Incentives and statistics, oh my...

So a lot of people are complaining that government payment policies are incentivizing hospitals and doctors to specify COVID-19 on death certificates because it means they get paid, even if the patient had never tested positive for COVID-19. Aesop says that's bullshit, based mainly on the idea that a diagnosis of COVID-19 is possibly via X-rays without specific testing, combined with the idea that the treatment is expensive and the cost of the treatment is more than what the government is paying so there's no financial incentive.

They are both right, I think.

The thing about costs and incentives is -- the patient is getting treated. The costs are there and already spent. The argument that "they don't want to spend the money to treat a patient for COVID-19 because it's not profitable" ignores that the patient is already there, already treated, and in this argument, already died... the question isn't how they will be treated, it's how any treatment will be reimbursed. As such, there's absolutely a financial incentive to put down COVID-19 on the death certificate and claim some of the government cash. It's better than nothing, and the money to treat the patient at this point is already spent.

The argument that COVID-19 can be diagnosed based on X-rays and symptoms also fails even though it's not actually wrong either. Yes, a doctor can probably look at an X-ray and note things specific to COVID-19 and reach a diagnosis with reasonable accuracy. But, as noted above, they have incentives to weight the scale and, by the time you are talking about a death certificate, a dead patient for whom getting it right is no longer a priority and getting paid is.

Against those incentives, the cost of a test so that we can KNOW is at this point pretty low. We're making millions of test kits. Just run the test and reduce the false-positive rate. There's really no reason not to. That doesn't mean you can't diagnose and treat the living patient based on that X-ray and professional judgement. But the dead guy is patient (pun intended) and the benefits of better statistics and knowledge about this disease are more important than the trivial costs of running another mass-produced test.

This entry was published Wed May 20 12:10:32 CDT 2020 by TriggerFinger and last updated 2020-05-20 11:45:39.0. [Tweet]

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