Post a link to your published letter in the comments
submitted the following to the Atlanta AJC -- waiting for a response (do the papers reply to advise they will be publishing, or do we just need to follow the paper to find out?) -- comments and feedback welcome (also, should we have any coordination about who is submitting where, eg would it seem funny if the AJC received similar letters at the same time?):
Letter to editor at AJC –
Let our hospitals lead the way out of this COVID-19 Pandemic by removing out-dated financial incentives of federal bureaucrats.
In the Pandemic’s early days when we were in the haze of battle, our health care industry fought hard to provide a uniform standard of care, and this included certain additional payments for treating COVID patients. Sometimes this provided an incentive to classify patients with COVID when in fact their reason for seeking health care was not COVID.
As we move through this Pandemic and begin nearing the Endemic stage, we must adjust our financial systems back to pre-COVID, so our hospitals and medical providers may once again treat patients with measures best suited to their care and not encouraged by any financial payments. Going further, our health care system should be incentivized most of all to parallel the outcomes of their patients, rewarding those who achieve the best outcomes.
Tom A., Roswell
Here is what I submitted to Cincinnati Enquirer (100 word limit):
During the height of the pandemic, a bold, simple policy for hospital reimbursement was necessary. But with a majority now vaccinated, and the milder Omicron variant now dominant, state and federal hospital subsidies for Covid-19 treatment should be at least partially tied to patient outcomes. Hospitals deserve to be paid more for better outcomes and always paid the most if the patient lives. Conversely, there should never be a higher payout if the patient dies. Serious cases do require more work, but that doesn’t justify poorly conceived incentives. One option: revert to the reimbursement policies already in place for influenza.
Submitted to Sarasota Herald Tribune, and Bradenton Herald in Florida. (my first writing assignment so go easy😜)
In 2007, Centers for Medicare & Medicaid Services (CMS) began a star rating system to help beneficiaries find plans that would improve their health outcomes. Pharmacies and Provider reimbursement transitioned from a fee-for-service to a pay-for-performance, meaning the healthier these medical entities could keep their patients, the higher their reimbursement amount from CMS. Sounds good right? During the pandemic, CMS and the CARES Act allowed incentive payments to hospitals across America for poor COVID-19 outcomes, including financial incentives for death. Per the CMS website, some of these additional payments include: added bonus payment for each positive COVID-19 diagnosis, another bonus for a COVID-19 admission to the hospital, a 20 percent “boost” bonus payment from Medicare on the entire hospital bill for the use of remdesivir, another and larger bonus payment to the hospital if a COVID-19 patient is mechanically ventilated, more money to the hospital if the cause of death is listed as COVID-19, even if the patient did not die directly of COVID-19 and a COVID-19 diagnosis would also provide extra payments to coroners. Maybe in the beginning of the pandemic, this "incentive" was needed because we didn't understand how this virus would impact our hospitals and resources. However, now 2 years in, we have other treatment options, and a variant which seems to cause much milder symptoms, with hospitalization numbers down considerably. Shouldn't we transition our hospitals and providers back to the pay-for-performance model and incentivize them for positive outcomes instead of continuing to incentivize death?
This is what I submitted to the Traverse City (MI) Record-Eagle and the Houston Chronicle (my former and current towns):
"I am writing to you on the subject of hospital reimbursement for Covid-19 cases.
At the start of the pandemic, when there was a lot of confusion and panic, it seemed appropriate to give hospitals extra incentives for the treatment of patients with Covid-19. However, we are now nearly two years into this pandemic and I feel a one-size-fits-all reimbursement policy is no longer in the best interest of our country or, indeed, the patients.
Now that a lot more is known about Covid-19, treatments are available and the dominant strain is a lot less severe, it is time hospitals were reimbursed on the basis of good outcomes. The payment should be highest if a patient fully recovers, and hospitals most certainly should not have financial incentives for patient deaths. Hospitals should be paid the LEAST if a fully-vaccinated person dies. This type of incentive policy is a lot fairer and would give patients and their family members more confidence in a good outcome.
The ideal solution, to my mind, would be to end state and federal subsidies for Covid-19 altogether, and begin treating it the same as influenza. After all, as SARS-CoV-2 is becoming endemic – a fact that is acknowledged by the CDC itself – it will be no more virulent than the common cold. "
Submitted to the Gainesville Sun and the Ocala Star Banner
I’ve been a registered nurse for over 25 years and have seen many changes to the Medicare and Medicaid (CMS) reimbursement structures.
While a uniform financial approach made complete sense at the height of the pandemic, now, two years later, it’s illogical. With the less virulent Omicron variant, and effective treatment protocols, it only makes sense that reimbursement is tied to better patient outcomes. In fact, the current CMS approach may even encourage hospitals to utilize less effective treatment protocols in order to receive higher reimbursement. Why not allow reimbursement to incentivize hospitals towards even more positive patient outcomes? Doing so would be consistent with other current CMS reimbursement structures.
Think about it, a better plan is one where CMS pays greater reimbursements for those who survive Covid, conversely, a lesser reimbursement for the fully-vaccinated patient who dies. Of course, patients with multiple comorbidities may be the most severely affected, thus making for a much more complicated, and expensive course of care. However, the complexity and expense may serve as additional motivators to utilize only the most effective, science-backed treatments available. Positive patient outcomes and shorter length of stay result in higher reimbursements.
It seems Covid is here to stay. Perhaps, financially, we should approach it as influenza, and end state and federal subsidies. A Covid patient’s death should never result in a higher CMS reimbursement rate; it’s a hospital conflict of interest at best, and morally and ethically reprehensible, at worst.
Dear NWF Daily News,
It’s hard to say just how much light we are glimpsing at the end of the pandemic tunnel, but the current dominant variant, Omicron, has certainly reduced the impact per case compared to the previous two dominant variants. Fewer hospitalized patients and fewer deaths per million cases are no small blessing when you consider that we are being saturated with this highly contagious variant and watching active cases shoot to new daily records close to 25 million confirmed cases nationwide. That’s the good news.
The bad news is that we are still locked in a battle royale for the health of the economy, and we need to make every dollar count. When this catastrophe began, we were grabbing for straws and throwing everything but the kitchen sink at it, hoping to contain it and minimize the damage. It was a natural response to declare an emergency and appropriate trillions of dollars toward stopping it in its tracks. That didn’t work. A major portion of the spending went towards buttressing the health care system to withstand the onslaught of serious, critical and fatal cases that would ensue. Payout guidelines were established to compensate hospitals and health care providers for all COVID-19 services rendered. We could not stand by and watch medical services crumble under the weight of a pandemic. That was then. This is now.
Now we are faced with the mop up and reconciliation of all accounts relevant to the disaster. We are facing the highest inflation rate in 40 years due, in part, to the massive deficit spending we engaged in to mitigate the plague. Now, we can take a breath and try to ramp up the bilge pumps to avoid an even greater disaster, an economic meltdown.
To that end, we should probably take a serious look at re-evaluating the pay scale for COVID services. Is it unconscionable to consider that we may have motivated poor outcomes by paying more for them than good outcomes? It is common knowledge in the health care trade that the emergency funding for COVID-19 cases was well defined and readily available for those who met the criteria, the criteria being largely defined by the seriousness of the case. Would it not be in everyone’s best interest if we took this opportunity to “flip the script” and devise a compensation scale that hinged on outcomes rather than simple diagnoses? The ultimate goal of health care is to pay for healing, not simply prolonged treatment. Paying more for the losses than the wins seems counterintuitive to me. There should be enough motivation to promote therapeutic advances while reducing any monetary incentives to admit or prolong unnecessary treatment of COVID-19 patients. I realize that it is a fine line between responsible and irresponsible treatment, but we have the time to figure that out. We have the time to compare costs, treatment and outcomes to other serious respiratory ailments and adjust the pay scale accordingly. The savings might not only be measured in billions of dollars but, hopefully, human lives.
Submitted to Tampa Bay Times and Miami Herald:
I am a concerned citizen watching events unfold that I could never have imagined a few short years ago. As a society, we have relied on our medical institutions and staff to provide the best treatment options available and have never needed this more than now. While it is possible to understand why broad incentive plans were put in place early on, I wonder why after TWO years, we are not making incentive improvements. This is a standard business model and, let’s face it, hospitals are businesses too. There are more treatment options in place and Covid is now being likened to a common cold or flu. Yet, hospitals are still being more incentivized for negative outcomes than positive ones. Who hasn’t heard of someone being turned away and told to come back only if they become severely ill? It defies belief that there would ever be an incentive for the death of a patient. After all, who would want to pay a mechanic for breaking their car or worse, totaling it? Do we pay car salesmen by the number of test drives they take in a day, or only those resulting in a sale? If we continue to incentivize negative results, then that is exactly what we will get. Let us not forget the first promise of the Hippocratic Oath, “do no harm”. We need to remind the hospitals of that oath and encourage subsidies that depend upon positive patient outcomes and recoveries.
Here's what I submitted to the Tampa Bay Times on Monday:
The pandemic has changed and so should hospital subsidies for the COVID-19 virus, given that more treatments exist and Omicron is less severe than previous variants. Now that the worst is over and cases of the virus are milder, it makes more sense to compensate hospitals based on more favorable outcomes.
When things were at their worst in 2020 and early 2021, the current "one size fits all" system of subsidies and reimbursements was appropriate. Now, however, hospitals should be incentivized with higher payments for better patient outcomes. Under no circumstances should a hospital be paid more if a patient dies, especially if a fully-vaccinated patient dies.
Bill Gates recently stated that once the current Omicron surge fades, cases of the COVID-19 virus can be treated "more like seasonal flu". Therefor, the ideal solution in light of a receding pandemic would be to end state and federal COVID-19 subsidies altogether.
I did my homework. I submitted the following to Akron Beacon Journal and Cleveland Plain Dealer here in Ohio:
At the start of the pandemic, it made sense for states and the federal government to direct huge financial resources in a uniform way for hospital treatment of COVID. Now that we are about two years in, it is time to revisit policies that, at first, made sense but now no longer do. As we enter into the endemic phase of the virus, effective treatments now exist and more mild variants have become dominant.
Subsidies and reimbursements to hospitals should now be linked to positive patient outcomes; hospitals should be paid more if patients live. It is inappropriate for hospitals to be paid more for poor patient outcomes even though the most serious cases require more work. Let’s financially incentivize hospitals who are most successful in restoring patients to health, or let’s abandon financial subsidies and reimbursements entirely.
Submitted to Cincinnati Enquirer and Community Pulse Journal (Warren County) yesterday. Nothing back yet. Thanks for making it easy, Jeff!
Now it is time to take stock in our new world of Omicron.
Unlike previous variants Omicron is very mild to those who are healthy, take recommended vitamins and
work for fitness no matter their age.
Rates have been astronomical as a review of the GPH tracker will show. Nearly the entire state is red.
Looking more closely however one can see the curves are now trending downward. This morning I saw
that Florida is now experiencing a Rt less than 1.0. Georgia will do likewise.
So let us talk a bit about our healthcare system in light of our current struggle.
During the alpha and delta waves our overburdened hospitals and healthcare professionals chose a
one size fits all approach. A standard model of care was adapted which discouraged seeking healthcare
until one was in difficult shape. Then remdesivir was prescribed which in those in moderate to late stage
respiratory failure led to ventilators and too often death.
Now, even those who are shielded from what is occurring across the globe by the censored MSM realize
that there are effective therapies which have been deployed saving thousands of lives. in Japan, states of India
and countries in Africa have employed those therapies which must not be mentioned to save many thousands
of lives. Why oh why do we here in America do otherwise? You know the answer, do you not?
It is time we incentivize our healthcare system, hospitals and providers, like we have in the past with one
size fits all treatment, to treat effectively with these therapies and in doing so pay them according to patient
outcome. It would be a win for the patient and win for the hospital and doctor.
Hospitals should definitely not have financial incentives for a pathway leading to and including patient death.
Alternatively, end subsidies for Covid and begin treating as a flu.
Stay strong people. We are in this together and we should work together for perhaps not the easiest answer to
this remaining Omicron but the best outcome for each person.
Let us untie the hands of our doctors and let them live up to their individual oath for their patients.
Let us work against those whom may choose to do otherwise for financial benefit.
We are the people and we have the power to effect change to benefit all.
PUBLISHED IN THE PICKENS PROGRESS
I just submitted this to the Omaha World-Herald editor:
(I wanted to keep it short, it's just 199 words. Not sure if it'll get published and I'm okay with it. Hospital administration is not my strongest subject. Here in Omaha the current hot button issue is an "emergency" mask mandate proclaimed by our County Health Director. She has no such legal authority. Thankfully most people are not complying. A legal hearing is set for Monday January 24th).
Topic: COVID-19 treatment in hospitals
My father-in-law was recently in the hospital. Twice. Neither hospitalization was for COVID-19.
My wife and I took our kids to visit him. The hospital was eerily quiet. Different than I remember.
It got me wondering about the way things have changed over these past two years.
Hospitals have received tremendous financial incentives during the pandemic. Did the financial incentives help?
In the beginning of the pandemic and during its height, a one-size fits all financially policy seemed to be appropriate. However, now that treatments exist and the dominant variant is less severe, what if state and federal hospital subsidies and reimbursements for COVID-19 treatment were tied to patient outcomes?
Why should hospitals receive financial incentives if a COVID patient dies? What if that deceased patient was fully vaccinated?
What if we ended state and federal subsidies for COVID and began treating it the same as the common cold or flu?
What if we simply stopped giving so much attention to COVID?
My questions might never be answered, but I have a feeling the less we talk about and the less we worry about COVID, it’ll eventually become just another type of common cold.
Submitted to the Tillamook Headlight Herald (a teeny tiny weekly newspaper on the Oregon Coast) January 19, 2022 - Covid-19 Treatments and Financial Incentives in Hospitals
For over a year now State and federal hospital have been receiving and are still receiving subsidies and reimbursements for Covid-19 treatments. Many of these treatments have been regulated by the doctors and medical professionals without input or approval from the patient and the family of the patient. All hospital treatments for Covid should be at least partially tied to patient consent and outcomes.
During the height of the pandemic, when no one knew exactly what was going to work to eradicate this virus for each individual patient, hospitals could only do what they thought was appropriate, timely and cost effective. Now that proven treatments exist, and the dominant variant is far less severe, hospitals should be paid more for better outcomes. Hospitals should be paid the most if the patient lives. Hospitals should never, ever receive financial incentives for patient death even if the more serious cases require far more work. There is no justification for any medical facility receiving incentives for dead patients. Hospitals should be paid the least of any kind of incentive if a fully-vaccinated person dies. There should never be an increased payment if the patient dies. An alternative would be to completely remove state and federal subsidies for Covid and begin treating it the same as influenza.
Submitted to Tampa Bay Times yesterday, keeping my fingers crossed.
Submitted Jan 19 to the Capital Journal in Pierre, SD. It had to fit into a word-limited field, so it's pretty short on Ethos and Pathos and sounds a bit grumpy. Oh well... better next time.
Financial incentives must change so hospitals will treat people with covid on an outpatient basis before they become critically ill.
Early outpatient treatments prescribed by doctors in some states have been successful. FDA is approving early treatment therapeutics offered up by pharma. Protocols that work are freely shared by the hands-on physicians who use them.
Doctors affiliated with South Dakota hospital systems should be encouraged and freed to use all of their knowledge and skill to give early patient-centered therapeutic treatment in a clinic, and then send the person home to convalesce.
Subsidies that reward hospitals for inpatient treatment of covid should end. Hospitals should not get increased payment for treating a covid patient who dies. Financial motivations to keep covid as a special income stream for hospitalizing patients must end. Treat the patient, not the disease.
Our local newspaper is only published once a week. Here is my submission published in today's edition.