1/ People are hardwired to get infuriated when they see injustice.

But I fear that applying this lens to covid vaccine distribution will lead to more deaths not fewer.

Stanford has screwed up, again. Some people who shouldn't have gotten it, did.
nbcbayarea.com/news/local/rac…
2/ What's the natural response then, from those all the way down the distribution chain, from state administrators to hospital execs worried about "wrong people" getting vaccinated first?

You spend more time collecting data, parsing into finer and finer gradations

You slow down
3/ Hospitals and nursing homes don't release more to staff until every i has been dotted.

States don't release more to hospitals and nursing homes until they've used up allotment

feds don't release more to states

Amidst a vaccine shortage, available supply sits in warehouses.
4/ this is a good thread by @ashishkjha about the cascade of failed accountability and the last mile problem.

And I have my own indignation about how distribution has been prioritized.

Frontline PCPs can't get vaccine while SNF HVAC techs get it 😤

5/ But the fact remains that we have millions of doses sitting in warehouses because people are worried about screwing up prioritization

The system is stopped up, and needs disimpaction, not surgical precision

...and we should use the normal channels we use to give vaccines
6/ I hope that @choucair and the incoming team consider how they can normalize these processes as vaccine supply ramps up even further (and I believe it will)
7/ and to return to where I started, we have to do this while deeply appreciating just how primal and powerful our reactions are to injustice.

If you haven't seen the cucumber-grape experiment video, it's worth a look :-)

8/ I appreciate the DMs from public health and hospital leaders saying in essence "this is exactly the problem we are having, but we can't talk about it publicly"

👇

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More from @Farzad_MD

29 Nov 20
1/ Opening schools in the midst of a COVID surge is a hard problem with unavoidable tradeoffs.

There are absolutist statements on either side of the debate, so I expect passionate rebuttals, but let me lay out a decision-making framework, from an epidemiologists' perspective
2/ First off, we have to make sure that the schools have the resources and space to implement the 5 key mitigation
strategies correctly and consistently.

Not a given.

*Masks
*Social distancing
*Contact tracing
*Hand hygiene
*Cleaning and disinfection

first 2 >> last 2
3/ Let's say we have some resources for testing, how does that contribute?

What we are trying to achieve?

Do you think the goal is Screening (identify asymptomatic infectious cases before they can expose others) or Surveillance (understand incidence to inform policy)?
Read 22 tweets
15 Nov 20
1/ It's indescribable seeing results from NYC EMS ambulance runs showing how cardiac arrests skyrocketed during COVID

(I started a program to monitor these symptoms in real time--among the very first application of syndromic surveillance in public health, 2 decades ago)
2/ Every day, crews from @FDNY are called to 20 to 30 patients who have collapsed, and attempt resuscitation. Can you imagine?

It's never like the movies. Most patients die, ribs cracked. 75% of the time you never get a heart rate back.

On April 6, there were 305.

305.
3/ In the dry language of medical research the researchers describe the horrible statistics.

During the peak, most patients had nonshockable presenting rhythms of asystole and pulseless electrical activity. 92.2% of the time they called off the resuscitation without a pulse.
Read 7 tweets
11 Nov 20
1/ I've been feeling more and more disengaged from COVID work, disillusioned with the growing realization that all the smart research and policy doesn't make a damn bit of difference

Not for the 1st time, I've seen that what I thought was an information problem is something else
2/ I so admire those public health Cassandras who've been unrelenting, continuing to beat the drum of science and policy for the past 9 months

repeating over and over again what must be done, as the cases and deaths mount, with no strategy in sight

tweets, interviews, articles
3/ It's perhaps no accident that they (and I) are "formers"

People who ran the agencies, who know the pain of the experts and scientists working inside, and are free to speak

CDC @DrTomFrieden
FDA @ScottGottliebMD
CMS @ASlavitt
FDA/CMS @DukeMargolis McClellan
WH @ZekeEmanuel
Read 10 tweets
10 Oct 20
1/ Policy makers: Wait, Isn’t quality of care better at large expensive health systems c/w independent practices?

Previous Research: Ummm no. But we can keep looking

@AHRQNews What if we look at high needs patients?

@RANDCorporation It’s ... worse?

onlinelibrary.wiley.com/doi/abs/10.111…
2/ To test hypothesis that health systems provide better care to patients w high needs, diff in quality b/w system‐affiliated & nonaffiliated physicians

ED visits were significantly *different* in system‐affiliated (117.5 per 100) & nonaffiliated POs (106.8 per 100, P < .0001).
3/ I love how delicately the RAND researchers approach this in their conclusion: “Health systems may not confer hypothesized quality advantages to patients with high needs.”

(Then why do they get paid so much more?)
Read 4 tweets
23 Sep 20
1/ How can we reduce Medicare spending without harming patients?

What we do @AledadeACO is transformative, but hard.

There are some low hanging fruit. This was one of them

Prior auth for repetitive, scheduled non-emergency ambulance transportation

cms.gov/newsroom/press…
2/ When CMS first released their public use files, I ran some analyses looking for aberrations-

One thing that jumped right out was...Repetitive non-emergency ambulance runs- often for the same person going back and forth to dialysis 3 times a week.

3/ In my blog @BrookingsInst back in 2014 I wrote:

"Medicare and law enforcement officials will need to create new processes for dealing with a potential flood of outlier reports from amateur sleuths like me."

But prevention >> fraud enforcement

brookings.edu/blog/up-front/…
Read 12 tweets
14 Sep 20
1/ Value-based care works. MSSP saved $2.6 billion dollars with $1.2 billion in net savings to Medicare, matching CBO’s savings expectations for 2019

Physician-led ACOs again out-performed hospital ACOs. What we need now is to help more practices participate in these models
2/ @AledadeACO is proud to be the largest, most successful nationwide enabler of physician-led ACOs, delivering better care at lower cost for >340,000 Medicare beneficiaries, saving Medicare and American taxpayers nearly $180 million in unnecessary health care spending last year!
3/ Here's the list of the physician-led ACOs we are supporting, and our performance data.

* It doesn't matter if you're urban, rural, suburban, or in which state

* It gets better. The longer you work, the more the chances of success

* More risk = Higher rewards
Read 10 tweets

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