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johng75370

*Poof* October sailings now gone

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I noticed where all November cruises for Regent are waitlisted and several December cruises are also waitlisted. It’s beginning to look like it will be 2021 before any Regent cruises happen. That may be one reason why Regent and other major cruise lines went out and got more cash in an attempt to ride this pandemic out for a longer period than originally hoped. 

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@pappy1022, most of the financial analysis I've skimmed quickly seems to indicate NCLH is bulking up cash in anticipation of a much extended pause period, so I think you're spot on.  The other majors also seem to be prepping for this, even Carnival which may have some European sailings on some of their lines.  

 

I suppose it's always good to hope for the best, but prepare for the worst.  Perhaps the next earnings report will provide more context as well.

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The way I look at the "waitlisted" cruises is that those are cruises where the destination or ports on the trip have already indicated they are most likely not taking cruise ships (like South Africa, various asian countries etc). The ones in December still "
sailing" are in South America and some Caribbean islands. And yes, while there might be some who would argue it's because of capacity...I see so many open cabins that I don't think it's capacity (maybe the Christmas Cruise from Miami).

Just thinking.... 

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25 minutes ago, Gcto said:

The way I look at the "waitlisted" cruises is that those are cruises where the destination or ports on the trip have already indicated they are most likely not taking cruise ships (like South Africa, various asian countries etc). The ones in December still "
sailing" are in South America and some Caribbean islands. And yes, while there might be some who would argue it's because of capacity...I see so many open cabins that I don't think it's capacity (maybe the Christmas Cruise from Miami).

Just thinking.... 

 

According to Pcardad (a TA with many nights on Regent), there will be no cruises to South America in the foreseeable future.  Their Covid-19 cases are almost as high as the U.S.

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3 hours ago, Travelcat2 said:

 

According to Pcardad (a TA with many nights on Regent), there will be no cruises to South America in the foreseeable future.  Their Covid-19 cases are almost as high as the U.S.

 

That was an opinion, not based on info from Regent. I am also of the opinion that Africa is off the table as well.

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1 hour ago, Pcardad said:

 

That was an opinion, not based on info from Regent. I am also of the opinion that Africa is off the table as well.

 

Sorry that I misquoted you😯

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No worries - I try to be extremely clear with fact vs. opinion around here.

 

😃

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On 7/17/2020 at 7:50 PM, wcsdkqh said:

It is also a fact that hospitals have an incentive to report as many COVID hospitalizations, ICU patients, and deaths as possible. The feds pay a premium to the hospitals in these instances.

Absolutely true.  My husband had cancer surgery in March and on the admitting report they included Possible Covid.  He was counted.  He never had any symptoms of anything!  More Hamiltons for the hospital.  Skewed numbers for all of us!  Happens every day.

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Posted (edited)
14 minutes ago, Caroldoll said:

Absolutely true.  My husband had cancer surgery in March and on the admitting report they included Possible Covid.  He was counted.  He never had any symptoms of anything!  More Hamiltons for the hospital.  Skewed numbers for all of us!  Happens every day.

Back in March, did the hospital have the rapid COVID test available for preadmission testing? Or did your husband have any COVID-related symptoms and they had to work off that (hope not, but the symptoms are fairly broad).  I see you indicate he did not, but again, the symptoms are wide ranging.  Heck, some of my anemia symptoms could well overlap with COVID - shortness of breath, etc.  

 

Of course, the important thing is I hope your husband has had a good recovery. 

 

Just curious.  I just had a planned procedure, and then an unplanned ER/critical care stay a few days later, at my hospital, just last week.  Got out last Friday.  Pre-procedure, of course was tested for COVID the day before and then quarantined myself.  ER the next week - was tested for COVID pretty much as they were starting a blood transfusion.  Both COVID test results came back in 15 minutes, as being negative for COVID.  That gave the hospital something tangible to work with, I think.

 

None of my records indicate that I was admitted for COVID (and, to be fair, if I had COVID, I would have been treated in the COVID ER and critical area  on the other side of the hospital, and my scheduled elective procedure would have been cancelled).

Edited by greykitty

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for all the comments that infer that hospitals are making money off of COVID, you should remember that 30-40% of hospital admissions are for people with no health insurance. Probably a higher percentage in minority communities.

 

Im not trying to defend the practice but if you don't want the healthcare system to go bankrupt you have to have adequate income.

 

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Well, I don't think my hospital made any money off my COVID tests last week.  Medicare paid a grand total of $51 for each test.  The end.  I cannot imagine that even approached the real cost of staff, testing materials, and analysis.  

 

I don't think hospitals or any healthcare workers are making bank on COVID.  Well, maybe some personnel are earning  overtime - but I'm guessing they'd hand every penny back if COVID would go away miraculously

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2 hours ago, Caroldoll said:

Absolutely true.  My husband had cancer surgery in March and on the admitting report they included Possible Covid.  He was counted.  He never had any symptoms of anything!  More Hamiltons for the hospital.  Skewed numbers for all of us!  Happens every day.

If the hospital received CARES money, than there is no additional payment for a COVID-19 patient.  If a COVID-19 patient requires ventilator support, there is an additional payment.  Overwhelmingly, most rates are a negotiated payment based on coding.  I can tell you in conversations with some of my hospital administrator colleagues, they are loosing money on every COVID patient.  Between the complexity of care, PPE and staffing costs it will end up bankrupting some hospitals. The major financial hit from COVID is that the "elective surgery" patients are not being done.  Such as,  breast cancer surgery, colon resections, and many other needed procedures and surgeries.  The reality is most patients that come for "elective procedures" are covered by some type of insurance.  Many COVID patients have no insurance.  I was just talking to a neurosurgeon college whose sole specialty are tumors.  He has a 26 year old patient with a brain tumor and a 45 year old patient with a tumor of the thoracic spine and he cant get them on the elective schedule.  

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2 hours ago, Caroldoll said:

Absolutely true.  My husband had cancer surgery in March and on the admitting report they included Possible Covid.  He was counted.  He never had any symptoms of anything!  More Hamiltons for the hospital.  Skewed numbers for all of us!  Happens every day.

Possible Covid does not equate to Positive Covid. Possible means they need to do the testing to determine if he has COVID. 

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To make this all about me, last Wednesday when my internist personally called me to tell me my morning bloodwork revealed severe anemia (4.8, I guess that's not a good number) and to skedaddle to the ER and prepare to stay a bit, I was at first hesitant about the idea of an overnight stay. 

 

He was just going to launch into a speech about it's ok to enter the hospital, they have taken extraordinary measures regarding COVID.  I had to interrupt and say I wasn't worried about COVID, I was worried about finding someone to cat sit at such short notice LOL.  He was actually glad to not have to talk someone off the 'I'm going to get COVID by stepping into an exam room' ledge.  

 

But, yes, people are, perhaps overly so, about getting their elective procedures done.  I had a colonoscopy the week prior - the outpatient center staff told me they're just now hitting their regular level of business.  I'm in Illinois - we were doing relatively ok with our openings, but now we're starting to see another rise in numbers.

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5 hours ago, Got2Cruise said:

Possible Covid does not equate to Positive Covid. Possible means they need to do the testing to determine if he has COVID. 

Absolutely, but in reality everyone on the planet Earth now has "Possible Covid," unless they are proven to have Covid.  We are not even sure about those who have recovered.

 

The issue is the numerical diagnosis codes the hospitals are using for billing.  I do not know if there are separate codes for possible and proven Covid, but there should be.  In either case putting either code on the patient's bill probably results in higher reimbursement for the hospital.  So of course the hospitals, which do have higher costs for all patients due to Covid, will code everything at the highest possible reimbursement rate.

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12 minutes ago, SusieQft said:

Absolutely, but in reality everyone on the planet Earth now has "Possible Covid," unless they are proven to have Covid.  We are not even sure about those who have recovered.

 

The issue is the numerical diagnosis codes the hospitals are using for billing.  I do not know if there are separate codes for possible and proven Covid, but there should be.  In either case putting either code on the patient's bill probably results in higher reimbursement for the hospital.  So of course the hospitals, which do have higher costs for all patients due to Covid, will code everything at the highest possible reimbursement rate.

Question -  I was tested for COVID prior to my elective procedure, and then a few days later during my ER admission.  Both came back that at those moments in time I did not have COVID.  Wouldn't this give the billing department actual data to base its coding on?  From what I can see, other than the two COVID tests themselves, COVID diagnosis has not been attached to any of the fun little bills.  That make sense?

 

Back in March, I don't recall if there were a lot of quick result testing available in the hospitals, or even if COVID testing was required before procedures.  Just don't remember.

 

And dang, who knew some of these things were so expensive - I'm having fun just looking up the Medicare code references to see if everything matches.  I have been told that Medicare has been releasing coding guidance regarding COVID on an ongoing basis.

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56 minutes ago, greykitty said:

Question -  I was tested for COVID prior to my elective procedure, and then a few days later during my ER admission.  Both came back that at those moments in time I did not have COVID.  Wouldn't this give the billing department actual data to base its coding on?  From what I can see, other than the two COVID tests themselves, COVID diagnosis has not been attached to any of the fun little bills.  That make sense?

I do not claim to be an expert in medical billing, especially not currently since I have been retired for some time.  So I am not sure about the details on Covid coding.  Your example should qualify for "Possible Covid" since they had some concern about it or they would not have tested you.  Whether or not that and reimbursement for your Covid tests is bundled into some global process outside of the normal billing, I do not know.  It might make sense to do it that way because Covid precautions have to be taken to some extent for everyone admitted to the hospital.

 

What I do know for a fact is that hospitals work hard to make sure their doctors put the most lucrative (but still hopefully legitimate) diagnoses possible in the charts so that they can code them for maximum reimbursement. 

 

From what I have read, there seems to be a significant amount of over-coding for Covid in both hospital admissions and death certificates.  For example, many people who were tested positive but asymptomatic for Covid (or questionably/minimally symptomatic and not tested) who were hospitalized for or died of something else being counted as a hospitalization or death due to Covid at least for statistical purposes.  IMO those who tested positive but are asymptomatic should count as a "case" but not a "hospitalization" and if they had Covid but died of something else, it should not count as a Covid death.

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Posted (edited)

@susieqft, thanks so much for that insightful analysis.  I know hospitals in my area now routinely test everyone coming in for an elective, to deliver a baby, or in need of immediate care.  I do think it's so they know if they need to segregate those patients testing positive into a COVID unit, or, if elective, cancel the procedure.  But, no doubt the codings are still a work in progress.  I was just thrilled earlier this year when Medicare, and a lot of the large insurers, did start covering the tests.

 

 

I'm not sure the rapid response tests were available back in February or March.  Well, at least folks being admitted don't have to be tested five days in advance anymore. 

 

And when I was in the ER, I could actually have a person stay with me, and designate one person as a visitor during the regular hospital stay - that was new within the week.  Hope we can maintain that level - it can get lonely in those hospitals. Well, I got to see the nurses every 90 minutes or so, though!

 

I still don't think hospitals are exactly profiteering during this challenging time.  I just hope we come out of it with a fairly robust hospital system at all.

Edited by greykitty

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Thought this topic was about Regent cancelling cruises?

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On 7/22/2020 at 5:30 AM, greykitty said:

Back in March, did the hospital have the rapid COVID test available for preadmission testing? Or did your husband have any COVID-related symptoms and they had to work off that (hope not, but the symptoms are fairly broad).  I see you indicate he did not, but again, the symptoms are wide ranging.  Heck, some of my anemia symptoms could well overlap with COVID - shortness of breath, etc.  

 

Of course, the important thing is I hope your husband has had a good recovery. 

 

Just curious.  I just had a planned procedure, and then an unplanned ER/critical care stay a few days later, at my hospital, just last week.  Got out last Friday.  Pre-procedure, of course was tested for COVID the day before and then quarantined myself.  ER the next week - was tested for COVID pretty much as they were starting a blood transfusion.  Both COVID test results came back in 15 minutes, as being negative for COVID.  That gave the hospital something tangible to work with, I think.

 

None of my records indicate that I was admitted for COVID (and, to be fair, if I had COVID, I would have been treated in the COVID ER and critical area  on the other side of the hospital, and my scheduled elective procedure would have been cancelled).

His diagnosis was  only cancer.  We caught it so early.  He was the last one admitted before the hospital closed down because they thought they would be slammed with 

Covid.  He had NO SYMPTOMS INDICATIVE OF COVID.  It was colon cancer.  They had NO REASON to test him and to put possible Covid on the chart.  Here the problem.  Our business was medical before we retired.  Ooops!  

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On 7/22/2020 at 3:00 PM, greykitty said:

@susieqft, thanks so much for that insightful analysis.  I know hospitals in my area now routinely test everyone coming in for an elective, to deliver a baby, or in need of immediate care.  I do think it's so they know if they need to segregate those patients testing positive into a COVID unit, or, if elective, cancel the procedure.  But, no doubt the codings are still a work in progress.  I was just thrilled earlier this year when Medicare, and a lot of the large insurers, did start covering the tests.

 

 

I'm not sure the rapid response tests were available back in February or March.  Well, at least folks being admitted don't have to be tested five days in advance anymore. 

 

And when I was in the ER, I could actually have a person stay with me, and designate one person as a visitor during the regular hospital stay - that was new within the week.  Hope we can maintain that level - it can get lonely in those hospitals. Well, I got to see the nurses every 90 minutes or so, though!

 

I still don't think hospitals are exactly profiteering during this challenging time.  I just hope we come out of it with a fairly robust hospital system at all.

They did have rapid response and I was not allowed in at ALL!

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On 7/22/2020 at 2:45 PM, SusieQft said:

I do not claim to be an expert in medical billing, especially not currently since I have been retired for some time.  So I am not sure about the details on Covid coding.  Your example should qualify for "Possible Covid" since they had some concern about it or they would not have tested you.  Whether or not that and reimbursement for your Covid tests is bundled into some global process outside of the normal billing, I do not know.  It might make sense to do it that way because Covid precautions have to be taken to some extent for everyone admitted to the hospital.

 

What I do know for a fact is that hospitals work hard to make sure their doctors put the most lucrative (but still hopefully legitimate) diagnoses possible in the charts so that they can code them for maximum reimbursement. 

 

From what I have read, there seems to be a significant amount of over-coding for Covid in both hospital admissions and death certificates.  For example, many people who were tested positive but asymptomatic for Covid (or questionably/minimally symptomatic and not tested) who were hospitalized for or died of something else being counted as a hospitalization or death due to Covid at least for statistical purposes.  IMO those who tested positive but are asymptomatic should count as a "case" but not a "hospitalization" and if they had Covid but died of something else, it should not count as a Covid death.

Yes you are right!

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On 7/22/2020 at 5:45 PM, SusieQft said:

I do not claim to be an expert in medical billing, especially not currently since I have been retired for some time.  So I am not sure about the details on Covid coding.  Your example should qualify for "Possible Covid" since they had some concern about it or they would not have tested you.  Whether or not that and reimbursement for your Covid tests is bundled into some global process outside of the normal billing, I do not know.  It might make sense to do it that way because Covid precautions have to be taken to some extent for everyone admitted to the hospital.

 

What I do know for a fact is that hospitals work hard to make sure their doctors put the most lucrative (but still hopefully legitimate) diagnoses possible in the charts so that they can code them for maximum reimbursement. 

 

From what I have read, there seems to be a significant amount of over-coding for Covid in both hospital admissions and death certificates.  For example, many people who were tested positive but asymptomatic for Covid (or questionably/minimally symptomatic and not tested) who were hospitalized for or died of something else being counted as a hospitalization or death due to Covid at least for statistical purposes.  IMO those who tested positive but are asymptomatic should count as a "case" but not a "hospitalization" and if they had Covid but died of something else, it should not count as a Covid death.

Its no secret, the over coding for Covid for hospitalizations  is because they get more Medicare $$$ for it. The dead people are also being "over coding" for Covid for political reasons. 

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@caroldoll, thanks for scratching my curious itch about your hospital having the rapid response tests so early  this year.  And, most importantly, so glad your husband was diagnosed quickly and did get treatment.  I hope you both continue to enjoy good health.

 

My state was pretty aggressive in actions to mitigation COVID transmission, but I don't think we were as fortunate in getting a large amount of tests to use for patients not exhibiting symptoms in early spring.  I remember reading that it was a real challenge for hospitals here to initiate treatment on patients before getting COVID test results back early on -there could be as much as 48 hours delay at that point. The 15 minute tests are a blessing, I think. 

 

My hospital literally within the past week opened to allowing one designated person to visit each patient.  Last Wednesday my ride and I were convinced I'd be a 'drop and run' at the ER, so we were pleasantly surprised that she was allowed into the hospital.  Hoping our current spike doesn't curtail visitors again, but better safe than sorry, so my head says.  Heart would love to allow patients to have all the comfort of family and friends.

 

I do have to say I'm still amazed/appalled at the low reimbursement rate Medicare is showing on my bills so far.  And I'm also blessed to have moved directly from a 'Cadillac' level private employer insurance plan to Medicare.   I keep thinking of those not fortunate to have that access.

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