County’s health authority: Doctors, hospitals aren’t making money off of COVID
Three days before the Nov. 3 election, Donald Trump made the claim that physicians across the country are inflating COVID numbers for profit. Whoa. This, while novel coronavirus cases across the country are surging past the nine-million mark, driven in large part by asymptomatic carriers? (Source: CDC.)
Late last month, the U.S. added one million new COVID cases in the short span of only two weeks, setting a new record pace for the spread of the disease, which has already claimed the lives of approximately 239,000 Americans -- adults, teens, and children.
Still, just prior to the election, during the last debate, the president was saying that the U.S. is “rounding the turn” with regard to COVID-19.
The big news this week, of course, is that there may well be an effective SARS-CoV-2 vaccine on the way to hopefully save the day and kick COVID-19 on down the road. The giant pharmaceutical company Pfizer and its German ally, BioNTech, are the ones who developed it. Once given the green light after the vaccine is proven safe, the two companies are set to release doses to countries around the world. Already, Pfizer and BioNTech have contracted to send 100 million doses to the U.S.
Ironically, neither of the two companies was part of the president’s “Operation Warp Speed” publicprivate partnership, initiated by Trump to facilitate and accelerate the development, manufacturing, and distribution of a COVID-19 vaccine. Rather, the money to develop it came from the German government ($445 million).
Still, the idea that physicians are making money off of COVID rankles some physicians, including Hidalgo County’s Health Authority, Dr. Ivan Melendez. For those who may not be familiar with the term “Health Authority,” it describes a physician, like Melendez, who is appointed by an elected body, in this case, the Hidalgo County Commissioners Court, to administer state and local laws related to public health within a certain jurisdiction. In this case, the jurisdiction is Hidalgo County.
Melendez is a Valley native who returned here decades ago to practice internal medicine, never imagining a scenario such as the one we have today when the Commissioners Court first appointed him Hidalgo County Health Authority in 2011. A COVID survivor himself, Melendez has pretty much been running non-stop since the pandemic landed in the RGV in late February, early March.
For his part, Melendez said during a recent phone interview that the president’s claims that he and his colleagues are making money off of COVID simply isn’t true. “It’s not true, and it’s not factual,” he said. “We get paid a level based on how sick the person is. We don’t get paid by diagnosis. We make, and we don’t make very much money.”
The RGV has one of the highest populations in the country when it comes to Medicare, Medicaid, and the underinsured. With regard to the uninsured in the U.S., the Rio Grande Valley is numero uno.
With that in mind, Melendez said, “We probably average about $70 a visit, which is very low, especially to expose your life (to the novel coronavirus) and bring it home to your family members. When President Trump spoke, he didn’t speak factually. The doctors do not have any incentive whatsoever to code high (COVID diagnosis) or for us to code low (low-level respiratory infection), because we don’t get paid based on that.”
The hospitals are a different story, but again, no one is making money off of COVID, according to Melendez.
“The hospitals got an additional 20-percent increase in their payment based on COVID,” he said. “This was part of the Cares Act. At least, that’s my understanding; and the reason that they get 20 percent more is obvious. They have to have more equipment. They have to be changing their gowns every time they go in the room. Gowns are expensive. They have to isolate wards. They have to re-modify their wards specifically for communicable diseases. They have to establish what’s called a negative pressure room, where all the air in the room is filtered outside the building, so that people don’t go in and get it, or carry it from room to room. So there’s a significant cost increase for the hospitals to provide services for people that have this disease.”
Also, keep in mind, said Melendez, “Doctors, we have absolutely no dog in this (political) fight. I also personally believe that a 20-percent increase in paying the hospitals is very reasonable because they close up other units. They stopped elective surgeries (for awhile), which is where the profit margins are. They need more equipment; but the docs, we have nothing to do with it. We don’t make any money off of it.” Trump, however, would claim otherwise. In remarks made late last month at a campaign rally in Waterford Township, Mich., he said, “Our doctors get more money if someone dies from COVID. You know that, right? I mean our doctors are very smart people. So what they do is they say, ‘I’m sorry but everybody dies of COVID.’”
Following President Trump’s remarks about doctors profiting from COVID, the AMA (American Medical Association) took the unprecedented step of actually refuting remarks made by a U.S. president. From AMA President Susan R. Bailey, MD:
“Throughout this pandemic, physicians, nurses, and frontline health care workers have risked their health, their safety and their lives to treat their patients and defeat a deadly virus. They did it because duty called and because of the sacred oath they took. The suggestion that doctors — in the midst of a public health crisis — are over-counting COVID-19 patients or lying to line their pockets is a malicious, outrageous, and completely misguided charge. COVID-19 cases are at record highs today. Rather than attacking us and lobbing baseless charges at physicians, our leaders should be following the science and urging adherence to the public health steps we know work — wearing a mask, washing hands and practicing physical distancing.”
Dr. Melendez, Hidalgo County’s Health Authority, said that not only were the president’s comments untrue, lacking any facts to back them up, but “there is this lack of understanding that we have lost many physicians (during this fight against COVID).
“We have lost over 1,200 physicians in the country to COVID, and that’s not counting nurses, paramedics, et cetera. I, myself, have lost five friends, colleagues who are physicians who are now dead from COVID, and of course they got it while doing their work. So it’s kind of offensive to hear that kind of talk.”
Another question that was bouncing along the presidential campaign trail pertained to the cause of death listed by physicians. From the president’s political base has come the charge that no matter what shape a patient is in when they die, if they have COVID, that will be put down as the official cause of death. Melendez said that simply isn’t the case.
“If someone dies who is COVID-positive, let’s say, from a broken neck (caused by a motorcycle accident, for example), and has suffered multiple body trauma, a fractured cervical spine, respiratory failure, we don’t count that as a COVID death.”
Melendez said he can’t speak for the entire state, the country, but in the RGV, “our numbers are pretty tight. It’s pretty good in reference to people who actually died from COVID.”
Also, said the seasoned physician, presenting the accurate COVID numbers to the county are important for multiple reasons.
“Our motivation from a public health standpoint is to get the right information (to the county’s health department and commissioners court), so we can all make the appropriate healthcare policies. We don’t get more funding if we have more cases. So most of us who are here (working at the county level), we’re definitely not here for the money.”
Melendez said that he has never met anyone in public health who has a financial motivation for what they’re doing, simply because the private sector pays more. In fact, the money he is paid to serve as the Hidalgo County Health Authority, he said, pales in comparison to the compensation he receives from his private practice, even though these days, the public-health hours he puts in are through the roof as he works to visit every county hospital on a regular basis, checking out the COVID units.
To put this entire COVID interview in a nutshell, Dr. Melendez said:
“Doctors don’t get paid any more or any less if (the cause of death is) COVID. Number two, the (county’s) health department has to confirm not only what the hospital report (reads), but (link it to a) medical record to make sure that the patient didn’t die from something else.
“That being said, it’s true that a lot of people die from a heart attack, but guess what? They’re in the COVID unit. They’re on high-flow oxygen. They’re infected (with the novel coronavirus). Their lungs are messed up. Someone may argue, ‘Yeah, but they didn’t die from COVID.’ The response is, ‘Well, yeah, they did.’ Everybody dies, quite literally, from a heart attack, because how do you define death? Your heart stops, right? The question is, how did the patient get to that heart attack? It doesn’t help if they are on a ventilator. If their lungs aren’t working, if they’re on multiple medications, because all of that is stressing their heart. So when people say, ‘Yeah, but they died from a heart attack.’ I say, ‘Yeah, but they’re in a COVID unit.’”
Melendez is a Valley native who returned here decades ago to practice internal medicine, never imagining a scenario such as the one we have today when the Commissioners Court first appointed him Hidalgo County Health Authority in 2011. A COVID survivor himself, Melendez has pretty much been running nonstop since the pandemic landed in the RGV in late February, early March.
Another question that was bouncing along the presidential campaign trail pertained to the cause of death listed by physicians. From the president’s political base has come the charge that no matter what shape a patient is in when they die, if they have COVID, that will be put down as the official cause of death. Melendez said that simply isn’t the case.