re: Recordings Reveal Lockstep COVID-19 Protocols, Patient Isolation by Hospitals

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There are plenty of public hospitals.

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There are no real public hospitals. 33% of all hospital revenue is CMS.

I’ll try to address a few things. Don’t have a ton of time to post tonight.

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denial of intravenous fluids to patients

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IV fluid administration in COVID leads to more deaths and more ventilator use. Not linking evidence. Citing experience. Could find evidence if I felt like digging. No clue why they would suggest that IV fluids are some sort of “right” for a hospital patient. It has been known that giving excess fluids (basically any at all for most people capable of eating/drinking) is unnecessary and leads to harm. They aren’t benign, and they’re certainly not benign in COVID patients.

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denial of access to patients by families, attorneys, and others

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Yes. Hospitals restricted visitors to patients with communicable respiratory diseases. No one was denied phone access, and I’ve never been in a hospital that didn’t have an in-room phone.

A step further- my hospital allowed visitation in rare circumstances even at the peak(s) of the pandemic. I, (and basically every other doctor. Believe me that I’m not special here) communicate with the family of those unable to talk on a daily basis. On rare occasions, the nurse will give the update. Usually I would call whoever would have been interested in the update and would have been in the room with the patient. Sometimes multiple times a day when needed. But certainly a daily update was given unless the family left without giving contact info and never tried to make contact again.

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imposition of remdesivir on patients despite risks of kidney and liver damage from that drug

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The drug hasn’t been very helpful. Early trials (and my early experience) showed great promise. The risk of harm from this medicine is miniscule. I read this a lot on here. This drug isn’t killing people. People are dying from COVID, and this drug probably isn’t very helpful.

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possibly safer alternatives, such as ivermectin.

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It was standard for a while in my hospital. No one saw a big benefit. None of us really use it in the hospital anymore for that reason.


Unrelated to the topic at hand, I haven’t seen a huge impact on the outpatient population with it, either, unfortunately. I see a much bigger impact from being vaccinated and/or receiving mAb, regardless of vaccination status.

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the scientists stopped administering it during the study because it was leading to a mortality rate above 50 percent—higher than any of the other drugs they tested.

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Ebola itself carries about a 50% mortality rate and certain outbreaks have had nearly a 90% mortality rate- thus the hype about it. Remdesivir having the highest mortality rate of a drug tried doesn’t mean remdesivir caused death. It means it was the least effective medication unless it increased the mortality rate. The wording of this concerns me for significant bias on the part of the author, the rest of the article doesn’t really change my mind on that concern.

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He also stated that the Centers for Medicare and Medicaid Services is “bribing hospitals” to choose remdesivir with a 20 percent bonus. CMS’s website does, in fact, refer to a “20% add-on payment” for claims coding for COVID-19 and for treatment by remdesivir or several other drugs.

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Government additions are fast. Subtractions are slow. New departments and funds are created and hang around long after they are due.
I will attempt to simply explain this, but it is a complicated topic. This isn’t a defense, but there is a truly logical explanation for all of this:


Generally speaking, hospital are paid on a “DRG” or “diagnosis related group.” Doctors write notes and come up with diagnoses. Someone decided to use actuaries to “normalize” payment to hospitals at some point. So “pneumonia” buys the hospital a (made up number) $10,000 payment. If the doctor is a little more specific, the payment may be higher or lower depending on the type of pathogen at fault and the typical course required to treat most patients. That’s overly simplified and probably a 2-4 hour lecture at minimum to get your head fully around the ins/outs of it.
CMS figured out pretty early on that when someone was hospitalized with COVID, they spent longer in the hospital. They often came out as sick/sicker than they would with other similar illnesses (influenza and other viral pneumonias would probably be the most similar, but again- that’s a simplification. They’re not totally alike, and I don’t mean to say that they are here). In addition, it’s more communicable than most similar illnesses, so when it hits someone who needs rehab, a nursing home, etc, they’re more cautious about accepting them. So patients have additional days where they may sit in a hospital and don’t necessarily “need” to be in the hospital (a nursing home, rehab, SNF, etc may be more appropriate), but they can’t go because of the risk to others. Believe it or not, traditionally, if Grandma who was on the border of caring for herself at home gets the flu and needs 2-3 nights in the hospital, if this happens on a Wednesday and she would’ve been good to go to the nursing facility on Saturday but the facility can’t accept her until Monday, the hospital is generally not getting extra money/eating the cost/losing profits/even losing money on the stay (goes back to the DRG, what the amount of money is, and it doesn’t take into account how different the medical world is on Saturdays, holidays, and Mondays other than being sort of accounted for in the gross averages from which the numbers are drawn from…again- this is a complex topic)
CMS sees a cost “bubble” for COVID patients and says, “ok, here’s extra money to right this problem, because that could create a significant stress on systems that are running on less than 3% margins”
Early on, there’s a promising cure, it’s expensive, falls out of standard pricing of treating a viral illness on DRG-type spending, so they say, “ok, if you write the expensive stuff, we are going to pitch in so that patients aren’t missing out because of their, their insurance, or their hospital system’s ability to stock/afford/pay for expensive stuff”
Believe it or not, most doctors get that it’s not particularly effective. Many no longer write it. Many have tried experimental stuff I’ve never seen written about on this board (colchicine at one point was looked at with some mixed results (actually increased DVT risk if I recall but with a lower hospitalization rate and faster time to viral clearance), tricor based on some microscopic findings written about in a few case studies…lots more, too, but two examples seems like enough for a wall of text). But it was, early on, the standard. And a government edict paid for it for a good reason, and the “taking it away” part is typical government inability to quickly act in the negative (although I’d argue it would be a positive) sense. This isn’t really a case of “brother in law” back room deal stuff.


No question there’s been tons of nonsense since this all started. No question there has been overreach on the government’s part under the guise of healthcare. But I’m actually having problems reading this article and matching it to the problems I’m seeing- this seems like it is written from someone who does not fully understand what they’re dealing with. And maybe systems and events need to change (good gosh I could talk about changes I want to see). But they weren’t created or a result of all of this. They were minor modifications to a complex machine that I’m fairly certain not one person fully understands.

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Gov. Cuomo forced nursing homes in New York

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And he should be in prison. But, that has nothing to do with what the allegations are with this thread.

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How is it NOT connected?!? Cuomo in New York “trusted the experts” and overruled common sense to get infected seniors back into nursing homes and a bunch of the most vulnerable in society died.


Now that the info is out and there’s blood on his hands, he just says I listened to the experts. No one is trying to hold the experts to task, even though they’ve been wrong at every turn in this plandemic.


They blame “changing science” after they get their way and they’re choices prove to fail disastrously. But Cuomo and his team were adamant they knew what they were doing and everyone should STFU and do as they’re told. The left has been adamant on masks despite a lick of evidence they work. They brow beat the “science” when it’s on their side, and act like they’re just helpless lambs when the science proves them dead wrong.

Without analysis of what happened, were doomed to keep repeating this phenomenon where the left steam rolls anyone and everyone in their way, then blame everyone else for the ensuing disaster they created. Case in point: shutting down the economy, paying people NOT to work, then being surprised when there’s supply chain issues and mass inflation. NO shite!!!!!

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Odd. As a Respiratory therapist I can assure you that ventilators are my departments biggest money maker.

Ventilators, traches and vapotherm/Airvo = $$$.

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Charges turned into patient accounts, sure. Ask your administrator does that get to the bottom line.

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Not that I see that money.

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Nor does your hospital.

Let's say with your ventilator and ICU charges result in the total hospital bill of $100,000. Now all this goes into your next cost report but if your patient was has a DRG rate of $75,000, guess what your reimbursement is? Your ventilator contributed to that $25,000 "cost" (read loss) vs reimbursement. If the remimbursement was 75,000 and your "bill" for $50,000, you still get $75K for being efficient and doing it better.

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Not that I see that money.

Nor does your hospital.

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Right- your department’s justification for existence is the service to patients that it provides. It’s a great and valuable service. The more ventilators, the more money that goes to the respiratory department.




…for the cost of the extra techs, tubing, sterilization, daily Trach/vent care, etc.

Generally speaking, the longer a patient stays in an ICU or is ventilated, the bigger the bill and the smaller the profit to the hospital. This is generally a good thing- who would want a world where hospitals got paid extra to keep people who didn’t know any better sedated and ventilated for days on end? The idea behind the DRG (and lack of money for readmissions that also exists) is that you get people in, out, and keep them at home after (or prevent them from needing to come back in, may be the better way to think about it for the layfolk) with a hunk of change for what you didn’t spend on. So that’s why hospitals don’t do back MRIs “because the patient was already here” and all that jazz. Argue right/wrong- that’s the system in place today. This isn’t defense of it or promotion of it. Merely a simple explanation of how it is.


Again, there was a CMS “blip” on the radar. There were a lot of people who legitimately needed prolonged hospital stays, ICU stays, and vent days. This is generally a “loser” on hospital bottom lines. Most hospitals aren’t able to sustain that coupled with the government mandates shutdown of the money makers (outpatient surgery, namely), so they said, “hm. We’ll pay you more for your COVID cases and that should balance out.”



If it sounds retarded, that’s because most government decisions in healthcare are.


ETA- I wrote “techs” but should have written “therapists.” Forgive me, but I leave my mistake to accept the due shame.

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Hopeful Doc

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So how did like the total assault on your integrity as a caregiver?

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Cuomo in New York “trusted the experts”

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bullshite. It started in a nursing home in Washington state. The "experts" were fawning over Cuomo. They should all be in jail.

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So how did like the total assault on your integrity as a caregiver?

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I try not to worry about things that don’t actually affect my day to day life. Words online fall into that category. For the most part, things have been different. We have made accommodations to take care of people. Most are appreciative. Some get annoyed by different/new things we do (masking, walking outside and seeing people with respiratory illnesses in the parking lot, trying to do telehealth with the technically incapable because we try now to avoid unnecessary office visits for things that can take place that way). Most understand.

I’m not particularly reliant on online reviews, praise from patients/others. I take criticism to heart and reflect on it. When it’s something I realise I’ve done wrong or poorly, I correct it. But overall, in the real world, I haven’t seen a ton of people “lose faith” in me, my practice, or my profession.

The field of medicine is changing and rapidly. I don’t particularly like the way it’s headed. The hoops to jump through increase rapidly. The option to only accept cash in lieu of third-party payers alienates the majority of what I love about my job (I actually enjoy and feel somewhat called to care for the poor, the dumb, the unfortunate). They piss me off more than anyone else, too. But watching someone learn what I would consider to be something simple that changes their life is probably my favorite thing about my calling. When those people quit showing up and move to the other folks around town, maybe I’ll question myself and my place in the field.

But just because all the organizations that claim to represent me or attempt to guide me in my practice are basically full of shite is no reason for me to wonder if I’m full of it, too. It just confirms what I thought of them for the last 5+ years and actually makes me feel a little less crazy about the opinion

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Generally speaking, the longer a patient stays in an ICU or is ventilated, the bigger the bill and the smaller the profit to the hospital.

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I don't disagree with this at all.

Now factor in LTACs. The hospital can keep ventilators patients up to maximum reimbursement days then send them out to an LTAC. LTACs in my area are capable of taking ICU level patients...vents or otherwise. Heck...it's the very reason LTACs were invented.

I know there is only so much reimbursement...no matter how large the bill. Isn't there some form of "claw back" at the end of the fiscal year where a hospital can submit it's "losses" (the difference in the charges and actual remibursement) and be paid for some of that?

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Now factor in LTACs. The hospital can keep ventilators patients up to maximum reimbursement days then send them out to an LTAC. LTACs in my area are capable of taking ICU level patients...vents or otherwise. Heck...it's the very reason LTACs were invented.

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So here is another odd piece in a complicated puzzle (the first part is obviously not directed at you but those who aren’t so familiar):
What is an LTAC and why do they exist? Probably the best simple explanation is those patients that “linger” in the hospital (going to need to be on a vent for a while because they’re not getting better but not getting worse. Need 2-8 weeks of IV antibiotics for a complex infection but there’s no good once a day option. Here’s LTAC- they basically know what they’re getting into ahead of time (long, complex care) but it allows them to staff appropriately (the way you take care of 4 patients on Vanc Who are stable is very different than a chest painer, a pneumonia, a pre op hip fracture, and a new sepsis patient. They more or less bargain their reimbursement for these patients and the insurance company basically says, “oh, yeah, that’s an outlier, that’s a fine place for them. We’ll give you X to take care of them.”

The theory is great. The problem is the availability. When my ICU was full and we had ventilated patients in tele beds, everyone else was similar, and the LTACs were mostly full and hard to get people to. I honestly don’t know if they put up a fence at first to keep the COVID patients out- we didn’t have a huge need/attempt to transfer to LTAC at that time, and then when I started looking into it was during these peak times when I got a lot of these “long haulers” right when everyone else did. The system currently had a place for this type of care. It got saturated, boom- CMS stepped in and paid extra to “fix” the problem.

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I know there is only so much reimbursement...no matter how large the bill. Isn't there some form of "claw back" at the end of the fiscal year where a hospital can submit it's "losses" (the difference in the charges and actual remibursement) and be paid for some of that?

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I would love for some transparency in hospital accounting. This sort of thing certainly exists for “uncompensated care” IE- the “self pay” ER visits that don’t pay the bill +/- their eventual hospital stays.
In times of weirdness where a hospital is “losing” I do think there are appeal processes like you speak of. I think CMS said “it’s probably just cheaper to give them more money now and make insurances pay for COVID than to go through appeals later”


I will admit- I am not involved in hospital finances. I don’t work for a hospital. I do have privileges and admit and bill. I have a decent framework of the day to day. The minutia/bigger game that you’re getting at here is at the fringe/outside of what I am confident in talking about. And part of the reason is that it seems we never go five years without some form of surplus/bonus money or grant given for a certain thing here/there from this/that program or from this hurricane or that “disaster” ice storm that plugs budget holes.