Hospitals Say They Lose Money on Medicare Patients but Make Millions

The VA patient waiting scandal in Phoenix is well documented. What is also well documented is that at least 70% of VA medical centers were engaged in similar schemes. Now a report prepared for the North Carolina State Treasurer’s Office revealed that many state hospitals and lobbyists are also guilty of misrepresentation.  The hospitals did not lose billions of dollars on Medicare patients as they previously claimed, but in fact made large profits from 2015 to 2020 (1).

“What we’re seeing is the biggest transfer of wealth in my lifetime in North Carolina,” North Carolina state Treasurer Dale Folwell said at a press conference on Oct. 25. “It’s a transfer of wealth especially from lower fixed-income people to these big multibillion-dollar corporations who disguise themselves as nonprofits”(2). “North Carolina hospital lobbyists claimed they lost $3.1 billion on Medicare in 2020—the same year hospitals reaped $87 million in Medicare profits,” North Carolina State Health Plan (NCSHP) stated (2). NCHSP said North Carolina hospitals charge privately insured patients 280 percent of Medicare, which forces patients and employers to pay thousands of dollars more for medical care. A range of 55 to 66 percent of more than 100 hospitals profited off Medicare from 2015 through 2020 in North Carolina, the report stated. “While many hospitals’ margins fluctuated, only 15 hospitals consistently lost money on Medicare, and 35 hospitals posted profits over all six years,” the report said (1). North Carolina ranked sixth overall in the states with the most profitable Medicare margins for five of those years, averaging between -0.3 percent and 2.5 percent Medicare margins, the report stated. Arizona ranked 13^th.

“This raises serious concerns over hospitals’ commitment to their patients and their charitable mission, and the steep costs passed on to nearly 740,000 members of the State Health Plan,” the state treasurer’s office said in a press release (2). “The hospital cartel is overcharging you because they can, not because they need to,” Folwell said, adding that hospitals have been hiding behind Medicare, claiming huge losses to justify “kneecapping” their patients (2). “This is the Wild West,” Folwell said. “Nobody’s watching it. Nobody’s holding them accountable. We need a commitment from the cartel to get back to their original mission and to stop putting profits over patients.”

Despite this statement, many researchers have found that billions have poured into hospitals through the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The CARES act created the Centers for Medicare and Medicaid reimbursement plan that allowed for hospitals that adhered to protocols for treating COVID-19 to reap up to $500,000 per patient, beginning with a positive COVID-19 test, the use of a National Institutes of Health-approved antiviral drug called remdesivir, putting the patient on a ventilator, and ending with the hospital listing COVID-19 as the cause of death on a death certificate. According to a report from TN Liberty Network, an independent think tank comprising 28 researchers, hospitals have taken lucrative payoffs from the federal government throughout the last several years (3).

In addition to the CARES Act, the Coronavirus Response and Relief Supplemental Appropriations Act provided another $178 billion in relief funds to health care providers and hospitals, with more relief funds siphoned to states from the American Rescue Plan Act beginning in March of 2021, $8.5 billion of which went to health care providers.

The North Carolina Healthcare Association (NCHA) responded to the report, stating that “Instead of bringing transparency and clarity to the public, Treasurer Folwell has created an incomplete and complicated report that fails to address how he will provide more affordable healthcare to state employees and retirees,” NCHA said. “North Carolinians deserve truthful and transparent information. This report fails to deliver it.” (2).

References

1. North Carolina State Health Plan For Teachers And State Employees, Rice University’s Baker Institute For Public Policy, and the University Of Southern California’s Sol Price School Of Public Policy. Overcharged North Carolina Hospitals Profit on Medicare. 2022. Available at: https://www.shpnc.org/media/3011/download?attachment (accessed 10/29/22).
2. McGregor M. North Carolina Treasurer’s Office Says Hospitals Reaping Billions from Medicare Despite Claiming Otherwise. Epoch Times. October 28, 2022. Available at: https://www.theepochtimes.com/north-carolina-treasurers-office-says-hospitals-reaping-billions-from-medicare-despite-claiming-otherwise_4824332.html (accessed 10/29/22).
3. DePriest AJ. Blood Money in U.S. Healthcare. Financial Incentives: The Use of “Covered Countermeasures”. TN Liberty Network. August 8, 2022. Available at: https://acrobat.adobe.com/link/review?uri=urn:aaid:scds:US:a22410b7-3189-4a4a-b59a-50bdfb023de9 (accessed 10/29/22).

Cite as: Robbins RA. Hospitals Say They Lose Money on Medicare Patients but Make Millions. Southwest J Pulm Crit Care Sleep. 2022;25(4):59-60. doi: https://doi.org/10.13175/swjpccs050-22 PDF 

Trust in Science Now Deeply Polarized

The Associated Press is reporting that Republicans' faith in science is falling as Democrats rely on it even more, with a trust gap in science and medicine widening substantially during the COVID-19 pandemic, new survey data shows (Figure 1) (1).

Figure 1. Percentage of adults who say they have a great deal of confidence in the scientific community.

Overall, 48% of Americans say they have "a great deal" of confidence in the scientific community, the 2021 General Social Survey data shows. Sixty-four percent of Democrats say that, compared with roughly half as many Republicans, 34%. The gap was much smaller in 2018, when 51% of Democrats and 42% of Republicans had high confidence.

It's the largest gap in nearly five decades of polling by the General Social Survey, a widely respected trend survey conducted by NORC at the University of Chicago that has been measuring confidence in institutions since 1972. The most recent survey was conducted Dec. 1, 2020, through May 3, 2021, and includes interviews with 4,032 American adults. Results for the full sample have a margin of error of plus or minus 2 percentage points.

That is unsurprising to more than a dozen scientists reached for comment by The Associated Press, but it concerns many of them. "We are living at a time when people would rather put urine or cleaning chemicals in their body than scientifically vetted vaccines," University of Georgia meteorology professor Marshall Shepherd told the AP in an email. "That is a clear convergence of fear, lack of critical thinking, confirmation bias and political tribalism."

Science used to be something all Americans would get behind, Rice University historian Douglas Brinkley said. "But we now see it falling prey to the great partisan divide," he said. "The world of science should be a meeting house where right and left can agree on data. Instead, it's becoming a sharp razor's edge of conflict."

The deepening polarization was not evident for other institutions asked about on the poll, according to Jennifer Benz, deputy director of The Associated Press-NORC Center for Public Affairs Research. "It's certainly plausible that this is a result of how politicized the pandemic became in the months between when it emerged and when the survey ran," Benz said. "It is definitely a stark change for these particular trends on confidence in scientific leaders and leaders in medicine, to see this degree of polarization."

Kelvin Droegemeier, former science adviser to President Donald Trump, said he thinks the pandemic increased the general public's insight into how scientific research works but the ever-evolving science probably seemed chaotic at times and the urgency of the pandemic complicated policymaking. "We hear 'follow the science,' but which results? The challenge lies in how to best use the scientific results, recognizing that what appears to be an 'answer' one day may be overturned, wholly or partly, another day," Droegemeier told the AP in an email.

That messiness, sometimes weak communication and political philosophies play into the trust gap, said Marcia McNutt, president of the National Academy of Sciences, which was set up by President Abraham Lincoln to offer the federal government expert advice. Scientists and policy makers tend to be conservative — not politically but in terms of being cautious and wary of risk — pushing safety, masks and vaccines while "Republicans as a group value individual liberty," McNutt said.

John Holdren, who was President Barack Obama's science adviser, said he blames GOP leaders' "nonstop denial and deception." The consequence of declining trust in the scientific community among Republicans is clear: AP-NORC polling shows Republicans continue to be less likely than Democrats to be vaccinated. Sudip Parikh, chief executive officer of the American Association for the Advancement of Science, the world's largest general science organization, said it's clear that science has become a wedge issue for many politicians. Some have tied themselves to it, he said, and others have seen value in shooting at it "because it helps them politically."

Parikh said he found it ironic that much of the distrust in science is spread by technology — social media, smartphones — that only exists because of scientific advances. Astrophysicist Neil deGrasse Tyson agreed: "The struggle continues, trying to get the general public to embrace all of the science the way they unwittingly embrace the science in their smartphones."

At the SWJPCCS we look at these numbers as disturbing. Rather than mistrust one wonders if political expediency might be a better term. Unfortunately, it has cost many, predominately Republicans, their lives (2). Faith in a demagogue can be potentially fatal.

Richard A. Robbins, MD

Editor, SWJPCCS

References

1. Borenstein S, Fingerhut H. Americans' Trust in Science Now Deeply Polarized, Poll Shows. Associated Press. January 26, 2022. Available at: https://www.usnews.com/news/politics/articles/2022-01-26/americans-trust-in-science-now-deeply-polarized-poll-shows (accessed 1/26/22).
2. Leonhardt D. Omicron Threatens Red America. NY Times. December 17,2021. Available at: https://www.nytimes.com/2021/12/17/briefing/omicron-spread-red-america.html (accessed 1/26/22).

Cite as: Robbins RA. Trust in Science Now Deeply Polarized. Southwest J Pulm Crit Care Sleep. 2022;24:8-9. doi: https://doi.org/10.13175/swjpccs005-22 PDF

SWJPCC Associate Editor Featured in Albuquerque Journal

Dr. Dona Upson forwarded an article from Sunday’s edition of the Albuquerque Journal featured Michel Boivin, a SWJPCC Associate Editor, in an article titled, “Exhaustion in the ICU: Doctors reflect on state’s nearly 5,000 COVID-19 deaths” (1). Boivin and his wife Teri Heynekamp, a married couple who were many years at the University of New Mexico, shared their thoughts last week on New Mexico nearing 5,000 COVID-19 deaths (Figure 1).

Figure 1. Lovelace doctors Michel Boivin and Teri Heynekamp, a married couple, walk through the intensive care unit at Lovelace Medical Center in Albuquerque. They and other doctors shared their thoughts last week on New Mexico nearing 5,000 COVID-19 deaths. (Eddie Moore/Albuquerque Journal)

Yesterday was Day 587 of the COVID-19 pandemic in New Mexico, just another brief hospital scene amid 19 months of loneliness, fatigue and grief. “We feel exhausted,” Heynekamp said in an interview, “like a type of exhaustion that I’ve never experienced in my life.” Doctors and other health care providers say their workload has hardly let up. Even the arrival of safe, effective vaccines, some doctors say, has provided little relief, introducing a new dynamic instead — the knowledge that most of today’s COVID-19 deaths are preventable. People who weren’t fully vaccinated accounted for 96% of the deaths in a recent four-week period.

Dr. Steve McLaughlin, chairman of the Department of Emergency Medicine at the University of New Mexico School of Medicine, said hospital leaders throughout the country are trying to address burnout among their workforce and “moral injury” — a concept usually applied to refugees and soldiers in wartime. In health care, moral injury refers to the distress endured by doctors and others as they’re forced to provide less care than normal. The preventable nature of most COVID-19 deaths, some doctors say, has added to the psychological toll.

Heynekamp said they and other providers have faced patients and family members who doubt the severity of the disease. Some families ask for a specific medicine, such as ivermectin, an anti-parasite drug not approved for COVID-19 treatment. A recent ICU patient, Heynekamp said, insisted his COVID-19 infection wasn’t worse than the flu. Others want to go home against medical advice, she said, and some families reject vaccination even after a loved one dies. “There’s so much anger toward health care providers,” Heynekamp said. “There’s so much animosity. There’s so much mistrust. “We’ve never dealt with that before.” Boivin put it this way: “The way that social media rewards disinformation and spreading lies at the expense of people’s lives has been unbelievably frustrating, as well as time consuming.”

The stress on health care providers goes well beyond coronavirus infections. New Mexico has had a long-standing shortage of doctors and nurses, especially in rural areas, and fewer beds per capita than the nation as a whole. Dr. Michel Boivin, a critical care physician at Lovelace, said a key challenge now is the scarcity of space available in larger hospitals to accept patients from smaller ones. “I had a guy who needed a pacemaker,” Boivin said, “and he was sitting in a rural New Mexico hospital for a whole day with his heart barely beating.” Before the pandemic, he said, there would have been no wait for a pacemaker-related transfer.

According to Dr. Sarah Medrick at the University of New Mexico, their state has one of the highest vaccination rates in the country (Table 1) (2).

Table 1. Vaccination Rate by State (2).

They urged people to get vaccinated, wear masks indoors and wash their hands. “I feel a lot of empathy for the families who are still losing their loved ones,” McLaughlin said. “I think it’s important to remind people that the pandemic is not over, and we have to continue to focus on the things we know can keep people safe and prevent additional deaths.” As Heynekamp walked through the seventh-floor ICU at Lovelace, she noted that she had stood in many of the rooms and watched patients say goodbye, often through a video call to loved ones.

It was, she said, a lonely way to die.

References

1. McKay D. Exhaustion in the ICU: Doctors reflect on state’s nearly 5,000 COVID-19 deaths. Albuquerque Journal. October 24, 2021. Available at: https://www.abqjournal.com/2440183/doctors-reflect-on-states-nearly-5000-covid19-deaths.html (accessed 10-25-21).
2. COVID-19 Vaccine Statistics. Our World in Data. Available at: https://www.google.com/search?q=covid-19+vaccination+rate+in+Arizona&rlz=1C1GCEA_enUS969US969&ei=jdF2YeeSEZ-e0PEP7MCJCA&ved=0ahUKEwinjYi49OXzAhUfDzQIHWxgAgEQ4dUDCA4&uact=5&oq=covid-19+vaccination+rate+in+Arizona&gs_lcp=Cgdnd3Mtd2l6EAMyBggAEBYQHjIFCAAQhgMyBQgAEIYDOgcIABBHELADOgUIABCABEoECEEYAFCl3hJYmuUSYK_sEmgBcAJ4AIABnAGIAbgGkgEDMS42mAEAoAEByAEIwAEB&sclient=gws-wiz (accessed 10-25-21).

Cite as: Robbins RA. SWJPCC Associate Editor Featured in Albuquerque Journal. Southwest J Pulm Crit Care. 2021;23:104-6. doi: https://doi.org/10.13175/swjpcc049-21 PDF 

CDC Warns of Increased Ivermectin Overdoses

The US Centers for Disease Control and Prevention (CDC) is warning of an increase in cases of ivermectin overdose due to people self-prescribing the drug in an effort to prevent or treat COVID-19 (1). Ivermectin is used to treat river blindness and intestinal roundworm infection in humans and to de-worm pets and livestock. 

A study published earlier this year showed that ivermectin killed SARS-CoV-2 in cells in vitro. The authors proposed that the medication be investigated as a cheap and easily available treatment for COVID-19. However, subsequent studies have failed to find any benefit in humans (3).

In a new communication to its Health Alert Network, the CDC says cases of overdose and misuse are rising (1). More than 88,000 prescriptions were written for the drug ivermectin in the week ending August 13, an increase of 2400% over the weekly average prior to the COVID-19 pandemic (Figure 1).

Figure 1. Ivermectin prescriptions by week (from CDC, reference 1).

Unfortunately, the signs of overdose are nonspecific but can include gastrointestinal symptoms (nausea, vomiting, and diarrhea), hypotension and altered mental status (change in consciousness, confusion, hallucinations, seizures, coma).

The CDC is asking doctors to alert their patients to the risks of ivermectin, particularly ivermectin products intended for veterinary use. Physicians might suspect ivermectin in a patient with unexplained symptoms and are encouraged to contact their local poison control for assistance.

References

1. CDC. Rapid Increase in Ivermectin Prescriptions and Reports of Severe Illness Associated with Use of Products Containing Ivermectin to Prevent or Treat COVID-19. August 26, 2021. Available at: https://emergency.cdc.gov/han/2021/han00449.asp (accessed 8/27/21).
2. Caly L, Druce JD, Catton MG, Jans DA, Wagstaff KM. The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral Res. 2020 Jun;178:104787. [CrossRef] [PubMed]
3. Popp M, Stegemann M, Metzendorf MI, Gould S, Kranke P, Meybohm P, Skoetz N, Weibel S. Ivermectin for preventing and treating COVID-19. Cochrane Database Syst Rev. 2021 Jul 28;7:CD015017. [CrossRef] [PubMed]

Cite as: Robbins RA. CDC Warns of Increased Ivermectin Overdoses. Southwest J Pulm Crit Care. 2021;23(2):62-3. doi: https://doi.org/10.13175/swjpcc038-21 PDF 

Poisoning by Hand Sanitizers

The CDC has recommended hand sanitizers as part of their strategy to prevent spread of the COVID-19 pandemic. However, some sanitizers contain high amounts of methanol and some people are drinking the sanitizers to get an alcohol high. Others have believed a rumor, circulated online, that drinking the highly potent and toxic alcohol can disinfect the body, protecting them from COVID-19 infection (1).

Banner Poison and Drug Information Center at Banner University Medical Center in Phoenix alerted the state health department, who brought in the CDC and FDA to investigate. In the CDC's Morbidity and Mortality Weekly Report from Aug. 14, the first 15 cases seen in Arizona and New Mexico were reported (2).

The FDA first alerted consumers about toxic hand sanitizers in mid-June, when the agency warned against the use of hand sanitizer products with methanol made by Eskbiochem. By Aug. 12, that list had grown to 160 brands. Prominent amongst these has been sanitizers manufactured by Global SAPI de CV from Mexico and sold under the name Blumen (3)

Besides methanol, the FDA warns, some hand sanitizers contain insufficient levels of ethyl alcohol or isopropyl alcohol, the acceptable active ingredients for hand sanitizers. In some cases, the companies with methanol in their products have voluntarily recalled them, following the FDA's recommendation. For others, the FDA has issued an import alert to stop the product from entering the country. While some hand sanitizers are marked "FDA approved," the FDA says that is a fraudulent claim, as there are none approved by the FDA.

Methanol, also called wood alcohol, can be toxic when ingested or very rarely when absorbed through the skin. Early clinical effects of methanol and ethanol poisoning are similar (e.g., headache, blurred vision, nausea, vomiting, abdominal pain, loss of coordination, and decreased level of consciousness), but persons with methanol poisoning might develop severe anion-gap metabolic acidosis, seizures, and blindness. If left untreated methanol poisoning can be fatal (5). Survivors of methanol poisoning might have permanent visual impairment, including complete vision loss; data suggest that vision loss results from the direct toxic effect of formate, a toxic anion metabolite of methanol, on the optic nerve (3).

The 15 adult patients with reported methanol poisoning including persons who were American Indian/Alaska Native (AI/AN). All had ingested an alcohol-based hand sanitizer and were subsequently admitted to a hospital. Four patients died and three were discharged with vision impairment. Persons should never ingest alcohol-based hand sanitizer, avoid use of specific imported products found to contain methanol, and continue to monitor FDA guidance (3). Clinicians should maintain a high index of suspicion for methanol poisoning when evaluating adult or pediatric patients with reported swallowing of an alcohol-based hand sanitizer product or with symptoms, signs, and laboratory findings (e.g., elevated anion-gap metabolic acidosis) compatible with methanol poisoning. Treatment of methanol poisoning includes supportive care, correction of acidosis, administration of an alcohol dehydrogenase inhibitor (e.g., fomepizole), and frequently, hemodialysis.

Richard A. Robbins MD

Editor, SWJPCC

References

1. Kathleen Doheny K. Toxic Methanol in Hand Sanitizers: Poisonings Continue. Medscape. August 17, 2020. Available at: https://www.medscape.com/viewarticle/935835?nlid=136939_5761&src=wnl_dne_200818_mscpedit&uac=9273DT&impID=2512049&faf=1#vp_1 (accessed 8/18/20).
2. Yip L, Bixler D, Brooks DE, et al. Serious Adverse Health Events, Including Death, Associated with Ingesting Alcohol-Based Hand Sanitizers Containing Methanol - Arizona and New Mexico, May-June 2020. MMWR Morb Mortal Wkly Rep. 2020;69(32):1070-1073. Published 2020 Aug 14. [CrossRef] [PubMed]
3. FDA. FDA updates on hand sanitizers consumers should not use. Current as of 8/18/20. Available at: https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-hand-sanitizers-consumers-should-not-use (accessed 8/18/20).

Cite as: Robbins RA. Poisoning by hand sanitizers. Southwest J Pulm Crit Care. 2020;21(2):54-5. doi: https://doi.org/10.13175/swjpcc047-20 PDF