are hoping to avoid another full lockdown.

COVID-19 infections in Europe, however, are still far below the consistently high numbers in the U.S., which has the most in the world, ahead of India and Brazil. As of Tuesday morning, more than 6,317,200 people in the U.S. have tested positive for COVID-19, and at least 189,076 Americans have died from the virus, according to the Times.

[PainRack]

David Pakman brought up a good point. With Americans barred from entry to other countries, those who rely on drugs from Canada and Mexico are no longer able to do so.
https://www.youtube.com/watch?v=Hblc81UzyhE

Trump EO 13938 of July 24, 2020 titled Executive Order on Increasing Drug Importation to Lower Prices for American Patients

https://www.whitehouse.gov/presidential ... -patients/

Thanks for letting me know. I wasn't aware of this. It would be interesting to see in a few months just how much prices, particularly insulin drops.

---------------------
In other COVID related news.

England bans gatherings of more than six as coronavirus cases spike

It just seems to be in England and not the rest of the UK AFAIK. It seems like Europe is having issues dealing with the second wave, especially when Coronavirus fatigue sets in. We are already seeing protests against restrictions.

Mk Sheppard didn't post Azar comment that he hoped this would force European countries to raise their prices, fucking drug shrill.


Also, isn't it strange that you have to resort to importing Canadian drugs, when much of Canadian drugs are sources from the US?

https://www.canadadrugshortage.com/causes/

So... Hurricanes in Puerto Rico and Texas can cause drug shortages in Canada. Yet, the solution is obviously to allow imports of drugs from Canada that are bought from US.

[PainRack]

Hmm...can't seem to find the news source that had Azar talking about companies raising prices past year in Jun but ultimately, this won't cover insulin and other biologics.

https://www.mdedge.com/hematology-oncol ... im-address

This has been on the cards since June 2019, with Dec 2019 being the announcement and release for commentary and etc. Trump EO does nothing other than say yeah , I support this.

[mr friendly guy]

To further expose the rort that is the US health system.

https://www.propublica.org/article/a-do ... ost-10-984

A Doctor Went to His Own Employer for a COVID-19 Antibody Test. It Cost $10,984.
Physicians Premier ER charged Dr. Zachary Sussman’s insurance $10,984 for his COVID-19 antibody test even though Sussman worked for the chain and knows the testing materials only cost about $8. Even more surprising: The insurer paid in full.

by Marshall Allen Sept. 5, 5 a.m. CDT

Guess how much the materials for the test actually cost?

When Dr. Zachary Sussman went to Physicians Premier ER in Austin for a COVID-19 antibody test, he assumed he would get a freebie because he was a doctor for the chain. Instead, the free-standing emergency room charged his insurance company an astonishing $10,984 for the visit — and got paid every penny, with no pushback.

The bill left him so dismayed he quit his job. And now, after ProPublica’s questions, the parent company of his insurer said the case is being investigated and could lead to repayment or a referral to law enforcement.

The case is the latest to show how providers have sometimes charged exorbitant prices for visits for simple and inexpensive COVID-19 tests. ProPublica recently reported how a $175 COVID-19 test resulted in charges of $2,479 at a different free-standing ER in Texas. In that situation, the health plan said the payment for the visit would be reduced and the facility said the family would not receive a bill. In Sussman’s case, the insurer paid it all. But those dollars come from people who pay insurance premiums, and health experts say high prices are a major reason why Americans pay so much for health care.

Sussman, a 44-year-old pathologist, was working under contract as a part-time medical director at four of Physicians Premier’s other locations. He said he made $4,000 a month to oversee the antibody tests, which can detect signs of a previous COVID-19 infection. It was a temporary position holding him over between hospital gigs in Austin and New Mexico, where he now lives and works.

In May, before visiting his family in Scottsdale, Arizona, Sussman wanted the test because he had recently had a headache, which can be a symptom of COVID-19. He decided to go to one of his own company’s locations because he was curious to see how the process played out from a patient’s point of view. He knew the materials for each antibody test only amounted to about $8, and it gets read on the spot — similar to an at-home pregnancy test.

He could even do the reading himself. So he assumed Physicians Premier would comp him and administer it on the house. But the staff went ahead and took down his insurance details, while promising him he would not be responsible for any portion of the bill. He had a short-term plan through Golden Rule Insurance Company, which is owned by UnitedHealthcare, the largest insurer in the country. (The insurance was not provided through his work.)

During the brief visit, Sussman said he chatted with the emergency room doctor, whom he didn’t know. He said there was no physical examination. “Never laid a hand on me,” he said. His vitals were checked and his blood was drawn. He tested negative. He said the whole encounter took about 30 minutes.

About a month later, Golden Rule sent Sussman his explanation of benefits for the physician portion of the bill. The charges came to $2,100. Sussman was surprised by the expense but he said he was familiar with the Physicians Premier high-dollar business model, in which the convenience of a free-standing ER with no wait comes at a cost.

“It may as well say Gucci on the outside,” he said of the facility. Physicians Premier says on its website that it bills private insurance plans, but that it is out-of-network with them, meaning it does not have agreed-upon prices. That often leads to higher charges, which then get negotiated down by the insurers, or result in medical bills getting passed on to patients.

Sussman felt more puzzled to see the insurance document say, “Payable at: 100%.” So apparently Golden Rule hadn’t fought for a better deal and had paid more than two grand for a quick, walk-in visit for a test. He was happy not to get hit with a bill, but it also didn’t feel right.

He said he let the issue slide until a few weeks later when a second explanation of benefits arrived from Golden Rule, for the Physicians Premier facility charges. This time, an entity listed as USA Emergency sought $8,884.16. Again, the insurer said, “Payable at: 100%.”

USA Emergency Centers says on its website that it licenses the Physicians Premier ER name for some of its locations.

Now Sussman said he felt spooked. He knew Physicians Premier provided top-notch care and testing on the medical side of things. But somehow his employer had charged his health plan $10,984.16 for a quick visit for a COVID-19 test. And even more troubling to Sussman: Golden Rule paid the whole thing.

Sussman was so shaken he resigned. “I have decided I can no longer ethically provide Medical directorship services to the company,” he wrote in his July 13 resignation email. “If not outright fraudulent, these charges are at least exorbitant and seek to take advantage of payers in the midst of the COVID19 pandemic.”

Sussman agreed to waive his patient privacy so officials from the company could speak to ProPublica. USA Emergency Centers declined interview requests and provided a statement, saying “the allegations are false,” though it did not say which ones.

The statement also said the company “takes all complaints seriously and will continue to work directly with patients to resolve issues pertaining to their emergency room care or bill. …The allegations received pertain to a former contracted employee, and we cannot provide details or further comment at this time.”

Physicians Premier advertises itself as a COVID-19 testing facility on its website, with “results in an hour.” According to the claims submitted by Physicians Premier to Golden Rule, obtained by Sussman, the physician fee and facility fees were coded as emergency room visits of moderate complexity. That would mean his visit included an expanded, problem-focused history and examination. But Sussman said the staff only took down a cursory medical history that took a few minutes related to his possible exposure to COVID-19. And he said no one examined him.

The claims also included codes for a nasal swab coronavirus test. But that test was not performed, Sussman said. The physician’s orders documented in the facility’s medical record also do not mention the nasal swab test. Those charges came to $4,989.

The claims show two charges totaling $1,600 for the antibody test Sussman received. In a spreadsheet available on its website on Friday, Physicians Premier lists a price of $75 for the antibody test.

For comparison, Medicare lists its payment at $42.13 for COVID-19 antibody tests. That’s because Medicare, the government’s insurance plan for the disabled and people over 65, sets prices.

Complicating matters, Texas is the nation’s epicenter for free-standing emergency rooms that are not connected to hospitals. Vivian Ho, an economist at Rice University who studies the facilities, said their business model is based on “trying to mislead the consumer.” They set up in locations where a high proportion of people have health insurance, but they don’t have contracted rates with the insurers, Ho said. They are designed to look like lower-priced urgent care centers or walk-in clinics, Ho said, but charge much higher emergency room rates. (The centers have defended their practices, saying that they clearly identify as emergency rooms and are equipped to handle serious emergencies, and that patients value the convenience.)

The day after he resigned, Sussman texted an acquaintance who works as a doctor at Physicians Premier. The acquaintance said the facility typically only collects a small percentage of what gets billed. “I just don’t want to be part of the game,” Sussman texted to him.

Shelley Safian, a Florida health care coding expert who has written four books on medical coding, reviewed Sussman’s medical records and claims at ProPublica’s request. The records do not document a case of a complex patient that would justify the bills used to code the patient visit, she said. For example, the chief complaint is listed as: “A generic problem (COVID TESTING).” Under “final acuity,” the medical record says, “less urgent.” Under the medical history it says, “NO SYMPTOMS.”

Safian described the charges as “obscene” and said she was shocked the insurer paid them in full. “This is the exact opposite of an employee discount,” she said. “Obviously nobody is minding the store.”

Congress opened the door to profiteering during the pandemic when it passed the CARES Act. The legislation, signed into law in March, says health insurers must pay for out-of-network testing at the cash price a facility posts on its website, or less. But there may be other charges associated with the tests, and insurers generally have tried to avoid making patients pay any portion of costs related to COVID-19 testing or treatment.

The charges for Sussman’s COVID-19 test visit are “ridiculous,” said Niall Brennan, president and CEO of the Health Care Cost Institute, a nonprofit organization that studies health care prices. Brennan wondered whether the CARES Act has made insurers feel legally obligated to cover COVID-19 costs. He called it “well intentioned” public policy that allows for “unscrupulous behavior” by some providers. “Insurance companies and patients are reliant on the good will and honesty of providers,” Brennan said. “But this whole pandemic, combined with the CARES Act provision, seems designed for unscrupulous medical providers to exploit.”

It’s illegal for medical providers to charge for services they did not provide. But ProPublica has previously reported how little insurers, including UnitedHealthcare, do to prevent fraud in their commercial health plans, even though experts estimate it consumes about 10% of all health care costs. For-profit insurance companies don’t want to spend the time and money it takes to hold fraudulent medical providers accountable, former fraud investigators have told ProPublica. Also, the insurance companies want to keep providers in their networks, so they easily cave.

In mid-July, Sussman used the messenger system on Golden Rule’s website to report his concerns about the case. Short-term health plans are typically less expensive because they offer less comprehensive coverage. Sussman said he appreciated that his plan covered the charges, and felt compelled to tell the company what had happened.

That led to a phone conversation with a fraud investigator. They went line by line through the charges and Sussman told him many of the services had not been provided. “His attitude was kind of passive,” Sussman said of the fraud investigator. “There was no indignation. He took in stride, like, ‘Yep, that’s what happens.’” The investigator said he would escalate the case and see if the facility had submitted any other suspect claims. But Sussman never heard back.

Maria Gordon-Shydlo, a spokeswoman for UnitedHealthcare, which owns Golden Rule, would not provide anyone to be interviewed. She said in an emailed statement that the company’s first priority during the pandemic “has been to ensure our members get the care they need and are not billed for COVID testing and treatment. Unfortunately, there are some providers who are trying to take advantage of this and are inappropriately or even fraudulently billing.”

“Golden Rule has put processes in place to address excessive COVID-related billing,” the statement said. “We are currently investigating this matter and, if appropriate, will seek to recoup any overpayment and potentially refer this case to law enforcement.”

Golden Rule’s 100% payment of the charges may simply come down to “incompetence,” said Dr. Eric Bricker, a Texas internist who spent years running a company that advised employers who self-fund their insurance. Insurance companies auto-adjudicate millions of claims on software that may be decades old, said Bricker, who produces videos to help consumers and employers understand health care. If bills are under a certain threshold, like $15,000, they may sail through and get paid without a second look, he said.

UnitedHealth Group reported net earnings of $6.6 billion in the second quarter of 2020. Bricker said the company may be paying bills without questioning them because it doesn’t “want to create any noise” by saying no at a time its own earnings are so high, Bricker said.

Texas has a consumer protection law that’s designed to prevent businesses from exploiting the public during a disaster. The attorney general’s office has received and processed 52 complaints about health care businesses and billing or price gouging related to the pandemic, a spokeswoman from the office said in an email. The agency does not comment on the existence of any investigations, but has not filed any cases related to overpriced COVID-19 tests.

Sussman said he got one voicemail from a billing person at Physicians Premier, saying she wanted to explain the charges, but he did not call back. He said he spoke out about it to ProPublica because he opposes Medicare-for-all health care reform proposals. Bad actors in the profession could cause doctors to lose their privilege to bill and be reimbursed independently, he said. Most physicians are fair with their billing, or even conservative, he said. “If instances like these go unchecked it will provide more ammo for advocates of a single-payer system.”

Did you guess correctly? The materials only cost $8.

[PainRack]

To further expose the rort that is the US health system.

https://www.propublica.org/article/a-do ... ost-10-984

A Doctor Went to His Own Employer for a COVID-19 Antibody Test. It Cost $10,984.
Physicians Premier ER charged Dr. Zachary Sussman’s insurance $10,984 for his COVID-19 antibody test even though Sussman worked for the chain and knows the testing materials only cost about $8. Even more surprising: The insurer paid in full.

by Marshall Allen Sept. 5, 5 a.m. CDT

Guess how much the materials for the test actually cost?

When Dr. Zachary Sussman went to Physicians Premier ER in Austin for a COVID-19 antibody test, he assumed he would get a freebie because he was a doctor for the chain. Instead, the free-standing emergency room charged his insurance company an astonishing $10,984 for the visit — and got paid every penny, with no pushback.

The bill left him so dismayed he quit his job. And now, after ProPublica’s questions, the parent company of his insurer said the case is being investigated and could lead to repayment or a referral to law enforcement.

The case is the latest to show how providers have sometimes charged exorbitant prices for visits for simple and inexpensive COVID-19 tests. ProPublica recently reported how a $175 COVID-19 test resulted in charges of $2,479 at a different free-standing ER in Texas. In that situation, the health plan said the payment for the visit would be reduced and the facility said the family would not receive a bill. In Sussman’s case, the insurer paid it all. But those dollars come from people who pay insurance premiums, and health experts say high prices are a major reason why Americans pay so much for health care.

Sussman, a 44-year-old pathologist, was working under contract as a part-time medical director at four of Physicians Premier’s other locations. He said he made $4,000 a month to oversee the antibody tests, which can detect signs of a previous COVID-19 infection. It was a temporary position holding him over between hospital gigs in Austin and New Mexico, where he now lives and works.

In May, before visiting his family in Scottsdale, Arizona, Sussman wanted the test because he had recently had a headache, which can be a symptom of COVID-19. He decided to go to one of his own company’s locations because he was curious to see how the process played out from a patient’s point of view. He knew the materials for each antibody test only amounted to about $8, and it gets read on the spot — similar to an at-home pregnancy test.

He could even do the reading himself. So he assumed Physicians Premier would comp him and administer it on the house. But the staff went ahead and took down his insurance details, while promising him he would not be responsible for any portion of the bill. He had a short-term plan through Golden Rule Insurance Company, which is owned by UnitedHealthcare, the largest insurer in the country. (The insurance was not provided through his work.)

During the brief visit, Sussman said he chatted with the emergency room doctor, whom he didn’t know. He said there was no physical examination. “Never laid a hand on me,” he said. His vitals were checked and his blood was drawn. He tested negative. He said the whole encounter took about 30 minutes.

About a month later, Golden Rule sent Sussman his explanation of benefits for the physician portion of the bill. The charges came to $2,100. Sussman was surprised by the expense but he said he was familiar with the Physicians Premier high-dollar business model, in which the convenience of a free-standing ER with no wait comes at a cost.

“It may as well say Gucci on the outside,” he said of the facility. Physicians Premier says on its website that it bills private insurance plans, but that it is out-of-network with them, meaning it does not have agreed-upon prices. That often leads to higher charges, which then get negotiated down by the insurers, or result in medical bills getting passed on to patients.

Sussman felt more puzzled to see the insurance document say, “Payable at: 100%.” So apparently Golden Rule hadn’t fought for a better deal and had paid more than two grand for a quick, walk-in visit for a test. He was happy not to get hit with a bill, but it also didn’t feel right.

He said he let the issue slide until a few weeks later when a second explanation of benefits arrived from Golden Rule, for the Physicians Premier facility charges. This time, an entity listed as USA Emergency sought $8,884.16. Again, the insurer said, “Payable at: 100%.”

USA Emergency Centers says on its website that it licenses the Physicians Premier ER name for some of its locations.

Now Sussman said he felt spooked. He knew Physicians Premier provided top-notch care and testing on the medical side of things. But somehow his employer had charged his health plan $10,984.16 for a quick visit for a COVID-19 test. And even more troubling to Sussman: Golden Rule paid the whole thing.

Sussman was so shaken he resigned. “I have decided I can no longer ethically provide Medical directorship services to the company,” he wrote in his July 13 resignation email. “If not outright fraudulent, these charges are at least exorbitant and seek to take advantage of payers in the midst of the COVID19 pandemic.”

Sussman agreed to waive his patient privacy so officials from the company could speak to ProPublica. USA Emergency Centers declined interview requests and provided a statement, saying “the allegations are false,” though it did not say which ones.

The statement also said the company “takes all complaints seriously and will continue to work directly with patients to resolve issues pertaining to their emergency room care or bill. …The allegations received pertain to a former contracted employee, and we cannot provide details or further comment at this time.”

Physicians Premier advertises itself as a COVID-19 testing facility on its website, with “results in an hour.” According to the claims submitted by Physicians Premier to Golden Rule, obtained by Sussman, the physician fee and facility fees were coded as emergency room visits of moderate complexity. That would mean his visit included an expanded, problem-focused history and examination. But Sussman said the staff only took down a cursory medical history that took a few minutes related to his possible exposure to COVID-19. And he said no one examined him.

The claims also included codes for a nasal swab coronavirus test. But that test was not performed, Sussman said. The physician’s orders documented in the facility’s medical record also do not mention the nasal swab test. Those charges came to $4,989.

The claims show two charges totaling $1,600 for the antibody test Sussman received. In a spreadsheet available on its website on Friday, Physicians Premier lists a price of $75 for the antibody test.

For comparison, Medicare lists its payment at $42.13 for COVID-19 antibody tests. That’s because Medicare, the government’s insurance plan for the disabled and people over 65, sets prices.

Complicating matters, Texas is the nation’s epicenter for free-standing emergency rooms that are not connected to hospitals. Vivian Ho, an economist at Rice University who studies the facilities, said their business model is based on “trying to mislead the consumer.” They set up in locations where a high proportion of people have health insurance, but they don’t have contracted rates with the insurers, Ho said. They are designed to look like lower-priced urgent care centers or walk-in clinics, Ho said, but charge much higher emergency room rates. (The centers have defended their practices, saying that they clearly identify as emergency rooms and are equipped to handle serious emergencies, and that patients value the convenience.)

The day after he resigned, Sussman texted an acquaintance who works as a doctor at Physicians Premier. The acquaintance said the facility typically only collects a small percentage of what gets billed. “I just don’t want to be part of the game,” Sussman texted to him.

Shelley Safian, a Florida health care coding expert who has written four books on medical coding, reviewed Sussman’s medical records and claims at ProPublica’s request. The records do not document a case of a complex patient that would justify the bills used to code the patient visit, she said. For example, the chief complaint is listed as: “A generic problem (COVID TESTING).” Under “final acuity,” the medical record says, “less urgent.” Under the medical history it says, “NO SYMPTOMS.”

Safian described the charges as “obscene” and said she was shocked the insurer paid them in full. “This is the exact opposite of an employee discount,” she said. “Obviously nobody is minding the store.”

Congress opened the door to profiteering during the pandemic when it passed the CARES Act. The legislation, signed into law in March, says health insurers must pay for out-of-network testing at the cash price a facility posts on its website, or less. But there may be other charges associated with the tests, and insurers generally have tried to avoid making patients pay any portion of costs related to COVID-19 testing or treatment.

The charges for Sussman’s COVID-19 test visit are “ridiculous,” said Niall Brennan, president and CEO of the Health Care Cost Institute, a nonprofit organization that studies health care prices. Brennan wondered whether the CARES Act has made insurers feel legally obligated to cover COVID-19 costs. He called it “well intentioned” public policy that allows for “unscrupulous behavior” by some providers. “Insurance companies and patients are reliant on the good will and honesty of providers,” Brennan said. “But this whole pandemic, combined with the CARES Act provision, seems designed for unscrupulous medical providers to exploit.”

It’s illegal for medical providers to charge for services they did not provide. But ProPublica has previously reported how little insurers, including UnitedHealthcare, do to prevent fraud in their commercial health plans, even though experts estimate it consumes about 10% of all health care costs. For-profit insurance companies don’t want to spend the time and money it takes to hold fraudulent medical providers accountable, former fraud investigators have told ProPublica. Also, the insurance companies want to keep providers in their networks, so they easily cave.

In mid-July, Sussman used the messenger system on Golden Rule’s website to report his concerns about the case. Short-term health plans are typically less expensive because they offer less comprehensive coverage. Sussman said he appreciated that his plan covered the charges, and felt compelled to tell the company what had happened.

That led to a phone conversation with a fraud investigator. They went line by line through the charges and Sussman told him many of the services had not been provided. “His attitude was kind of passive,” Sussman said of the fraud investigator. “There was no indignation. He took in stride, like, ‘Yep, that’s what happens.’” The investigator said he would escalate the case and see if the facility had submitted any other suspect claims. But Sussman never heard back.

Maria Gordon-Shydlo, a spokeswoman for UnitedHealthcare, which owns Golden Rule, would not provide anyone to be interviewed. She said in an emailed statement that the company’s first priority during the pandemic “has been to ensure our members get the care they need and are not billed for COVID testing and treatment. Unfortunately, there are some providers who are trying to take advantage of this and are inappropriately or even fraudulently billing.”

“Golden Rule has put processes in place to address excessive COVID-related billing,” the statement said. “We are currently investigating this matter and, if appropriate, will seek to recoup any overpayment and potentially refer this case to law enforcement.”

Golden Rule’s 100% payment of the charges may simply come down to “incompetence,” said Dr. Eric Bricker, a Texas internist who spent years running a company that advised employers who self-fund their insurance. Insurance companies auto-adjudicate millions of claims on software that may be decades old, said Bricker, who produces videos to help consumers and employers understand health care. If bills are under a certain threshold, like $15,000, they may sail through and get paid without a second look, he said.

UnitedHealth Group reported net earnings of $6.6 billion in the second quarter of 2020. Bricker said the company may be paying bills without questioning them because it doesn’t “want to create any noise” by saying no at a time its own earnings are so high, Bricker said.

Texas has a consumer protection law that’s designed to prevent businesses from exploiting the public during a disaster. The attorney general’s office has received and processed 52 complaints about health care businesses and billing or price gouging related to the pandemic, a spokeswoman from the office said in an email. The agency does not comment on the existence of any investigations, but has not filed any cases related to overpriced COVID-19 tests.

Sussman said he got one voicemail from a billing person at Physicians Premier, saying she wanted to explain the charges, but he did not call back. He said he spoke out about it to ProPublica because he opposes Medicare-for-all health care reform proposals. Bad actors in the profession could cause doctors to lose their privilege to bill and be reimbursed independently, he said. Most physicians are fair with their billing, or even conservative, he said. “If instances like these go unchecked it will provide more ammo for advocates of a single-payer system.”

Did you guess correctly? The materials only cost $8.

Wow.......I depleted my benefits and recent savings to pay for my current medical expenses but that was six months worth of prodding and poking with a PET CT scan..... Granted... The flip side is that I will definitely hit the deductible on this.


And here we were complaining that Aviva is no longer covering diagnostic scopes because they claim providers are abusing it

[FireNexus]

Trump admitted to telling Woodward he was bullshitting about “Just the flu” back in February right away. This is the first time I have ever seen an accusation that Trump said some bad shit confirmed by Trump without at least a couple of days of denials first.

I feel like this is super weird and concerning.

[Gandalf]

Not to turn it back to the election, but maybe he's hoping not to draw the story out?

Look for some crazy attention grabbing tweets soon.

[mr friendly guy]

So if Bob Woodward knew in March, that Trump as early as February was aware of how deadly COVID 19 was, why they hell did he wait until his book was published to release this information? Is he a goddamn sociopath?

Also if the Left believe this claim, will they stop blaming China for not giving the US/UK enough advance warning if the White House already knew as early as February. *

* Actually US experts already knew on Jan 1, because they were in touch with their Chinese counterparts who were already postulating bad scenarios even before human to human transmission was confirmed, but its not like facts matter to the voting public.

[FireNexus]

So if Bob Woodward knew in March, that Trump as early as February was aware of how deadly COVID 19 was, why they hell did he wait until his book was published to release this information? Is he a goddamn sociopath?

Also if the Left believe this claim, will they stop blaming China for not giving the US/UK enough advance warning if the White House already knew as early as February. *

* Actually US experts already knew on Jan 1, because they were in touch with their Chinese counterparts who were already postulating bad scenarios even before human to human transmission was confirmed, but its not like facts matter to the voting public.

An argument could be made for a strategic release of the information. “Donald Trump is lying about COVID” was known at the time, and the confirmation wouldn’t really have meant much. Same number of people (maybe more, if he tantrumed) would be dead and it wouldn’t be a release that had the impact it has now that almost 200k are dead. It made the connection between the lie and the inevitable deaths a lot more emotionally relevant.

Of course, this presupposes that we know nothing would have happened if this came out in March. Which you could easily argue is not certain. If I were betting on what happens if we rewind it and convince Woodward to go public in March, however, I would bet on a couple of news cycles of outrage followed by mostly the same stupid shit and the same number of deaths.

[mr friendly guy]

Parts of Brazil are now claiming they could produce a Chinese vaccine for mass distribution as early as December, which seems quite optimistic.
https://www.scmp.com/news/world/america ... -year-says

To give the salient points
1. Brazil's president, lets face it, is a dick and not just someone who downplayed it, so legitimate questions will be asked about how reliable the researchers are given that its being done in Brazil. In this case its done by the Instituto Butantan which wiki states is one of the major scientific centres of the world, so seems reliable at least on a quick surface glance.
https://en.wikipedia.org/wiki/Instituto_Butantan

2. US vaccine makers are also doing phase 2 and 3 trials in Brazil. So Brazil because of the high number of cases seems an attractive test area. If its unreliable, it will not just cast doubts into the research by Chinese vaccine makers, but western ones as well. In this case, it seems both sides are willing to work with Brazil in testing vaccines, so hopefully this confidence is not misplaced.

3. This vaccine if produced will be done by the local government at Sao Paulo and it runs counter to Jair Bolsanaro's preferred candidate of the Oxford Astra zeneca vaccine. The same vaccine that recently suspended trials while studying a case where a participant developed some illness. For those interested, the information hasn't been confirmed what illness yet, but it appears to be a neurological one. Its been floating around the patient developed either multiple sclerosis or transverse myelitis (inflammation of the spinal cord).

4. Bolsanaro himself is stated in the article to have tensions with China. A quick search and it reveals information I had forgotten. His idiotic son blamed China for the virus, but supposedly he made up with China. Not sure if something else happened in the interim. So political sheenanigans can still occur.

[mr friendly guy]

An argument could be made for a strategic release of the information. “Donald Trump is lying about COVID” was known at the time, and the confirmation wouldn’t really have meant much. Same number of people (maybe more, if he tantrumed) would be dead and it wouldn’t be a release that had the impact it has now that almost 200k are dead. It made the connection between the lie and the inevitable deaths a lot more emotionally relevant.

Of course, this presupposes that we know nothing would have happened if this came out in March. Which you could easily argue is not certain. If I were betting on what happens if we rewind it and convince Woodward to go public in March, however, I would bet on a couple of news cycles of outrage followed by mostly the same stupid shit and the same number of deaths.

Well Woodward has now admitted its because he needed time to confirm if what Trump said was true. So he needed a few months to confirm that COVID spread by air transmission and was more deadlier than the flu. Okaaaaay. Going by face value, than Woodward's journalistic skills seem to lie in getting people to talk to him but not so great at researching what other people have already stated or published. Of course I think you're most probably right, its strategic.. for his book sales. Its still fucked up though.

[FireNexus]

Yeah, with that said I do suspect this has had a bigger impact than it would have then. No matter what reason Woodward actually did it.

[mr friendly guy]

https://www.latimes.com/science/story/2 ... s-outbreak

The coronavirus may have reached Los Angeles even before China announced its outbreak

By KAREN KAPLANSCIENCE AND MEDICINE EDITOR
SEP. 10, 20207:45 AM
Was the novel coronavirus on the loose in Los Angeles way back in December, before the World Health Organization was even aware of an unusual cluster of pneumonia cases in Wuhan, China?

A new analysis of medical records from UCLA hospitals and clinics suggests the answer might be yes.

Researchers from UCLA and their colleagues at the University of Washington documented an unmistakable uptick in patients seeking treatment for coughs. The increase began the week of Dec. 22, 2019, and persisted through the end of February.

Some of those patients were treated in outpatient centers. Others came to emergency rooms, and some were ultimately admitted to the Ronald Reagan UCLA Medical Center or other hospitals operated by UCLA.

Officials with the U.S. Centers for Disease Control and Prevention first recognized that the coronavirus had reached American shores in mid-January, when a man in Washington state who had traveled to the area around Wuhan tested positive for an infection. By then, UCLA doctors may have treated dozens of COVID-19 patients without realizing it, the study authors wrote. (Indeed, it would take another three weeks for COVID-19 to get its official name.)

The researchers didn’t conduct any diagnostic tests, so they can’t say with certainty when doctors first encountered anyone infected with the virus that came to be known as SARS-CoV-2. But if the coronavirus had indeed been spreading under the radar since around Christmas, the pattern of patient visits to UCLA facilities would have looked a lot like what actually happened, they wrote in a study published Thursday in the Journal of Medical Internet Research.

“A significantly higher number of patients with respiratory complaints and diseases starting in late December 2019 and continuing through February 2020 suggests community spread of SARS-CoV-2 prior to established clinical awareness and testing capabilities,” wrote the team led by Dr. Joann Elmore, who is both an internist and professor of health policy and management at UCLA.

To look for signs of early COVID-19 patients, Elmore and her colleagues searched through more than 9.5 million outpatient visits, nearly 575,000 emergency room visits and almost 250,000 hospital admissions going back more than five years. Medical records that said a patient complained of a cough were included in the analysis.

The researchers counted a total of 2,938 patients who went to a clinic seeking help for a cough in the 13 weeks between Dec. 1, 2019, and Feb. 29, 2020. That was about 1,047 more than the average number of cough patients seen during the same three-month period in the previous five years. It was also about 739 more than the number of patients seen in the winter of 2016-17, which until this year had been the busiest cough season for clinics since 2014.

In emergency rooms, the researchers tallied 1,708 cough patients this past December, January and February. That was about 514 more than the average for the previous five winters, and about 229 more than in 2018-19, the busiest of the five prior winters, the researchers estimated.

Finally, the search of medical records turned up 1,138 patients who were hospitalized in December, January or February and treated for acute respiratory failure. That was about 387 more than the average number of acute respiratory failure patients admitted over the previous five winters, and about 210 more than the number admitted in the winter of 2018-19, the worst of the five earlier winters.

“It is possible that some of this excess represents early COVID-19 disease before clinical recognition and testing,” Elmore and her colleagues wrote.

Breaking things down week by week, the study authors found that the number of cough patients coming to clinics this past winter was higher by a statistically significant margin in 10 out of the 13 weeks analyzed. That was also true for cough patients in ERs in six of the 13 weeks. And inside hospitals, the number of patients with acute respiratory distress was significantly higher in seven out of the 13 weeks.

Even if only some of these “excess visits” were from patients with COVID-19, it could still be a sign that the novel coronavirus was silently spreading in and around Los Angeles, the researchers wrote. As became clear later in the pandemic, about 40% of those infected with SARS-CoV-2 never develop any symptoms of illness, and those with minor symptoms might not bother seeking medical treatment. That means the patients who did go to a clinic or hospital probably represent just the tip of the iceberg, the study authors explained.

To be sure, some of these extra cough patients probably had the regular seasonal flu, especially since flu cases peaked earlier than usual this winter, the researchers wrote. It’s also possible that the 2019 outbreak of a vaping-related respiratory illness contributed to the excess, they added.

But the idea that the coronavirus was circulating in California even before Dec. 31, when the Wuhan Municipal Health Commission first announced its cluster of unexplained pneumonia cases, might not be far-fetched.

We now know that seven patients treated at Los Angeles County-USC Medical Center in mid-March for a flu-like illness actually had COVID-19. The fact that they all felt well enough to leave their homes and had no clear ties to anyone who had recently visited a COVID-19 hotspot suggests they became infected through sustained community transmission, another group of researchers wrote in the Journal of the American Medical Assn.

Similar cases seen in Santa Clara County around the same time suggest the virus was at large in the Bay Area by then as well, according to a study in the CDC’s Morbidity and Mortality Weekly Report.

We may never know for sure exactly when the coronavirus arrived in Los Angeles — or anywhere else in the United States. Still, the results of the new study show that data gleaned from clinic medical records “can provide an early warning to emergency departments and hospital intensive care units of what is to come,” the UCLA team wrote.

“Lessons learned from this pandemic will hopefully lead to better preparation and the ability to quickly provide warnings and track the next pandemic,” they added.

[Zaune]

Well Woodward has now admitted its because he needed time to confirm if what Trump said was true. So he needed a few months to confirm that COVID spread by air transmission and was more deadlier than the flu. Okaaaaay. Going by face value, than Woodward's journalistic skills seem to lie in getting people to talk to him but not so great at researching what other people have already stated or published. Of course I think you're most probably right, its strategic.. for his book sales. Its still fucked up though.

And to be fair, if he'd released this information in early July (about the latest point at which any of the salient facts about COVID-19 were still disputed by anyone credible) it would have been lost in the background noise from all the other awful shit Trump's done since. With less than six weeks to go before the election, it's going to be fresh in people's minds.

I doubt it will matter very much, given the two possible election outcomes are "Trump wins" and "Trump incites another War of Southern Aggression", but it was worth a shot.