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Thanks to corona, surprise bills are ba-ack. And as you read below, you’ll see why coronabills will be a thing in 2020.
You can listen to a new podcast on this exact topic when you go to work. That is, assuming, you either work in an essential industry that you need to actually go to, such as supermarkets, first-responding or healthcare (and thank you for that!!!), or you work at a place where you can easily socially distance, such as repairing Maytags, arguably the safest job on earth.
The private equity firms that own these out-of-network practices are no doubt relieved that surprise bills have magically disappeared from the headlines — but they have not magically disappeared from your claims spend. PE firms have not suddenly decided en masse to become good citizens. Quite the opposite – their other investments are foundering, with out-of-network providers being the bright spots in their portfolio. All thanks to surprise billing.
Here are three of the Six Things You Need to Know about Coronabills.
1. There is zero chance of federal surprise billing legislation this year
Consider the rather sketchy ad campaign run in “swing districts” last year by the private equity firms owning these practices. The theme was that if doctors don’t get paid enough, there won’t be enough doctors.
Well, as effective as that campaign apparently was in 2019 (you didn’t see any surprise bill prohibition passed into law, right?), imagine how effective it would be in 2020. All they would need is a few live shots of overwhelmed emergency rooms, which aren’t exactly hard to come by.
Prediction: it’s not just that nothing will pass. You won’t even see a bill make it out of Committee this year.
2. Because your total health spending will drop precipitously in 2020, you won’t carefully parse your bills
Executives pay more attention to healthcare spending – or any budget item – when it is rising. Elective procedures and doctor visits are so far off this year that total spend will decline. Hence you probably won’t even notice these surprise bills.
3. The canary in the coal mine would be employee complaints about surprise bills. Except that the copay is zero in many cases
As an ERISA plan, you don’t have to offer full coverage for treatment. But most of you will follow your carrier’s guidance. Which is to say, you will offer full coverage. Hence employees won’t be balance-billed. And that in turn means they won’t notice the total bill. Or, if they do notice, they won’t care. Bottom line: these bills won’t come to your attention.
It’s human nature to look for a cure or treatment for a serious disease. People tried to ward off the plague with garlic. Those with long memories might recall Laetrile, for example. Laetrile was relatively harmless – at least in comparison to chloroquine or hydroxychloroquine, which self-medicating people have already died from. That stuff, newly approved to treat COVID-19 by the FDA, is figuratively flying off the shelves — in what appears to be nothing more than the latest coronafad. (If that is not a word, it should be.)
It is featured in our current quiz, which also introduces our first picture questions. Meanwhile, here are Six Things you and employees should know about this latest coronafad.
(1) All the studies are small
And all the analysis is rushed. But studying the impact of an intervention on an acute condition doesn’t take years, the way a diabetes prevention study might.
There is also a rule of thumb in these situations that if an impact is big, it should show up in a small sample. The best example of that how few patients were needed to conclude that smoking caused lung cancer or that severe hypertension caused strokes. (In both cases, those weren’t even acute events. Yet the results were known relatively quickly because they were so clear.)
(2) The French study, which launched this, was not controlled
Yes, hydroxychloroquine was given to a small group of patients, and yes, they improved. But the results were largely anecdotal. In normal times, no respected journal would even let it get to peer review. But these aren’t normal times. Nonetheless, there is something called a “meta-analysis,” where multiple results showing minor changes can be combined into one ersatz study that would be statistically significant.
(3) The most recent study, from China, was also small and shows no impact
Unfortunately, the reverse was true here. The “confirming” study showed the opposite.
Of the 15 patients who got treated, 13 tested negative (you probably know this already, but “negative” is good, as this brief video demonstrates) after a week of treatment. That sounds promising — except that of the 15 patients in the “usual care” control group, 14 also tested negative. This is why control groups are considered the “gold standard.” Most of us over 60 had our tonsils out as kids, to make earaches go away…but it turns out earaches would have gone away anyway. There was no control, merely pre-post.
That sample of 30 is too small to say that the drug does not work. However, it can clearly be stated that it doesn’t work well in an undifferentiated population hospitalized with pneumonia. It can’t be ruled out that it has a positive impact if administered at an early stage, or on some cohort (younger people or women might be examples of discrete cohorts).
However, people with mild cases need to consider the side effects…
(4) …There were side effects in that study
The more serious the condition, the more side effects are tolerable. So chemotherapy and HIV drugs have substantial side effects…and yet get approved by the FDA because the alternative may be death.
Hence, an approved (though not for this use!), powerful drug that somehow treats both malaria (caused by a parasite) and allegedly coronavirus (caused, of course, by a virus) could be expected to have some side effects…and indeed it appeared to, in the study group.
Once again, though, some patients in the control group got complications too. Because the patients were so ill, attribution to the drug itself would have been difficult even in a larger sample.
(5) These side effects in general are serious and substantial
For malaria, this drug was researched multiple times, because during World War II so many troops in the South Pacific were getting it.. While showing some promise as a treatment, the side effects were unbearable for many subjects, even prisoners who were promised early release if they followed through.
The dose that triggered these toxicity effects was a small fraction of the dose in the French study, though the specific French formulation should be safer in similar dosages.
(6) This looks like a massive case of confirmation bias
Probably within weeks, this drug will go the way of zinc, elderberry concentrate, essential oils and other immune “boosters” as just another coronafad. It may find some niche in treatment of certain small segments in which the benefits (if any) exceed the possibility of harm, but for the rest of us the reverse will certainly be true.
If you want to indulge in a harmless or even potentially beneficial albeit useless coronafad, try the sips of water every 15 minutes. This allegedly washes down the virus, the way you might drink milk to wash down a cookie. (This isn’t the way viruses work, but that’s a blog for another time.)
The wellness industry has been encouraging us to do this for years. Water, water, everywhere. The only possible risk is tripping and falling on your way to the bathroom.
Sign up here to join our mailing list and to receive the new Coronaquiz IV: Busting the Myths and Gobsmacking the Fads…featuring (you guessed it) chloroquine.
And visit https://www.quizzify.com/coronavirus to play all four coronaquizzes to identify knowledge gaps and obtain accurate, up-to-date information.
Dear They Said What Nation,
We are all corona all the time now.
Here is our latest coronaquiz, and all our previous coronaquizzes, now all in one place. These are all freely sharable (with attribution, please) to get the word out. This latest quiz covers, among other things, the unexpected greatest hazard of grocery-shopping. Normally we would tease this to get more click-throughs, but we are actually going to give you the answer here both because desperate times call for desperate measures and also we are already getting tons of click-throughs.
The answer is: the handle of the shopping cart. Imagine how many other people have been grasping that handle all day. You’re distancing yourself from other shoppers, using self-checkout, shopping at off-hours…and yet you are physically embracing the #1 item — hard plastic — where the virus survives the longest.
Fortunately, for just that reason, my local Stop & Shop thoughtfully provides a dispenser of wipes…
…so you can disinfect your hands before you wheel your cart out into the parking lot.
In my opinion, it would also be helpful if the dispenser actually contained wipes, but maybe that’s just me.
A special shout-out to the organizations that have stepped it up in this crisis by making these quizzes easily available to members
Among wellness vendors, these quizzes are being made easily available by Sonic Boom and US Preventive Medicine. (Now let’s not always see the same hands.)
Among wellness trade and professional organizations, by National Wellness Institute and WELCOA. (HERO is apparently still pursuing a more traditionally broccoli-centric agenda, though they did thank us graciously for our offer to share our quizzes with their members. Not.)
But the biggest shout-out goes to Melissa Burkhart and the gang at Futurosolido. At considerable expense, they have made Spanish versions of the first two quizzes available on Quizzify and their own http://www.futurosolidousa.com websites.
Dear They Said What Nation,
Here are two updates for you.
First, on Tuesday you will have an opportunity to query arguably the country’s leading authority on corona, as profiled here in the New Yorker. (Disclosure: he is my brother-in-law.) Yes, the Validation Institute is doing a webinar on Tuesday at 2 PM EDT– as a Friend of Al, it is free if you enter PRESS in the promo code. His name is Dr. Ian Lipkin, the John Snow Professor of Virology and Immunology at Columbia. If you recognize the name, it’s because he’s on TV fairly often.
Examples of rumors floating around the internet that you might ask him about: can you get re-infected? Are there two strains? Does the virus mutate? Could hydroxychloroquine prevent it? (This is a real thing — it sounds like something would make up.)
Second, two employee Q&A sets are now available. The original one is now updated — lots of material can change in two weeks. So if you haven’t circulated this one yet, now is a good time.
The sequel is still good to go. It covers why your employees might want to color their fingers like this.
There have been a zillion hits — we are allowing complete reuse of it with nothing other than attribution required.
There are certainly ways to avoid coronavirus risk altogether, such as isolating yourself. But sometimes you just have to go to work, or interact with others. While you should be very concerned, keep in mind that in the last 30 days there have been many more cases of and deaths from the flu than coronavirus, though that could certainly change in a future month.
At this point, if you are reading this, you know the basics about hand-washing, not touching your face etc., but maybe there are 6 simple risk-reduction “hacks” you are not aware of.
(1) Mark your fingers like this
Use an indelible marker or tie a string or rubber band around your fingers, especially on your right hand. This will remind you not to shake hands, and to wash your hands or sanitize them if you do. If you are left-handed, you should probably do both hands.
(2) Use humidifiers at work
Most workplaces are very dry. Viruses can stay airborne longer in dry air. (Winter air being drier is thought to be one of the reasons flus are seasonal.) To oversimplify, the viruses attach to water droplets and fall to the ground faster in humid air.
Nor do you want to overdo it. If the air feels humid, it’s probably too humid. Other pathogens — molds in particular — thrive in moist areas. However, very few workplaces have this problem.
(3) Avoid contact with hard surfaces
One would think that viruses would live longer on soft, cushy surfaces than hard, shiny ones. That’s quite counter-intuitive. If you met someone for the first time, you would certainly open their door, but you wouldn’t jump into their bed. (Cue sophomoric joke here about swiping right.)
And indeed beds and other soft surfaces do harbor all sorts of other microscopic life forms, most of which wouldn’t harm you or we’d all be extinct by now. For instance, you should swap out your pillows every year or so because dust mites like to set up housekeeping in them. But for cold, flu and coronavirus, it’s the hard, shiny public surfaces that will get you.
(4) Reduce the number of hard surfaces in public places
Prop open doors. Door handles (or pushing on revolving doors) are probably the #1 surface that people come into contact with, without thinking twice about it.
Obviously, this isn’t always practical. One could do it for the break rooms but perhaps not the restrooms. In that case, perhaps wrap tape around the door handles. Viruses die sooner on softer surfaces, and since people think of softer surfaces as carrying more germs (they do – just not coronavirus), they will be more likely to wash afterwards.
(5) Check the ingredients in your hand sanitizer
Good old-fashioned alcohol should be the main ingredient — at least 60%. Many, for aesthetic reasons, prefer better-smelling or faster-drying active ingredients. Those will offer some protection, but alcohol rules.
(6) Play the Quizzify coronavirus quizzes…and send them to your employees
Like with The Pink Panther and arguably The Godfather and National Lampoon’s Vacation, the sequel — which is just coming out now — is better than the original.
Once again, we will be re-posting from Quizzify. This post also turned out to be very popular and we even incorporated a couple of extra suggestions from readers to update the blog post. We will also have some quiz questions available next week.
Highlights for those who don’t want to click through (though we aren’t contagious):
- wash your hands for 20 seconds at a time
- unless you recently washed them, keep your hands away from your nose and mouth
- your odds of getting the flu are vastly greater than getting coronavirus, at least for now — even if you had the flu vaccine (though that is a good idea in general)
- facemasks don’t work
- there are no magic potions or other preventive formulas
- go about your everyday lives
That’s the information for now. Check back next week. We might have question sets to distribute.
And the emphasis is on “for now.” In the immortal words of the great philosopher Yogi Berra: “It’s tough to make predictions, especially about the future.”